Hi all, for anyone interested in policy, sharing this piece about sustainability in the NHS Cancer Plan that a collaborator and I had published recently in the Lancet Oncology: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(26)00246-9/abstract
The full text is below:
The National Cancer Plan for England, published in
February, 2026, sets out ambitious plans for the future
of cancer care in England over the next 10 years.(1)
Overlooked in the plan, however, is the need to align
these plans with the legal commitment of the National
Health Service (NHS) to developing an environmentally
sustainable health-care system, reducing health care-
associated greenhouse gas emissions to net zero by
2045.(2) Many policies set out in the plan could contribute
to achieving this goal—realising co-benefits for health
and environment—but the potential environmental
impacts of some proposals need careful evaluation
before and during implementation. Mitigating these
impacts will also support the plan’s health equity
ambitions, with the consequences of climate change
disproportionately felt by vulnerable populations.(3)
Clear areas of co-benefit in the plan include improved
cancer prevention through tobacco control, obesity
prevention, and human papillomavirus vaccination,
reducing the burden of disease and, therefore, health
service demand. However, a key omission in the
prevention strategies listed is the opportunity to
reduce cancer incidence and environmental harm
through reductions in air pollution, limiting exposure
to carcinogens including fine particulate matter (PM2·5)
and simultaneously often reducing greenhouse gas
emissions.(4)
Changing models of care provide another opportunity
to maximise co-benefits. Shifting towards community-
based and neighbourhood care will reduce travel-
associated emissions and pollution. Streamlined, lean
care pathways, including straight-to-test and patient-
initiated follow-up, reduce unnecessary appointments.(5)
Increased use of digital monitoring and patient-reported
outcomes will also support this transition, although
potential environmental harms of digital services and
infrastructure should be considered.(6)
Innovations in radiotherapy are already improving
patient care and reducing its environmental impact,
based on evidence from UK-led clinical trials.
Hypofractionation in breast and prostate radiotherapy
reduces hospital visits, patient travel, and per-patient
machine time, reducing emissions without impacting
patient outcomes.(7,8) Improved access to stereotactic
ablative radiotherapy is likely to have similar impacts.
The world-class cancer research environment promised
by the cancer plan could drive innovation towards
sustainable cancer care across pathways, particularly
if intentionally supporting these aims (eg, treatment
optimisation trials), but environmental impacts of the
research itself must also be minimised.
In areas of the plan in which there are potential trade-
offs between environmental impacts and patient,
financial, and other system outcomes, the optimal
balance between these can only be obtained when
sustainability is explicitly considered. A substantial
investment will be required to expand community
diagnostic centres: ensuring new capacity is designed
for a high utilisation rate while retaining geographical
accessibility will minimise financial and environmental
outlay. Expanded diagnostic and screening programmes,
aimed at delivering benefit through early diagnosis,
could also increase overdiagnosis, which should be
considered and mitigated against.(9)
Likewise, requiring considerable investment is the
commitment to expanding genomics capacity for both
population risk profiling and guidance of treatment
decisions. The environmental footprint of genomic
profiling for the guidance of treatment decisions could
be offset by avoidance of ineffective treatment for
patients, reducing carbon intensity of care alongside
other obvious benefits. However, the environmental
costs of rolling out sequencing and bioinformatic
analysis at a population scale mean that this should be
underpinned by robust evidence of utility.
The plan’s emphasis on accelerating access to novel
systemic therapies, including immunotherapies,
antibody-drug conjugates, and targeted agents, reflects
genuine clinical advances enabled by many of these.
Balancing these benefits with the patient, financial,
and environmental costs will mean working with
industry and academic partners to ensure that dosing
and scheduling are optimised, shifting away from the
old paradigm of maximum tolerated dose. The plan
also commits to accelerating uptake of drugs targeting
GLP-1. Although these drugs are undoubtedly clinically
effective, resulting in environmental benefits in some
contexts from avoided complications of obesity,10
they have not been explicitly proven to reduce cancer
risk. Expansion in commissioned indications without
evidence of benefit risks outweighing any prevention-
related reductions in environmental footprint.
Trade-offs around known, direct environmental costs
of artificial intelligence—particularly its substantial
energy consumption and water use—versus potential
environmental benefits from efficiency or other gains,
are recognised in the cross-departmental Government
Digital Sustainability Alliance guidelines. In this,
and in the other areas discussed, it is disappointing
that this plan does not explicitly align with NHS and
wider governmental priorities on environmental
sustainability. The plan’s ambition is to deliver bold
action for patients with cancer. Given the potential
impacts of climate change on cancer incidence and
outcomes, the urgency now required to avoid the worst
effects of climate change, and the public support for
action, those implementing the plan must also be bold
in delivering transformational change to sustainable
cancer care.
SB is funded by the National Institute of Health and Care Research and has an
unpaid role as steering committee member in the advocacy group Oncology
Advocates United For Climate and Health. SVL declares no competing interests.
*Sara V Lightowlers, Sarah Briggs
sara.lightowlers3@nhs.net
Department of Oncology, North West Anglia Foundation Trust, Bretton Link,
Peterborough PE3 9GZ, UK (SVL); Nuffield Department of Medicine, University
of Oxford, Oxford, UK (SB)
1 Department of Health and Social Care. The National Cancer Plan for
England: delivering world class cancer care. February, 2026. https://assets.
publishing.service.gov.uk/media/69dce11fd3e08b8871b6662c/national-
cancer-plan-for-england-delivering-world-class-cancer-care.pdf (accessed
April 2, 2026).
2 NHS England. Delivering a ‘net zero’ National Health Service. https://www.
england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/
delivering-a-net-zero-national-health-service.pdf (accessed July 22, 2024).
3 Munro A, Boyce T, Marmot M. Sustainable health equity: achieving a net-
zero UK. Lancet Planet Health 2020; 4: e551–53.
4 De Guzman R, Schiller J. Air pollution and its impact on cancer incidence,
cancer care and cancer outcomes. BMJ Oncol 2025; 4: e000535.
5 Reed S, Crellin N. Patient-initiated follow-up: will it free up capacity in
outpatient care? Aug 8, 2022. https://www.nuffieldtrust.org.uk/research/
patient-initiated-follow-up-will-it-free-up-capacity-in-outpatient-care
(accessed April 16, 2026).
6 Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of
virtual consulting in developing environmentally sustainable health care:
systematic literature review. J Med Internet Res 2023; 25: e44823.
7 Murray Brunt A, Haviland JS, Wheatley DA, et al, and the FAST-Forward
Trial Management Group. Hypofractionated breast radiotherapy for 1 week
versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue
effects results from a multicentre, non-inferiority, randomised, phase 3
trial. Lancet 2020; 395: 1613–26.
8 Chuter R, Stanford-Edwards C, Cummings J, et al. Towards estimating the
carbon footprint of external beam radiotherapy. Phys Med 2023;
112: 102652.
9 Dunn BK, Woloshin S, Xie H, Kramer BS. Cancer overdiagnosis: a challenge
in the era of screening. J Natl Cancer Cent 2022; 2: 235–42.
10 European Society of Cardiology. Treating heart failure patients with anti-
obesity medication reduces greenhouse gas emissions and improves
clinical outcomes. Aug 27, 2025. https://www.escardio.org/news/press/
press-releases/Treating-heart-failure-patients-with-anti-obesity-
medication-reduces-greenhouse-gas-emissions-and-improves-clinical-
outcomes/ (accessed April 16, 2026).
2 www.thelancet.com/oncology Vol 27 [
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