{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:16:50Z","timestamp":1790727410518,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To calculate the environmental and labour impact of two complete care pathways for patients with muscle\u2010invasive bladder cancer (MIBC) with similar oncological outcomes: radical cystectomy (RC) and chemoradiation (CRT), by quantifying the total carbon footprint and staff demands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      The RC was robot\u2010assisted surgery with pelvic lymph node dissection and ileal conduit. CRT included 20 fractions of 2\/2.75\u2009Gy with mitomycin C (Day 1) and capecitabine every radiation day. Waste audits identified medical products (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009284), for which a cradle\u2010to\u2010gate environmental impact analysis was conducted from treatment selection to first post\u2010treatment evaluation. Energy use was based on primary data, technical specifications or literature. Patient travel was based on the average distance, assuming petrol\u2010fuelled cars. Staff demands were assessed by timing clinical staff assignment. The carbon footprint was calculated in CO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010equivalents using the Ecoinvent Database 3.10.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The carbon footprint was 208\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010equivalents for RC vs 264\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010equivalents for CRT. The larger footprint of CRT arose from travel movements and energy use: 5\u2010 and 1.5\u2010fold higher than RC, respectively. Main contributors to the total footprint were medical products for RC (49%), and patient travel for CRT (74%). A hotspot analysis identified 10 medical products with the highest impact, which accounted for 60% of the total impact of all medical products. RC averaged 93.5\u2009staff hours per patient vs 29.0\u2009staff hours per patient for CRT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to analyse the environmental impact of complete care pathways in uro\u2010oncology. Key strategies to reduce the carbon footprint of MIBC treatment include low\u2010impact patient travel, reviewing high\u2010impact surgical products, and using renewable energy by hospitals. Insight into staff demands per treatment assists efficient allocation of scarce personnel.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16876","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T09:47:03Z","timestamp":1756892823000},"page":"1048-1056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Carbon footprint and staff demands of surgery and chemoradiation for muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2452-5357","authenticated-orcid":false,"given":"Vera C.","family":"Rutten","sequence":"first","affiliation":[{"name":"Department of Urology Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone A. W.","family":"Hesseling","sequence":"additional","affiliation":[{"name":"Metabolic  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Franckena","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahlita C. M.","family":"Zuiverloon","sequence":"additional","affiliation":[{"name":"Department of Urology Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie G. J.","family":"Robbrecht","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"IJzerman","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy and Management  Rotterdam The Netherlands"},{"name":"Sir Peter MacCallum Department of Medical Oncology, Faculty of Medicine, Dentistry and Health Sciences University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxin","family":"Lin","sequence":"additional","affiliation":[{"name":"Metabolic  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan","family":"Mes","sequence":"additional","affiliation":[{"name":"Metabolic  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Hunfeld","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Adults Erasmus MC Cancer Institute  Rotterdam The Netherlands"},{"name":"Department of Hospital Pharmacy Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost L.","family":"Boormans","sequence":"additional","affiliation":[{"name":"Department of Urology Erasmus MC Cancer Institute  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"Bladder cancer statistics [Internet]","author":"World Cancer Research Fund International","year":"2022"},{"key":"e_1_2_14_3_1","volume-title":"EAU Guidelines on Muscle\u2010Invasive and Metastatic Bladder Cancer 2025 [Internet]","author":"European Association of Urology","year":"2025"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(23)00170-5"},{"key":"e_1_2_14_5_1","volume-title":"Een stuur voor transitie naar duurzame gezondheidszorg [Internet]","author":"Gupta strategists","year":"2019"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00244-3"},{"key":"e_1_2_14_7_1","volume-title":"Prognosemodel Zorg en Welzijn [Internet]","author":"Ministry of Health, Welfare and Sports","year":"2024"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2022.12.006"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2018.0001"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16477"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06940-6"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11367-016-1246-y"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110601"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2023.102652"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2024.100768"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2024.100834"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.12.023"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30996-6"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab406"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000001984"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2003.11.005"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.16876","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:18:20Z","timestamp":1767975500000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.16876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/bju.16876"],"URL":"https:\/\/doi.org\/10.1111\/bju.16876","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]},"assertion":[{"value":"2025-09-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}