Perceptions of the environmental impact of oncology care: A cross-sectional survey of French and Belgian healthcare professionals.

BACKGROUND: Health care is a major contributor to greenhouse gas emissions; however, the specific environmental burden of oncology is poorly characterized. This study aimed to assess oncology healthcare professionals' perceptions of the environmental impact of their clinical practice. METHODS: We conducted an anonymous, cross-sectional survey between January and April 2025 among oncology healthcare professionals in France and Belgium. A 23-item questionnaire was developed by a multidisciplinary team and administered via professional networks, oncology societies, and social media. The survey assessed perceptions of oncology's environmental impact, attitudes toward sustainable practices, and willingness to modify clinical decisions when supported by scientific evidence. RESULTS: Among 330 respondents (73% women; median age, 39 years), 32% were medical oncologists, 25% nurses, 8% advanced practice nurses, and 35% other professionals involved in cancer care. Respondents mainly worked in comprehensive cancer centers (45%) or university hospitals (29%). Two-thirds perceived oncology as having a greater negative environmental impact than other medical specialties. Ranked from most to least impactful, the main perceived sources of environmental burden were chemotherapy, biotherapy, radiotherapy, imaging, and patient transport. The integration of environmental considerations into clinical decision-making was low (mean score 8.3/100, SD 14.9), and institutional efforts to reduce impact were perceived as insufficient (mean 15.3/100, SD 20.7). Almost all respondents (97.7%) were willing to implement lower-impact strategies if supported by equivalence data regarding efficacy. CONCLUSION: Oncology professionals in France and Belgium recognize that the environmental footprint of cancer care is insufficiently addressed. They express a strong willingness to adapt their practice toward more sustainable models, provided scientific validation exists. Integrating environmental criteria into oncology decision-making and research frameworks will be important for the future sustainability of cancer care.