Environmental sustainability can feel like a systemic challenge — one needing national policy, major infrastructure investment, and years of coordinated effort. And it is. But some of the most impactful changes in healthcare have started with a single clinician, a modest audit, and a willingness to ask if we could do this differently?
Here are five practical quality improvement and audit projects that oncology teams have carried out — or could carry out — to reduce the environmental impact of their department.
1. Audit G-CSF prescribing in your chemotherapy patients
Granulocyte colony-stimulating factors such as filgrastim and pegfilgrastim are among the most resource-intensive supportive medications in oncology, requiring cold-chain storage, generating pharmaceutical waste, and producing considerable single-use plastic waste. They are also frequently prescribed where the evidence base is limited. A simple audit comparing G-CSF prescribing against ASCO, ESMO or NICE febrile neutropenia risk threshold guidance(1–3) — examining whether low or intermediate risk patients are receiving G-CSF that is not guideline-recommended — can be completed with routine prescribing data and sits neatly at the intersection of clinical quality, resource stewardship, and environmental impact.
2. Map the waste streams on your ward or unit
Most clinical teams have little visibility of what happens to the waste they generate. A structured waste audit — categorising clinical, pharmaceutical, and offensive waste across a ward or chemotherapy day unit — frequently reveals incorrect classification, with general waste being disposed of as clinical waste at much higher financial and environmental cost. Not the sexiest of topics, but NHS England's Delivering a Net Zero NHS report(4) identifies waste segregation as one of the most accessible entry points for clinical sustainability work.
3. Review your SACT preparation and wastage
Unused systemic anticancer drugs are one of the most environmentally and financially costly forms of waste in oncology. Shared vial schemes have been shown to reduce wastage, particularly in synergy with strategies such as centralisation of drug preparation and coordination of scheduling(5). An audit of drug wastage rates in your pharmacy or day unit, benchmarked against published data, can make a compelling case for change.
4. Examine patient travel patterns
Patient travel represents a significant proportion of the NHS carbon footprint, and oncology patients — often attending for multiple cycles of treatment — are among the highest-mileage patients in the system. A simple survey of how patients travel to your unit, combined with mapping of journey distances, can identify where telemedicine follow-up, transport coordination, or satellite clinic models could reduce travel burden.
5. Audit blood test appropriateness on your oncology ward
Routine daily blood testing is deeply embedded in inpatient oncology practice, but a significant proportion of tests ordered are repeated before results are likely to have changed meaningfully — adding to laboratory workload, consumable waste, and patient discomfort without clinical benefit. The Royal College of Pathologists' Minimum Retesting Interval (MRI) guidance(6) sets evidence-based minimum intervals for common blood tests, and provides a ready-made benchmark for an audit of inpatient requesting patterns. Comparing actual retesting intervals against RCPath recommendations using clinical records and laboratory data has the potential to reduce unnecessary venepuncture, single-use consumable waste, and the carbon footprint of laboratory processing — while making a case that is easy to communicate to your colleagues in terms of patient experience as well as sustainability.
Getting started is often the hardest part. If you've carried out a sustainability project in your oncology department we would love to hear about it. Share your experience in the network forum and help build the evidence base that the field urgently needs.
References:
1. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488
2. Klastersky J, Naurois J de, Rolston K, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines †. Ann Oncol. 2016;27:v111-v118. doi:10.1093/annonc/mdw325
3. Overview | Neutropenic sepsis: prevention and management in people with cancer | Guidance | NICE. September 19, 2012. Accessed March 23, 2026. https://www.nice.org.uk/guidance/cg151
4. Delivering a Net Zero National Health Service. NHS England; 2022. Accessed July 22, 2024. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/…
5. Rajangom KS, Erenay FS, He QM, et al. Cancer Drug Wastage and Mitigation Methods: A Systematic Review. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2025;28(1):148-160. doi:10.1016/j.jval.2024.08.006
6. National minimum retesting intervals in pathology. Accessed March 23, 2026. https://www.rcpath.org/static/253e8950-3721-4aa2-8ddd4bd94f73040e/g147_national-minimum_retesting_intervals_in_pathology.pdf
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