Stepping Stones to Sustainability Within Cancer Clinical Trials in Ireland.

Cancer clinical trials contribute significantly to healthcare-related greenhouse gas emissions, highlighting the need to address sustainability in this area as the climate crisis intensifies. This study provides the first national assessment of sustainability awareness, attitudes, and practices within the Irish cancer clinical trials community. A 21-item cross-sectional survey was distributed to 613 cancer research professionals affiliated with Cancer Trials Ireland, including clinicians, research nurses, trial coordinators, patient advocates and industry staff, yielding a 20.6% response rate. Survey items assessed awareness of sustainability tools, perceived carbon contributors, training received, confidence in implementing green practices, and perceived barriers and enablers to sustainability. Awareness of existing carbon footprint tools was low, with only 21% familiar with the Sustainable Clinical Trials Group guidelines and fewer than 6% aware of the National Institute for Health and Care Research calculator. Despite limited training and low confidence in implementing carbon-reductive measures, 86% of respondents expressed willingness to engage with sustainability initiatives. Trial-related travel, sample kit waste, and trial set-up were perceived as the highest contributors to emissions, though perceptions did not always align with published data. Key barriers included lack of education, institutional support, and regulatory clarity, while financial incentives and training were identified as enablers. Coordinated, system-wide interventions are needed to embed sustainability into cancer clinical trial design, governance, and funding processes.