For People or Planet: The Environmental Toll of Chemotherapy

In 1942, Yale physicians Louis Goodman and Alfred Gilman administered the first form of chemotherapy, having discovered that nitrogen mustards could be used to systematically target and kill cancer cells in the human body (DeVita & Chu, 2008). This marked a revolutionary breakthrough in oncology, initiating the era of modern chemotherapy. Chemotherapy has extended and saved millions of lives since then, but there is one major concern when it comes to this treatment: the environmental cost (Abuamer, 2025). 

Producing anticancer active pharmaceutical ingredients (APIs) is highly inefficient, as small-molecule anticancer agents typically require 10-20 synthetic steps, leading to compounding yield losses (Rose, 2025). Additionally, APIs used in oncology treatments must meet a highly strict standard, causing API production to be even less efficient than the already concerning pharmaceutical average. Furthermore, the waste and disposal of these pharmaceutical agents are entering the natural environment, notably aquatic environments, causing harm to the ecosystems there. Studies have shown traces of cytotoxic cancer treatments in samples from rivers and seawater in multiple countries, and one study in particular followed the effects that incorrectly disposed of anticancer drugs had on crustaceans. They found a significant increase in DNA damage and a decrease in reproductive potential of crustaceans in this environment following exposure to the anticancer drugs etoposide, cisplatin, 5-fluorouracil, and imatinib (Walker & Ghiya, 2021). 

Another growing concern regarding chemotherapy is the disposal of chemotherapy waste into human water systems. These chemicals enter water systems primarily through cancer patients’ feces and urine, as conventional wastewater treatment plans are not equipped to fully remove these genotoxic compounds from the water supply. It is estimated that 30-90% of chemotherapy drugs, varying by agent, are excreted unchanged or as active metabolites in feces and urine (Cirstia et al., 2025). Cyclophosphamide and ifosfamide, widely used alkylating chemotherapy medications, are continuously being detected in effluents and surface waters, since they are not degradable via standard wastewater processes (“Cancer Drugs Persist in Water Cycle, Creating Genotoxic Health Risk,” n.d.). Cytostatic drugs and their metabolites then travel through sewage systems into surface water, allowing these DNA-damaging materials to re-enter drinking water systems. Flushing unused or expired chemotherapy medications is also a concern, as this is another pathway for these compounds to enter the sewage system. This poses a genotoxic risk to the population, as cytostatics are inherently genotoxic, and low-dose yet chronic exposure to these chemicals is a public health concern, especially for immunocompromised individuals, pregnant individuals, children, and other members of vulnerable populations. 

Although studies on this topic are limited, it is evident that there is a growing concern when it comes to the toll chemotherapy treatments have on the environment. This issue must be looked at from a cross-industrial standpoint, as pharmaceutical companies, hospitals, wastewater treatment plants, technology developers, and environmental agencies all have a role to play in mitigating the negative effects of this life-saving yet damaging treatment. 

References

Castellano-Hinojosa, A., Gallardo-Altamirano, M. J., González-López, J., & González-Martínez, A. (2023). Anticancer drugs in wastewater and natural environments: A review on their occurrence, environmental persistence, treatment, and ecological risks. Journal of Hazardous Materials, 447(130818), 130818. https://doi.org/10.1016/j.jhazmat.2023.130818

Cirstea, I., Radu, A.-F., Radu, A., Tit, D. M., & Bungau, G. S. (2025). Healthcare waste toxicity: From human exposure to toxic mechanisms and management strategies. Journal of Xenobiotics, 15(5), 155. https://doi.org/10.3390/jox15050155

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Li, D., Chen, H., Liu, H., Schlenk, D., Mu, J., Lacorte, S., Ying, G.-G., & Xie, L. (2021). Anticancer drugs in the aquatic ecosystem: Environmental occurrence, ecotoxicological effect and risk assessment. Environment International, 153(106543), 106543. https://doi.org/10.1016/j.envint.2021.106543

Sustainability Directory. (2025, November 19). Cancer drugs persist in water cycle, creating genotoxic health risk. News → Sustainability Directory. https://news.sustainability-directory.com/health/cancer-drugs-persist-in-water-cycle-creating-genotoxic-health-risk/

(N.d.). Pharmaceutical-journal.com. Retrieved September 21, 2026, from https://pharmaceutical-journal.com/article/opinion/chemotherapy-is-harming-the-environment-it-is-time-for-regulators-manufacturers-and-pharmacy-to-take-action