Rideshare Intervention to Promote Access to Care and Environmental Sustainability Within Oncology

PURPOSE Transportation is a critical determinant of cancer care access, particularly for patients undergoing daily radiotherapy. In 2020, University of California, San Francisco Health launched a subsidized rideshare transportation program to reduce barriers to care. Recognizing the environmental impact of transportation-related emissions, this study evaluated a 12-month quality-improvement initiative designed to increase the use of low-emission vehicles for hospital-funded radiotherapy transport. METHODS Between July 2023 and June 2024, transportation for eligible patients was scheduled via Uber Health, with staff instructed to prioritize Uber Green (hybrid and electric vehicles) over UberX (primarily internal combustion vehicles) when available. Ride-level data were retrospectively analyzed, including trip distance, cost, vehicle type, and completion status. Tailpipe greenhouse gas (GHG) emissions were estimated using publicly reported emissions factors. Socioeconomic distribution of rides was mapped using patient home zip codes and US Census data. RESULTS During the 12-month period, 5,383 rides were completed for 217 patients. Uber Green accounted for 66.2% of rides and 57.4% of miles traveled, yet contributed only 46.1% of total GHG emissions. Emissions per mile were significantly lower for Uber Green than UberX (0.14 v 0.23 kg CO 2 /mile). Ride completion rates (97.4% v 95.0%) and costs ($4.85 v $3.93 per mile) were comparable. The intervention averted an estimated 1,500 kg CO 2 emissions. More than half (54%) of rides originated from zip codes with ≥10% of residents living below the federal poverty line. CONCLUSION Prioritizing low-emission vehicles within an existing patient transportation program reduced transportation-related emissions without compromising access or incurring substantial additional cost. This intervention offers a scalable, low-barrier model that cancer and broader health centers can adapt to advance institutional goals around patient-centered access to care and environmental stewardship.