November 19, 2013
By Jason Schroer, AIA, ACHA, LEED AP and Carol Kartje, AIA, IIDA, LEED AP, Associate Principals and Senior Vice Presidents, HKS, Inc.

Understanding the need:  The rise of cancer in the United States has triggered focused efforts on treatment and prevention of the disease, with a corresponding need for uniquely responsive cancer care environments. New technologies, new medicines, advanced research, and specialty treatment and care centers have increased two-fold over the last decade. According to the Centers for Disease Control and Prevention, cancer accounts for approximately 580,000 deaths annually in the U.S., second only to heart disease (approximately 600,000 deaths). While more than 1.6 million people are newly diagnosed with cancer every year, mortality rates are trending downward, which means survivorship is rising. This disease, once synonymous with imminent death, is evolving into a focus on disease management. Medicine and technology are improving and people with cancer are living longer.

The National Institute of Health reports the following key facts: 

  • Fifty percent of all cancer patients receive chemotherapy.
  • There will be 18.1 million cancer survivors in 2020, 30 percent more than in 2010.
  • The annual cost of of cancer care is $157 billion annually (in 2010 dollars).
  • Growth and aging of the U.S. population are the primary causes for increases in cancer.

It is evident that hospitals and caregivers are treating more chronic cases; therefore, the need for facilities that respond to the unique needs of cancer patients also is increasing. Rising demand and the special needs of these patients have created a shift to specialty care centers, both inpatient and outpatient, that focus on the treating and preventing cancer. 

So what makes the cancer patient unique? What makes cancer care distinctive? What about specially trained caregivers? How can the physical environment support these needs? This four-part series will focus on these issues and address the fundamentals of cancer center design, and explore ideas and solutions for creating a holistic approach to designing and planning cancer centers that are uniquely responsive to the needs of this special patient population and their caregivers. 

  • Part 1: The Growing Need and the Cancer Patient
  • Part 2: The Caregivers
  • Part 3: Effective Cancer Center Design Strategies
  • Part 4: Cancer Center Case Studies 

Some consider this type of specialty environment (the cancer center) the same as any healthcare setting, utilizing a traditionally methodic design approach driven by function and operations. While functionality is essential to any healthcare environment, buildings that are designed for cancer care must encompass characteristics that address the distinctive aspects of the cancer patient and their care team, which indeed, are unique.  Paramount to success, we must remember that the spaces and places we design are ultimately for the people who inhabit them.  Understanding and empathizing with these constituents is vital for the design team to create a responsive and supportive environment. 

Part 1: The Growing Need and the Cancer Patient

Understanding the Patient:  It must be noted that every cancer patient’s journey is personal and no two patients are alike. This disease has no bias as to age, ethnicity or gender. Cancer, in its many forms, can have a catastrophic effect upon normalcy of daily life for individuals and families impacted by the disease. While no two diagnoses are identical, many cancer patients do share similar treatment experiences including an array of physical trials, emotional challenges and spiritual journeys.  As designers, it is important that we understand the spectrum of journeys that these patients experience, to gain true empathy to inform design of environments that more effectively support their fight. With deeper understanding, we increase our ability to design uniquely responsive places that have the potential to help in the healing process and provide a place that echoes respect, dignity and security. 

Physical attributes of the cancer patient receiving infusion
Many patients receiving infusion treatments also have experienced, or will experience, surgery and radiation which cumulatively takes a toll on patients physically and reduces their sense of well-being. These treatments often cause weakness and a compromised immune system. Susceptibility to viruses, flu and seasonal colds increases and can disrupt the healing process and lessen the ability to fight the cancer.

A cancer patient’s new state of normal can become an overall feeling of sickness, similar to flu symptoms. Treatments, and even pain medications for intermittent or chronic pain, also can cause them to feel perpetually nauseous and trigger gastrointestinal issues. This may leave patients vulnerable to uncontrollable accidents, increasing their levels of stress and anxiety. 

Changes in physical appearance are a common result of chemotherapy and other cancer treatments. Many patients experience hair loss, scars, skin changes, weight loss or gain, sensitivity to smells and temperature, and loss of muscle tone, creating limitations in activity and altering familiar daily life. 

Furthermore, patients often are burdened with the financial impact of treatment. This additional challenge can increase mental stress, causing physical fatigue which may influence their ability to heal or even make decisions about the course and/or frequency of treatment.  

Psychological/mental attributes of the cancer patient
Much like the impact of cancer treatment on the physical attributes of the patient, it also can affect their mental and psychological makeup. The journey can be an emotional roller-coaster, with peaks and valleys of progress and setbacks. These ups and downs can lead to a general sense of a loss of control. Battling a disease that has overtaken their body and not knowing the outcome of their personal battle, can lead to feelings of fear and uncertainty.  

The cancer journey also can lead to a degradation of a patient’s dignity. During treatments, evaluations and consultations, they repeatedly have to undress and gown, resulting in unwanted exposure of their bodies to staff and family members. Surgery and radiation treatments can leave scars and skin discoloration; their presence and exposure often leading to embarrassment and shame. Many patients struggle with the overall lack of privacy along their journey.  Being exposed, probed, prodded, studied and examined becomes par for the course and can be a difficult adjustment. 

Short-term memory loss or experiencing general fogginess is frequently reported as a side effect of many treatments. This typically is attributed to a combination of the side effects of the medication and mental strain from fighting a disease that disrupts their normal mental alertness. Regardless of the catalyst, mental fatigue is a common issue. 

The pride of independence also is disrupted. Patients, who were once the nurturers or caregivers, find themselves seeking help due to their lack of health and well-being. They can be faced with feelings of guilt because they find themselves having to rely on others for care and assistance with simple daily activities. This aspect of the journey also compounds the “loss of control” feelings. 

Patients are hungry for information. One way they cope with loss of control is to learn as much as possible about their disease and treatment. This enables them to stay knowledgeable so they can have engaged and informed conversations with their caregivers. New information could perhaps help them find other ways to gain some control and cope with their disease and changing condition. At the same time, the complexity and overwhelming volume of information available online can be daunting. Face time with expert oncology caregivers is invaluable in navigating to credible resources. 

More than any time in their lives, the burden of cancer and the imminent fight can weigh heavy on one’s psyche, leading to sadness and sometimes depression. To face these challenges, patients have a deep need to stay positive and find purpose in their situation. Positive focus, inspiration, connection and introspection provide opportunities for renewed hope, uplifting energy shifts, and rejoicing at milestones and small breakthroughs along the journey. 

Spiritual attributes of the cancer patient
Walking the tightrope of this journey requires a safety net made up of family, friends, caregivers and sometimes, a spiritual footing. While not all patients believe in a higher power, it is essential for them to find solace during their journey. Support from and connection to others and/or a higher power can help them find comfort and a reason to fight the fight.  It is a daily battle that often spans many months or years and feeling supported and staying positive have shown to enhance the ability to heal. 

Designing environments for the care and treatment of people with cancer takes a holistic and sustainable approach, encompassing empathy, operational knowledge and creative design thinking from the architects, interior designers, engineers and client team. There are layers of issues and considerations that must be addressed to design an effective and responsive cancer center – many of which will be explored in the continuation of this series. 

Up Next:

Part 2: Designing Uniquely Responsive Cancer Care Environments – The Caregivers

Posted in Health
Tagged cancer centers, Carol Kartje, Jason Schroer