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Designing Uniquely Responsive Cancer

Care Environments Part 1: The Need and
the Patient
November 19, 2013







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By Jason Schroer, AIA, ACHA, LEED AP and Carol Kartje, AIA, IIDA, Subscribe
LEED AP, Associate Principals and Senior Vice Presidents, HKS,
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,




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
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,




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
Part 1: The Growing Need and the Cancer Patient
Understanding the Patient: It must be noted that every cancer
patients 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
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 patients 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
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 rollercoaster, 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 patients
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
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
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
More than any time in their lives, the burden of cancer and the
imminent fight can weigh heavy on ones 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 Healthcare
Tagged cancer centers, Carol Kartje, Jason Schroer


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