More than 1.6 million people are newly diagnosed with cancer every year.

However, cancer diagnosis,

once synonymous with a death sentence, is evolving into focused disease management.
As mortality rates trend downward, the number of cancer survivors increases. With medical and
technological advances, more cancer patients are living longer. As hospitals and caregivers treat
greater numbers of chronic cases, facilities that respond to the unique requirements of cancer patients
become essential.
The increasing number of cancer cases has triggered a two-fold increase in the number of specialty
treatment and care centers, both inpatient and outpatient, over the last decade.
Some consider cancer center design 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 provide cancer care must encompass characteristics that
address the distinctive aspects of the cancer patient and the care team, which are both unique.
In addition to meeting the functional healthcare requirements in a specialty cancer treatment center,
the answers to the following questions should be an important part of the design process:

What makes the cancer patient unique?

What makes cancer care distinctive?
What are the needs of specially trained caregivers?
How can the physical environment support the needs of patients, caregivers, and family

members?
How can the design support the focused efforts for both cancer treatment and disease

prevention?
How can we incorporate the latest technologies, new medicines and advanced research, and
specialty treatment?

Paramount to success in creating uniquely responsive cancer care environments, designers must
remember that the spaces and places created 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.
The cancer patient
Every cancer patients journey is personal; no two patients or diagnoses are exactly alike. The
disease has no bias as to age, ethnicity, or gender. In its many forms, cancer can have a catastrophic
effect upon normalcy and daily life for individuals and families impacted by the disease. However,
many cancer patients do share similar treatment experiences that include an array of physical trials,
emotional challenges, and spiritual journeys.
As designers, its important to understand the complete spectrum of journeys that cancer patients
experience, to gain true empathy that informs the design of environments to more effectively support
the cancer fight. With deeper understanding, we increase our ability to design uniquely responsive
places that have the potential to aid the healing process and to provide a place that reinforces
respect, dignity and security.
Physical attributes of the cancer patient receiving infusion
Many patients receiving infusion treatments also have or will experience surgery and radiation. The
cumulative result of these invasive treatments 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 result in an overall feeling of sickness, similar to flu
symptoms. Treatments, and even pain medications for intermittent or chronic pain, can also 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 are often burdened with the financial impact of treatment. This additional
challenge can increase mental stress, causing physical fatigue that 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
In addition to the impact of cancer treatment on the patients physical state, it also can affect their
mental and psychological makeup. Furthermore, the journey can create an emotional roller coaster,
with peaks and valleys of personal progress and setbacks. These ups and downs often lead to a
general sense of losing control. The dual challenges of battling a disease that has overtaken their
body and not knowing the outcome of their personal battle often leads to emotions of fear and
uncertainty.
Regardless of the catalyst, mental fatigue is a common issue. The cancer journey can also result in a
degradation of a patients dignity. During treatments, evaluations, and consultations, they repeatedly
have to undress and gown, resulting in unwanted revelation of their bodies to staff and family
members. Surgery and radiation treatments can leave scars and skin discoloration; their presence
and exposure often lead to embarrassment and shame. Many patients struggle with the overall lack of
privacy. 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 is often attributed to a combination of the side effects of the medication and the
mental strain of fighting a disease that disrupts their normal life.
Pride and independence are also disrupted. Patients, once nurturers or caregivers, find themselves
seeking help due to their lack of health and well-being. They can be faced with guilt because they
have to rely on others for care and assistance with simple daily activities. This aspect of the journey
also compounds their 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 identifying credible resources.
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 depression. To face these challenges, patients have a deep
need to stay positive and find purpose. 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 cancer treatment requires a safety net of family, friends, caregivers, and, for
many individuals, a spiritual footing. While not all patients believe in a higher power, its essential for
them to find solace during their journey. Support from and connection to others and/or a higher power
can assist them in finding comfort and a reason to fight the fight. This daily battle often spans many
months or years. If the patient feels supported and stays positive, the overall result can enhance their
ability to heal.

Designing environments for the care and treatment of people with cancer requires a holistic and
sustainable approach, encompassing empathy, operational knowledge, and creative design thinking
from the architects, interior designers, engineers, and client team. This includes addressing the many
complex layers of issues and factors that must be addressed to design an effective and responsive
cancer centermany of which will be explored in this series.
In the next installment, well define the role of caregivers in the cancer center environment as well as
their unique needs.
Jason Schroer, AIA, ACHA, LEED AP, is cancer center practice leader and associate principal at HKS
Inc. He can be reached at jschroer@hksinc.com. Carol Kartje, AIA, IIDA, LEED AP, is a cancer
survivor, interior designer, and associate principal at HKS Inc. She can be reached
atckartje@hksinc.com.

This is the first part of Healthcare Designs four-part special report on cancer center design. Read the
second installment, "Fundamentals Of Cancer Center Design: The Caregivers".