Healing Gardens for Cancer Patients
Lavisha Jaswani, Ar. Dhanashree Utagikar, Ar. Preeti Kale
Dr. D. Y. Patil College Of Architecture
Email: lavishajaswani@gmail.com
ABSTRACT
Number of cancer patients keeps on increasing
every year and the number of specialist
hospitals to treat them are inadequate and the
existing hospitals don’t provide a healing
atmosphere, rather a hospice environment.
Dedicated cancer care facilities are not able to
tackle the cancer burden, as over 11 lakh
patients are diagnosed every year. Many
patients have a negative outlook on cancer as
there is a lack of healing facilities available, to
provide hope psychological benefits. The main
purpose is to explore design solutions for an
architectural cure for cancer, to provide
solutions that empower people to battle
cancer, to illustrate the factors that contribute
to a positive user experience, those that
detract from it, and why. The paper is based on
data provided by Indian Council of Medical
Research, National Institute of Cancer
Prevention and Research, case studies,
interviews. Both Qualitative and Quantitative
research methodology is used in this paper in
the form of literature study, behavioral
analysis of the patients and doctors, case
studies of existing centers and observations.
This paper attempts to quantify the various
surveys conducted and analyses the data
presented in charts, tables, graphs and other
figures to organize the results. This paper
discusses the broad perspective, since how one
feels is abstract, some variables cannot be
quantified as it depends on an individual’s
perception of space. Hence the methodology
used yields a wide range of different results.
Keywords: Healing landscape, oncology,
Diagnostics, Supportive Care, User Experience
Introduction:
Cancer is a class of diseases in which a group of
cells display uncontrolled growth (division
beyond the normal limits), invasion (intrusion
on and destruction of adjacent tissues), and
sometimes metastasis (spread to other
locations in the body via lymph or blood). The
problem of cancerous cell is caused by
mutations or abnormal activation of the genes
which control cell division. When the genes are
abnormal they are called Oncogenes. Among
public institutions, the large buildings and
complicated intervening and surrounding
areas of hospitals usually tend to be seen by
the public as removed from the urban context,
as spaces to be feared, which one only
accesses in emergencies or out of necessity.
However, this psychological perception of their
distance and separation can be decreased by
today’s more hospitable approaches to their
content and design.
Healing Landscape:
Traditional healing gardens are often found
within or adjacent to indoor healthcare
settings. Healing gardens can be found in
mental health hospitals, schools and centres
for the disabled, hospices and nursing homes;
however, possibly the most popular examples
of healing gardens are found within or adjacent
to hospitals and Alzheimer’s treatment
facilities. Healing Gardens meant for users that
are specifically ill or disabled will be useful to
the extent that these special needs
populations are present and able to physically
or at least visually access these sites. However,
even within a healthcare setting, healing
gardens are often used by a larger population
including staff and visitors as well as patients
and/or residents. At a larger scale, some
believe that any garden can be a healing
garden and that the general population can
find restorative benefits from such spaces,
regardless of physical health needs. Taken at
this scale, green spaces with restorative effects
should be easily accessible by the surrounding
population.
RESEARCH QUESTION
 How to improve psychological healing
and promote physical healing of
cancer patients with the help of
healing gardens.
 Design guidelines of a healing garden
for cancer patients
 Attempt to find out the relationship
between the landscape elements and
the psychology of cancer patients in
hospital design
Aim and Objectives:
Aim is to explore design solutions for an
architectural cure for cancer.
Objective is to
• provide solutions that empower
patients to battle cancer.
• To establish how the built form,
specifically Oncology healthcare
facilities, impacts on User Experience
• To illustrate the factors that
contribute to a positive user
experience, those that detract from it,
and why
Scope:
Cancer is the second leading cause
of death globally, and is responsible for an
estimated 9.6 million deaths in 2018. Globally,
about 1 in 6 deaths is due to cancer.
Approximately 70%
of deaths from cancer occur in low- and
middle-income countries. (According to WHO)
Estimated number of people living with the
disease in India is around 2.25 million and
every year, new cancer patients registered:
Over 11 lakhs. Oncologists say the number of
dedicated cancer care facilities will not be able
to tackle the burden in the future According to
ICMR-NICPR: The government has realized that
cancer burden is increasing and hospitals
treating it are meagre in number. There are
only 62 dedicated cancer care hospitals in the
country, including both regional and national
facilities, according to the National Cancer
Grid. This is woefully inadequate as an
estimated 2.25 million people in India live with
cancer as of March 2018, according to the
National Institute of Cancer Prevention and
Research (NICPR).
Limitations:
The paper is limited to the effect that healing
landscape has only on cancer patients. Since
how one feels is abstract, therefore methods
like interviews introduces bias to the study.
The paper is based on case studies from
different countries so user behavior may vary
and not be similar in India.
Methodology
The methodology used will be quantitative, in
the form of available data from ICMR-NICPR
for measuring, ranking, categorizing,
identifying patterns and making
generalizations. Qualitative, in the form of
interviews for contextualizing and interpreting
the perception of patients and doctors in depth
insight. Mixed methods, allowing the
conversion of some variables into quantitative
forms.
The paper will also analyze the case studies of
existing centers to understand positive and
negative factors catering to the patients’
recovery. This will help to provide contextual
real-world knowledge about the behaviors,
social structures and shared beliefs of the
patients and doctors. Another methodology
employed will be literature study, such as
publications, research papers.
Literature Review:
Based on research by the Kaplans and Ulrich, it
could be argued that any garden is healing.
However, to be defined as such, a healing
garden should give a sense of restoration from
stress and have other positive influences on
patients, visitors and staff/caregivers. These
healing landscapes can be located in or
outdoors, but to qualify as healing “gardens”
they should have real nature such as plants
and/or water features (Cooper-Marcus and
Barnes, 1999).
According to research conducted by Prof.
Musa Muhammad Aminu on the use of
landscape elements in hospital environment to
enhance the psychological recovery of cancer
patients, he concluded that there is 38%
decrease in psychological depression in cancer
patients that are exposed to landscape, even
within a short period of time.
He further conducted a stage wise study, which
showed that landscape elements have more
effects on Stage I than II and more on II than III
and then IV.
According to a report published by BMC
cancer, Experiencing the garden as a living
system allowed a metaphorical approach to
reassembling old and integrating new life
components. Nature offered rich metaphors to
capture these creative and adaptive processes.
For example, in the study, participants drew
symbolism from the gardens, which they
related to their own state of being or more
specifically to their experiences of cancer and
the so-called “cancer journey”. Being
‘symbolic of life and renewal in the life cycle’,
nature inducted patients to the states of life
they were confronting. For example, the
garden also provided participants with an
opportunity to be involved with the life cycle.
Maintaining enjoyable activities could
strengthen ties with normality and sustain
positive health behavior like gardening.
Adopting new activities was helpful when
attempting to break away from cancer related
experiences. Nature activities including
gardening and dragon boating resulted in
physical benefits such as adopting healthier
diets, increased physical activity, improved
fitness, and loosened joints. Overall, benefits
extended beyond the physical dimension and,
in participants own words, included: ‘buffer
against stress’.
It is also important to remember that activities
in healthcare outdoor space can range all the
 way from completely passive to very active, for
example:
• Viewing garden through window
• Sitting outside
• Dozing/napping/meditation/prayer
• Gentle rehabilitation exercises
• Walking to preferred spot
• Eating/reading/doing paper work
outside
• Taking a stroll
• Child playing in garden
• Raised bed gardening
• Vigorous walking
• Sports.
Factors Supportive of stress reduction and
healing in hospitals:
 Accessibility
 Places of privacy
 Seating encouraging interaction
 Contact with nature
Factors Hindering stress reduction and healing
in hospital gardens:
 Predominance of hardscape
 Ambiguous, abstract art.
 Intrusive mechanical sounds
 Lack of privacy, places to sit.
 Lack of choice
 Lack of shade
 Feeling of insecurity or risk
 Crowding.

 Convenient way finding to garden

List of plants used for treatment of chronic inflammation/cancers

S/n Plant names Family Local Plant Use

o names part used
01 Cochlospermu Cochlospermacea Rawaya Root Antiinflammatory/anticanc
m tinctorium e er
A. Rich
02 Cissus ibuensis Ampelidaceae Daddori Leaves Antiinflammatory/skin
Hook
03 Bridelia Euphorbiaceae Kirnii Stem bark Skin cancer
ferrugineae
Benth
04 Euphorbia lateri Euphorbiaceae Fidda Stem Cancer/reduce bleeding and
.ora Schum. & Sartse relieve of pains after
Thonn. circumcisions
05 Desmodium Fabaceae Dangere Leaves Many cancers
velutinum Willd e
06 Annona Annonaceae Gwandar Stem Skin cancer/leukemia
senegalensis daji bark/leave
Pers s
07 Vismia Hypericaceae Kiska Leaves Cancer
guineensis Linn. wali

Case Studies: CASE STUDY 1
Massey Cancer Center, Virginia, US
The healing garden at VCU Massey Cancer
Center offers patients, family members and
medical staff a chance to be around nature and
to escape, if for only a little while, the stress
and stimulation of a clinical environment. The
garden offers another aspect of healing that the drug vinblastine; and autumn crocus,
goes along with medicine but is different from which makes a substance tested against
medicine. These are the benefits of nature that leukemia.
come from plants and wonderful light and the
trickling of water. For a sick patient, a stressed
relative or a tired nurse, the garden will be a
temporary place of peace in the midst of
dealing with illness and pain. Perhaps it will
mean the difference between a bad day and a
hopefulday.

Fig no. 3- Massey Cancer Center

But most of the plants come from everyday

life, and the healing aspect is intended to come
from this very familiarity.

Fig no. 1- Massey Cancer Center
According to the landscape architect, "The
focus is on life rather than illness," and that
plants with strong scents are absent because
some cancer treatments increase sensitivity to
them.

CASE STUDY 2

Healing Garden at Mount Zion Clinical

Cancer Center, San Francisco, California
Fig no. 2- Massey Cancer Center
This large medical center is located in the heart
The restorative power of gardens is an ancient
of san Francisco, at the intersection of two
idea that still has therapeutic power. The
busy streets, Sutter and Divisadero. Across
Healing Garden is growing shade trees,
Sutter from the main high rise building is a one
perennials, evergreens, shrubs, vines and
story women health center. This building and
groundcovers. Water sculptures and a tranquil
the courtyard garden hidden within it were
pool add to the atmosphere. Views from the
once the home of the hospital’s clinical center.
garden are framed by bronze screens that
The center has since moved across the street
borrow design elements such as birds and
to the main building, but the garden remains
reeds from the nearby Egyptian Building, which
and is included here as a case study of an
was the original medical school built in 1845.
exemplary garden for cancer patient.
The garden has plants with anti-cancer
This courtyard garden is bounded by hospital
properties, including the yew tree, which was
buildings and a commercial property, roughly
the original source of the drug paclitaxel;
half of the garden still receives direct sunlight
Madagascar periwinkle, which is used to make
at noon. Plants were chosen to provide blooms
throughout the year and to provide a variety of
green hues. There is a small fountain to screen
out noise from a nearby street and many
wooden benches, tables and moveable chairs.
Fig no. 4- Mount Zion Clinical Cancer Center
The garden was once a mostly-hardscaped
courtyard, designed by Tommy Church. An
artist-patient at the center provided the idea
and effort to redesign the space into a more
garden-like setting. During the design process
workshops were held where patients and staff
provided suggestions on the necessary garden
elements. There were also a number of tile-
making workshops where patients added their
survival stories to tiles with imprints of Asian
plant specimens used in cancer treatment.
These tiles made up the wall of the indoor
corridor that passes by the garden; the tiles are
one element of permanence next to a
constantly changing garden. This garden has
been quite successful with patients, staff and
visitors. It is a green oasis within the hospital
complex and gains much of its popularity
through the community process that is was
created from.
Fig no. 5- Mount Zion Clinical Cancer Center
The gardenesque style of this garden
comprises curvilinear pathways of
decomposed granite that border planting beds
filled with a great variety of annuals and
perennials, including white blooming
impatiens, hydrangeas, and Japanese
anemone in the shady half of the garden and
the colourful blooms of roses, begonia,
penstemon, pansies, lavender. The plants have
been chosen to provide blooms throughout
the year, as well as to offer a variety of shades
of green. Attractive wooden garden benches
with backs and arms, a number of round
wooden tables with movable chairs, and a
curvilinear stone seating wall provides a
variety of places to sit in the sun or shade.
CASE STUDY 3
The Mary & Al Schneider Healing Garden,
Cleveland, USA
The Mary & Al Schneider Healing Garden was
designed as an integral part of the new
Seidman Cancer Center. The garden creates an
experience of respite for cancer patients, staff
and families – an “Island” designed to both
calm and delight one’s senses in the core of
downtown Cleveland. Requests were made for
creating a sense of calm for visitors who want
to recharge and rejuvenate yet also provide a
sense of whimsy, of being able to touch rocks,
allowing those journeying with cancer
something to hang onto and feel the rock’s
strength, of being able to find a place of
respite, to inspire by quotations, having an
open space to breathe, a place to be away from
busy streets yet a part of the urban fabric.
both organized programs by hospital staff, and
self-initiated walks by any who visit the garden.
Visitors can walk the labyrinth alone, or guided
walks are available. The path around the
labyrinth has large sculptures that represent
earth, air, fire and water.

The lower area of cafe tables and chairs,

accessible by ramp or steps, becomes a place
to sit and meet, to move a chair into sunshine
or shade; to enjoy a sense of respite, or savor
one’s lunch. The healing garden, which is about
one-third of an acre, isn't visible from the
street. A wall separates the setting from hectic
Euclid Avenue. But the public, whether visiting
Fig no. 6- The labyrinth
Seidman or not, is welcome inside the garden,
which is accessible from the intersection of
Euclid and University Hospitals Drive.

Fig no. 7- Representation of elements of earth-

fire
Fig no. 8- lower area of café tables and chairs,
As one enters the garden, one becomes aware
accessible by ramp
of entering “somewhere else instead”. One
begins to feel transported as one eases down
the accessible pathway into the subtly walled
garden.

Below the busy corner of UH Drive and Euclid

Avenue, the garden becomes a “green oasis”.
Immersed under a canopy of trees, providing
shade in summer months, the accessible
pathway leads into a walled garden inspired by
the elements of earth, fire, wind and water. Fig no. 9- Inspirational quotes along the way
One arrives at the carved granite labyrinth to and The large rock seat at left is veined in a
find its opening beckoning an invitation; the way that suggests an angel .
labyrinth is a walking meditation tool engaging
the right brain. It provides opportunities for
Overview:

Case study I: Massey Cancer Center, Virginia, USA

Case Study II: Healing Garden at Mount Zion Clinical Cancer Center, San Francisco, California

Case Study III: Mary & Al Schneider Healing Garden, Cleveland, USA

Comparative Analysis:

Case Study framework Physical Factors Sense of control Natural

Name Distraction

Massey The healing garden The Healing Garden Most of the For a sick patient,
Cancer offers patients, is growing shade plants come from a stressed
Center family members trees, perennials, everyday life, and relative or a tired
and medical staff a evergreens, shrubs, the healing nurse, the garden
chance to be vines and aspect is will be a
around nature and groundcovers. intended to come temporary place
to escape, if for Water sculptures from this very of peace in the
only a little while, and a tranquil pool familiarity. midst of dealing
the stress and add to the with illness and
stimulation of a atmosphere. Views The focus is on pain. Perhaps it
clinical from the garden are life rather than will mean the
environment. The framed by bronze illness and that difference
garden offers screens that borrow plants with between a bad
strong scents are
another aspect of design elements day and a hopeful
healing that goes such as birds and absent because
day.
along with reeds from the some cancer
medicine but is nearby Egyptian treatments
increase
different from Building, which was
medicine. the original medical sensitivity to
school built in 1845. them.

Healing This courtyard The gardenesque There were also a The typical
Garden at garden is bounded style of this garden number of tile- scenario on a
Mount Zion by hospital comprises making summer day is,
Clinical buildings and a curvilinear workshops people come into
commercial pathways of where patients the garden to eat
property, roughly decomposed added their lunch, wait for an
Cancer half of the garden granite that border survival stories to appointment,
Center still receives direct planting beds filled tiles with hold small staff
sunlight at noon. with a great variety imprints of Asian meetings, sit or
Plants were chosen of annuals and plant specimens quietly talk with
to provide blooms perennials, used in cancer a family member,
throughout the including white treatment. These do paperwork or
year and to provide blooming tiles made up the relax in the sun.
a variety of green impatiens, wall of the indoor So the garden
hues. hydrangeas, and corridor that does a good job
Japanese anemone passes by the in distracting
in the shady half of garden; people from the
the garden and the monotonous life
colourful blooms of of treatments.
roses, begonia,
penstemon,
pansies, lavender.

Mary & Al The Mary & Al Integrated into the The garden The garden
Schneider Schneider Healing Schneider Healing creates an creates a sense of
Healing Garden was Garden at Seidman experience of calm for visitors
Garden designed as an Cancer Center, is a respite for cancer who want to
integral part of the labyrinth in 11 patients, staff recharge and
new Seidman circuit Chartres and families – an rejuvenate yet
Cancer Center. The pattern. It is “Island” designed also provide a
garden, which is constructed of 948 to both calm and sense of whimsy;
about one-third of pieces of honed cut delight one’s of being able to
an acre, isn't granite and is senses in the core touch rocks,
visible from the surrounded by an 8- of downtown allowing those
street. A wall foot-wide Cleveland. journeying with
separates the bluestone path. A cancer something
setting from hectic snowmelt system to hang onto and
Euclid Avenue. But keeps the pattern feel the rock’s
the public, free of ice and snow strength, of being
whether visiting enabling able to find a
Seidman or not, is accessibility of place of respite,
welcome inside people of all ages to inspire by
the garden, which and stages, quotations,
is accessible from wheelchairs and IV having an open
the intersection of poles. space to breathe,
Euclid and a place to be
University away from busy
Hospitals Drive. streets yet a part
of the urban
fabric.
Design guidelines:
Accessibility: People of all ages and abilities
need to be able to enter and move around in
the garden. Paths must be wide enough for
two wheelchairs to pass (minimum of six feet),
they should be smooth and wide enough for a
patient on a bed or gurney to be wheeled into
the garden, paving joints should be narrow
enough so as not to catch a cane, the wheels of
a walker or an IV-pole.
Familiarity: When feeling stressed, many seek
environments that are familiar and comforting.
A depressed person may be reluctant to leave
their bed; an anxious person may seek the
familiarity of home. Similarly, those in medical
settings who are stressed from overwork,
illness, or anxiety need to have access to
garden settings which are soothing in their
familiarity.
Quiet: If a garden is to have therapeutic value
in a medical setting, it needs to be quiet — a
complete contrast to the public
announcements, TVs, and rattling trolleys of a
hospital interior. People using the garden need
to feel a sense of calm, and to be able to hear
birdsong, wind chimes, or the sounds of a
fountain
Comfort: Hospital patients often feel
vulnerable. Patients who are elderly, infirm or
mobility-impaired need the reassurance of
handrails, seating at frequent intervals
(especially near the entry door), and paving
materials that do not cause excessive glare.
Patients, staff and visitors also need to feel
psychologically secure: a garden space needs
to feel and be safe, with some sense of
enclosure and the absence of feeling that users
are in a “fishbowl,” being stared at.
Conclusion:
For a patient, visitor, or member of staff,
spending long hours in a hospital can be a
stressful experience. Nearby access to natural
landscape or a garden can enhance people’s
ability to deal with stress and thus potentially
improve health outcomes.
It is important to recognize that “healing” is
not synonymous with “cure.” A garden cannot
cure cancer, but it can do the following:
 Facilitate stress reduction which helps
the body reach a more balanced state
 Help a patient summon up their own
inner healing resource
 Help a patient come to terms with an
incurable medical condition
 Provide a setting where staff can
conduct physical therapy, horticultural
therapy, etc. with patients
 Provide staff with a needed retreat
from the stress of work
 Provide a relaxed setting for patient-
visitor interaction away from the
hospital interior.
A healing garden can have the effect of
awakening the senses, calming the mind,
reducing stress, and assisting a person to
marshal their own inner healing resources. For
a garden to provide maximum therapeutic
benefits, it needs to have a plentiful supply of
plant materials, some with distinctive seasonal
changes; leaves or grass which move with the
slightest breeze; subtleties of colour, texture,
and leaf shape especially where frail people
may move slowly looking down or where
people may sit for long periods in one setting.
Trees can provide metaphors of solidity,
strength and permanence; perennials of
persistence and renewal; annuals of growth,
budding, blooming, seeding, decay, death and
transformation. A healing garden should also
provide views to the sky and changing cloud
formations, pools that reflect the sky or trees
and that can attract wildlife, reminding those
in ill-health that life goes on, elements that
feature the sight and sound of moving water,
and where possible, views to the horizon or to
landscape. The layout of the garden should be
such that walking or being pushed in a
wheelchair through the garden provides a
variety of open and closed views, experiences
of differing sub-spaces, even elements of
positive surprise or whimsy.

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