Perspectives 03.18.2021

The Evolution of Cancer Care: Aligning Facility Design with Operational and Technological Trends

Sapna Bhat, a healthcare design leader in our Dallas studio, tracks cancer care’s historical milestones and explains how we’re responding to new forces.

Milestones in Treatment: An Overview

The earliest known description of cancerous tumors was found in Egypt in a surgical text dating back to around 3000 B.C. that reads, “There is no treatment.” Thanks to the advanced research and progress made in science, technology, and healthcare, many cancer patients now undergo successful treatments and can enjoy a good quality of life for years to come.

Information Source: The American Cancer Society

The introduction of anesthesia in the 18th century paved the way for the development of advanced surgical procedures. The modern microscope accelerated the study of diseased tissues in the 1800s. By the turn of the century, the invention of the X-ray enabled radiotherapy in cancer diagnosis and treatment. The 20th century ushered in further developments: chemotherapy, immunotherapy, the invention of the ComputedTomography (CT) scanner, and the discovery of the chemical structure of DNA. In the last two decades, the science of cancer care has progressed further than in all preceding centuries combined, with new methods of treatment such as intensity modulated radiation therapy, image-guided radiation therapy, and radiogenic therapy.

As the knowledge of cancer deepens, it has informed and influenced the physical and operational aspects required for its procedures and treatments. The design of cancer care facilities has come a long way from the first cancer hospital in France, which was forced to move out of the city due to a fear of contagion. Modern-day cancer facilities, in contrast, are continually moved closer to the communities they serve. These facilities also have a much greater focus on the patient and staff experience by combining strong design principles built around nature and the local community. Through a careful evaluation of operational and technological trends in cancer care, designers can prioritize clients’ operational goals with effective and responsive care facilities.

Computer Corridor Natural Light
Harold C. Simmons Radiation Oncology Building, UT Southwestern Medical Center
Dallas, Texas

Integrating Telemedicine

As my colleague Heidi Costello wrote, the increase in telemedicine is a positive byproduct of the disruption caused by COVID-19. Telemedicine has a farther reach than traditional care because it is cost-saving, efficient, and more equitable, extending access to rural communities. Specifically, for cancer care, telemedicine/teleoncology applications are wide-ranging. They include cancer telegenetics, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and potentially increased access to cancer trials. Teleoncology makes it easier to bundle clinical services and reduce travel time between referring sites and consulting sites. Designers mindful of telehealth’s role are including designated telemedicine rooms that are fully equipped with technology, as well as agile exam rooms that can be either telemedicine rooms or a physician’s office space.

Prioritizing Emotional Wellness

Particularly in light of a challenging past year, cancer care facilities place an increased emphasis on mental and emotional wellbeing. To maximize patient comfort, designers are incorporating amenities and support functions such as private lounges for patient check-ins in lieu of typical admitting bays, patient education spaces, pharmacies, wellness facilities, massage facilities, and boutiques.

As patients are usually accompanied by family members for longer periods of time, support zones like waiting or work areas, as well as cafes or nutrition zones, ensure their comfort. For patients, options are important—like the ability to choose between a private infusion zone or a community one, where they can exchange information with and derive comfort from other patients. Additional strategies aimed at reducing stress include separating first-time patient consults from ongoing treatment patient consults, providing comfortable gowning areas, and creating program adjacencies that reduce travel distances.

Many studies have reinforced the positive impacts of nature within a healthcare environment, from providing a sense of hope to physically rejuvenating patients. Ample daylight and views to the outside, healing gardens, and programming—like farmers markets, art integration, and cooking classes—can all improve well-being. We applied many of these strategies at  Richard M. Schulze Family Foundation American Cancer Society, Hope Lodge, a “home away from home” for cancer patients undergoing treatment. Here, we designed a beautiful and accessible garden that reinforces nature’s healing properties and natural light. Communal activity rooms promote positive social interaction amongst guests, while spacious suites allow for a private retreat after tiring treatments. Guided by our Precautionary List, we selected natural materials, which contribute to a healthy and inviting environment for all guests.

 

Memorial Sloan Kettering Monmouth Ambulatory Care Center
Middletown, New Jersey
Collaborative HC Space
Harold C. Simmons Radiation Oncology Building, UT Southwestern Medical Center
Dallas, Texas

Creating Collaborative Spaces

Disease-oriented care teams, now standard practice across many facilities, enable a multidisciplinary group of researchers and physicians to collaborate on a focused anatomic cancer area. In the design of cancer care facilities, it has become customary to strategically group physician and staff spaces based on their disease expertise to promote collaboration with other teams. Additionally, designers prioritize spaces that encourage serendipitous collisions amongst care providers, which helps spark innovative approaches to problem-solving. Combined, these strategies facilitate a deeper understanding of the subject matter at hand and open up opportunities to gain insight from other teams’ research and success stories.

New Technology

As in the past, technology is revolutionizing cancer care today. Free mobile apps help patients maintain their goals and confidently make difficult decisions while providing real-time data to providers and researchers. Artificial intelligence and big data are already making their presence felt in the industry. Radiofrequency identification (RFID) sensors are being deployed to track medical supplies and monitor patients. In addition, these can control HVAC settings and customized lighting and music to meet individual patient preferences.

As our ability to analyze data and predict outcomes improves, so too will the treatments and care approaches. Thanks to the advent of 3D printing, researchers can manufacture inexpensive facial prostheses for eye cancer patients who have gone through surgery and even print biodegradable implants to cure bone cancer. 3D printing offers even greater advantages in research and development. Current R&D relies heavily on biological research, which requires spaces to hold test subjects and provide conducive support spaces. Now, tissues can be generated to aid research, greatly reducing the need for animal test subjects in research buildings. The lab may instead offer spaces for housing 3D printers and visualization technology.

 

MR Linac Technology
MR-Linac offers real time imaging and tracking of radiation response in patients.
Image Credit: Nick de la Torre

Newer technologies benefiting cancer care include upright technology, superconducting magnet gantries (reduced footprint of the treatment area), and self-shielded medical equipment that serve as patient treatment vaults (no requirement of concrete shielding). For example, MR-Linacs Radiation therapy cancer treatment combines imaging and radiation therapy on a real-time basis and offers significant advantages over time and efficacy in treating patients.

Gantry
This heavy ion rotating gantry uses superconducting magnets to irradiate patient tumors.
Image Credit: National Institutes for Quantum and Radiological Science and Technology/National Institute of Radiological Sciences
Upright Cancer Care
Upright Particle Therapy provides sophisticated patient positioning system while enabling comfortable treatment positions for patients.
Image Credit: Leo Cancer Center

Looking Ahead at the Future of Cancer Care

The treatment of cancer has been molded by centuries of societal change, scientific research, and technological advancements. And we’ve seen change in just the last year, with COVID-19 forcing facilities to adapt to new methods of reducing in-person contact, such as curbside lab draws and drive-through pharmacies. The opportunities to continue creating innovative solutions within the built environment are endless. As the architects of care facilities, we must be responsive to these shifts, ensuring that our work most effectively supports the work of the incredible doctors and researchers advancing the study of this disease.

Sapna_Bhat_Dallas
Sapna Bhat, RA, LEED AP

Sapna is a Senior Project Manager and Senior Associate in our Dallas studio. With over 19 years of healthcare design experience she has become our resident expert on cancer care design.