Cancer Centers:
A Look at Environmental Issues and Patient Needs

J. Mark Smith, MBA, Assoc. AIA
Vice President
Easter & Mason Healthcare Consulting Corporation
Nashville

The cancer center varies in its scope, from a specialty center for specific treatment or diagnosis to the "comprehensive cancer center" designated by the National Cancer Institute. In most cancer facilities, regardless of scope, the physical environment is very much governed by high-technology equipment. Often the equipment costs more than the architecture, and the facility serves as a "box" to hold the "guts" that are most important to patient care.

The cost-control factor combined with traditional modes of thinking about the clinical environment have resulted in a nightmare for patient comfort and peace of mind. Sufficient evidence indicates that anxiety, fear, and stress actually inhibit the patient's capacity to be cured, while positive visualization and relaxation enhance the treatment process. Stress may be subliminal to the patient, a product of unspoken environmental cues that create anxiety. The staff may be conditioned to create stress for the patient by mirroring these cues of the environment. Now that "cure rates" are relatively established in cancer care, such environmental factors need more attention.

Almost as an afterthought, the fish tank in the soft-textured waiting room and a chapel or meditation room have been added on to some centers. The best solutions to creating the therapeutic environment would go deeper. This study reviews current trends to "humanize" the cancer center. We will also explore physical issues at cancer centers.

The cancer patient is often sensitive to physical conditions around him: sights, smells, pedestrian traffic, light, and noise. Harsh or strong smells such as popcorn or fresh-cooked food can be nauseating to patients under chemotherapy. Strong lights are painful to the eyes of patients lying on a gurney or bed and gazing at the ceiling.

Furthermore, environmental factors of building infrastructure, safety, and air quality present obstacles to patient success and effective maintenance and operations at the hospital facility. The physical plant infrastructure and building issues will be addressed also, as these have a major impact on health programs and the well-being of patients, visitors, and staff.

Erle Janssen is Director of Environmental Health and Safety (EHS) at the University of Texas and was formerly Director of EHS at the University of Texas M. D. Anderson Cancer Center (1984-1998). He indicated that comprehensive cancer centers are unique because of "the diverse nature of programmatic areas integrated into one facility." Programs include patient care, research, education, and cancer prevention. Each program has different needs and desires and therefore different priorities related to physical plant and safety issues. For example, a research laboratory would not be placed next to a patient care area because flammable liquids could not be used in the lab. Certain laboratory procedures would be restricted, as would storage and use of hazardous chemicals.

Different programs should not be required to compete for the same space. This issue relates to the layout, the proximities, and the adjacencies of programs and their respective departments.

Obviously, the large healthcare facility such as a cancer center should be patient oriented. Wayfinding should be developed in the initial planning stages, not after the facility is already built. Corridors should be straight and free of convolutions. Planners and hospital staff should consider how the patients move through the facility and interact with the staff and the environment. In the multidisciplinary setting of the cancer center, the concept of "one-stop shopping" should be planned and designed for the patient. Therefore, program and department proximities should be carefully "stacked and blocked."