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SHOWCASE: Cancer Center Treats the Whole Patient

By Anne A. Bernardini, HarleyEllis

For someone diagnosed with cancer, the personal experience can be expressed in a full range of responses, from devastation, frailty, and bewilderment, to courage, hope, and understanding. The Van Elslander Cancer Center located in Gross Point Woods, MI addresses the spectrum of physical, emotional, and spiritual needs of cancer patients by consolidating comprehensive oncology care in one location.

Given the alarming statistics provided by the American Cancer Society that an estimated 45,800 new cases of cancer would be diagnosed in 2002 in the state of Michigan, the opening of a world-class, patient and family oriented center by St. John Health System of Detroit is reassuring and welcome news.

The three-story Cancer Center-completed in October 2001-exemplifies current advancements in oncology care in an uplifting, healing environment that combines diagnostic, treatment, and support services and state-of-the-art medical technology. Designed by Detroit-based architects and engineers HarleyEllis as a warm and comfortable setting for cancer patients and their families, the 69,000 square foot facility serves as an outpatient facility housing traditional oncology services along with extensive complementary medicine modalities, including aromatherapy, nutrition, massage therapy, herbal treatment, and meditation.

Strategically Consolidating Care

St. John Health System, a large tertiary care provider and part of the Catholic health ministry Ascension Health, has an established emphasis on its oncology care services. But clinical departments were dispersed and fragmented in the Detroit area, causing patients the inconvenience of making separate appointments and traveling to different areas of the hospital.

"The basic goal in this facility was to pull together a number of services in patient cancer care modalities and have them all under one roof," explains Dimitris E. Bitzarakis, PE, director of St. John Health System's Design and Construction Services. "In addition to the standard types of diagnosis and treatment, we also wanted to address the whole person-not just the medical condition, but also the psychological and mental state."

Five In One

The specialties and offerings of each of the five centers within the Van Elslander reflect the variety and depth of programs. The Liggett Breast Center provides education, early detection, risk factor information, screening, and treatment options.

The Meade Pediatric Hematology Oncology Center serves children from birth to age 21, providing multidisciplinary cancer diagnosis and treatment. The Healing Arts Center features services to strengthen the spirit including massage, reflexology, meditation, yoga, music therapy, and holistic assessment.

The Cracchiolo Radiation Center offers state-of-the-art treatment options through two linear accelerators with photon, electron, and dose intensity modulating treatment capabilities, a CT scanner, and radiation physics equipment. The Infusion Center is an open, airy, and reassuring space for patients undergoing treatment.

"We always had a good oncology program, but we felt we could do even better. We needed to address capacity constraints, as well as recognize the growing importance of cancer care and its inevitable increase in the future," notes Bitzarakis. "The consolidation places convenience and comprehensiveness in one location. Patient anxiety is minimized when one visit addresses a number of different aspects of diagnosis and treatment."

"One of the key indicators of quality oncology services is multidisciplinary care. The design of our building has allowed clinicians and staff to reach our goal of multidisciplinary care for patients," observes Donna Handley, administrative director of Oncology Services at the Van Elslander. "Center Physicians are able to collaborate with one another. To be able to visit three physicians in one day, and have lab work done on the same floor as appointments, is significant."

Blending the Art and Science of Healing

The design of the Van Elslander Cancer Center recognizes the total needs of a patient and balances them with the complex needs of technology. The design team sought to create a place that upholds the dignity and self-respect of the patient. But they also needed to accommodate highly specialized equipment, engineering systems, and operational efficiencies. The combination of both distinct sets of requirements in one environment.

The art of design creates a setting that allows for active participation of the patient, control over their immediate environment, and a supportive sense of community. Through the science of design, the team incorporated an effective and flexible response to medical technology and inevitable change.

A Caring Environment

Patients and families are welcomed by an identifiable and gracious entrance canopy. Arriving within the rich-toned interior cylindrical lobby, patients are greeted to a warm, open space filled with abundant natural light and comfortable seating. Patients are directed to the Center's first floor for an express lab area and radiographic services for diagnostic use prior to treatment, and a radiation therapy unit.

On the second floor, pediatric services incorporate a "village" theme with park area, town square, and streetscape. Adult outpatient infusion and private practices are also found on the second level-a grouping that promotes the Center's approach to seamless patient care.

The focus of the third floor is a life enhancement center that includes integrated alternative medicine methods such as aromatherapy, mineral baths, yoga, nutrition, t'chi, and an information and resource area with Internet service. The comprehensive Breast Center, medical and surgical oncology practice, time share/gynecological suite, and conferencing facilities fill out this top level.

Coinciding with the Center's holistic service offerings, a healing garden and labyrinth walk were designed as a place for meditation and relaxation. It features the 22' Santa Rosa Labyrinth, based on a pattern created by Lea Goode in 1997 for the Angela Center in Santa Rosa, CA. The Santa Rosa is modern labyrinth incorporating seven circuits, or concentric paths, with a "heart-space" on the fourth path approachable from four directions. The labyrinth is framed in an octagon, reminiscent of baptismal fonts symbolizing rebirth. It is constructed with concrete unit paver bricks and a bronze dedication plaque placed in the center.

Landscape architect and site designer Debra J. Axelrood, ASLA, associate at HarleyEllis, explains, "The ancient ritual of walking a labyrinth has experienced a resurgence in popularity in recent years. It is thought to relax the logical, reasoning side of the mind while enhancing spiritual mind/body healing."

Bitzarakis describes the quality of the Center, "A major emphasis of our facilities is to make the patient and family as comfortable as possible. The spaces are soothing and relaxing. We have tried within the limitations of an urban site to improve views and create green space around the facility. The choice of materials, lines, and lighting help create softer common spaces."

Handley also sees the effect of humanized space and operational efficiencies on a day-to-day basis. "The facility is so beautiful and patient oriented, it is immediately soothing and appealing. The design of our pediatric area, for example, is fantastic, and has done so very much for the children. The children feel like the space is their space. Parents stay with them, physicians come to them, music therapists come in to provide distraction and therapy."

A Flexible Infrastructure

"Creating a comprehensive Cancer Center required not only the high quality aesthetic elements of a healing environment, but also the engineering infrastructure and technological backbone to accommodate sophisticated equipment and the rapid change of this complex medical specialty," states Daniel Caren, AIA, project manager, HarleyEllis. "Accomplishing this within a $17,750,000 budget added to the already unique challenge. In order to meet the allocated budget, and not reduce the programmed space, we eliminated the basement and positioned mechanical ventilation equipment on the rooftop."

Caren also explained that they implemented features to add to future expansion as well. Bridges can be connected to the the adjacent parking deck and new medical office buildings.

A constant volume reheat system, controlled by state-of-the-art Johnson Controls Metasys direct digital control, met criteria of cost, flexibility for future expansion, patient and staff comfort, ease of operation and energy efficiency. Two efficient, gas fired, flexible tube hot water boilers are sized for both initial and potential expanded building heating loads.

Air is distributed by two roof mounted air handling units with supply fan, return fan, direct expansion cooling system, and filters. Because the building is designed for future vertical expansion of two additional floors, main supply and return trunk riser ducts were capped above the roof. HVAC units can be installed on a newly constructed roof with ductwork connected to the existing system without taking the existing air handling units out of service. The existing air handling equipment can then be demolished after the new systems are up and running.

Patient Consideration

Concern for patient comfort was paramount in the selection of mechanical systems. Slightly higher than normal temperatures and finer controlled areas address the susceptibility patients undergoing treatment and therapy have to temperature extremes, particularly cooler temperatures. Hot water radiant ceiling panels at infusion stations along the exterior wall are controlled by simple electric twist timers, allowing each patient undergoing chemotherapy infusion to adjust heat as desired at the infusion chair. In consideration of the tendency for patients undergoing chemotherapy to experience nausea and react to odors, special effort was also made to keep the building very well ventilated, with any food preparation areas having exhaust to the outdoors.

Local humidification was provided to areas containing humidity sensitive equipment such as the linear accelerator vaults, and digital ultrasound rooms. A special glycol process cooling system with city water back-up was provided for cooling the linear accelerators.

Linear accelerator vaults protect people from radiation during chemotherapy. Because in most radiation room settings, traditional doors are not radiation resistant, patients and medical personnel must go through a maze before reaching the actual treatment space. At Van Elslander, HarleyEllis assembled two lead composite masonry "mazeless" vaults. Here the doors are sliding and provide direct entry from the outside to inside the treatment area. The new technology of the vault doors required less square footage and the ability to dismantle the vaults in the future.

"Here at the Center, we talk a great deal about why patients choose a program or a facility. When a person is diagnosed with cancer, they want the very best, states Handley. "We are able to provide that in a building like ours and through programs like ours. The design team worked well with our clinical staff, bringing their expertise, patience, and understanding."

Bringing together five individual treatment areas to the Van Elslander Cancer Center allows patients to get the significant medical services in one facility and creates a convenient, cohesive, convalescent environment.