Oncology advancements will rapidly accelerate over the next 10 years - changing the cancer center landscape

Forecasted demand for cancer care over the next five to ten years will severely test the healthcare industry’s ability to deliver comprehensive care and services to this growing population (see below)¹. Healthcare leaders are finding that their organizations often lack the physical capacity to care for the growing demand. Furthermore, prevention, diagnostics and therapeutic capabilities are evolving at an increasingly rapid speed (e.g., immunotherapy, theranostics, CAR-T, CRISPR, Cryo-EM), where providers are finding that not only are they lacking capacity but the right capacity. It is expected this unprecedented innovation and advancement curve will dramatically shift the paradigm of cancer care in the next 5 -10 years. Providers are looking to make significant investments and build facilities to accommodate demand, but there is inherent difficulty in building for the future when we cannot predict what the care demand and delivery will look like in a decade due to these transformative advancements. “We (healthcare providers) are designing Swiss watches when we need to design a Swiss-army knife. We cannot over design and need to be able to quickly and thoughtfully pivot and flex as care, therapeutics, and technology change” says Dr. Manuel Hernandez, Vizient Principal, Strategic Campus Planning.

Projected Rise in the Incidence of Cancer Diagnosis (2020-2040)¹

• Increase by 29.5% from 1.86 million to 2.4 million cases

• Outpaces projected US population growth by 12.3%

• Patients >65 years old will make up 82% of all new cancer diagnoses

• Cancer diagnoses are projected to increase in racial monitory groups, with a projected 44% increase for Black Americans and 86% for Hispanic Americans

A successful design begins with a series of guiding questions leaders need to answer. Some examples include: 

• Who do you want to be to your community and to your patients?

• How will you differentiate in your market? How will this impact your center design? What will make patients want to come to you and providers want to work with you?

• What is your program’s identity in cancer care? Is your philosophy rooted in prevention or is it reactive? It will be impossible to be everything to every patient.

• What are your cancer program capabilities and how do they align with future trends in care delivery? Are there opportunities to grow and expand competencies?

• Will the center serve as the sole location for all oncology care, or will it serve as a hub with outlying sites bringing selected care closer to patients?

• Will the center operate alone or as part of a larger network to offer patients access to services beyond its scope or capabilities?

• What steps can be taken today to anticipate for the years ahead?

• How should facility design accommodate for potential growth and expansion?

• What are your goals for addressing health equity in your community (e.g., access, affordability, and convenience)? How does this impact your care delivery?

These and other considerations will provide the foundation for cancer center design activities. 

To successfully navigate opportunities and risks associated with this complex and costly undertaking, we recommend health system leaders focus attention on three areas that will significantly influence facility design, including the Care Centric Setting, Medical Practice Model, and Enabling Technologies & Services. 

Care Setting
- Bring care to the patient
- Balancing care and lifecycle
- Effects of nature
- Collaboration

Medical Practice Model
- Precision care
- Access to care
- Integrated care
- Survivorship
- Shared Learnings

Enabling Technologies & Services
- Acquisition Timing & Staging
- Ongoing Technology Advancements
- Space & Placement Considerations
- Enabling Remote Care
- Pharmacy

Care-Centric Setting

The details of planning and designing cancer care facilities – the physical space, the social systems, the clinical and nonclinical workflows, and the patient-facing services – directly influence patient 
experience and outcomes. Cancer facilities should be conceived and constructed with evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. 

Facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control and support, streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness. The design should be tailored to your patients. From conception to completion, institutions can make their facilities reflect the excellence in cancer care that they aim to deliver to patients.⁷

Considerations & Insights:
Bringing Care to the Patient: The Fred Hutchinson Cancer Center is designed to create an experience that embodies hope. The design team spent hours designing a facility layout that delivers care to the patient in their room rather than having to negotiate moving from department to department for treatment. They merged patient and family needs with staff requirements to effectively treat patients. Everything happens in the same room. It is the patient’s home for the day. 

Collaboration: Cancer care will not be confined to a singular location, but instead teams of health providers working under one network, or through collaborative arrangements, will provide care.⁸ Consideration should be given to identifying key adjacencies for an integrated practice unit. Further, most oncologists agree that future of cancer care is precise and personalized combination therapies – making collaboration paramount. Creating a flexible infrastructure, including whiteboards, smart screens, and shared offices and workspaces enables multidisciplinary teams to interact and design an optimal treatment plan for each patient. 

Balance Care and Lifestyle: Build based on the needs of the community you serve. For example, the right balance of “privacy and openness” will differ based on your community. While patients commonly enjoy building relationships and finding support in infusion rooms, there are some cultures and individual patients who want privacy. In Veteran Affairs (VA) facilities, patients often find camaraderie essential.

Effects of Nature: Embracing nature’s healing properties, the Scully-Welsh Cancer Center at the Cleveland Clinic Indian River Hospital designed their center to ensure that all patient treatment and public areas have access to nature. The main lobby, dining, and relaxation areas provide visual and physical connections to the gardens. 

Shaping the Medical Practice Model

There is tremendous variability in the scope and scale of oncology services offered, with each program possessing unique features and capabilities. The emergence of personalized, precision cancer medicine is giving rise to new and complimentary care models which in turn has “implications for the procurement and organization of resources, including facilities and space, to provide the most appropriate and state of the art cancer care.”²  The ability to rapidly and accurately diagnose patients and reduce time to treatment tailored to the patient will be paramount in the competitive landscape of cancer care. Organizations planning a cancer center must be prepared to address leading and emerging oncology practice models.

Considerations & Insights:
Access to Care: Research suggests that there are poorer survival rates among patients who live further from tertiary treatment centers, making access a core issue.³ The National Cancer Institute recommends a hub and spoke model based on three components: research bases, community sites, and minority/underserved sites.⁴ Design considerations should include a strategic master plan to locate the services and advanced care as close to patients as possible. 

Survivorship: Cancer as a chronic disease with survivorship for all cancers now exceeds 69%.⁶ Survivorship can take many paths, including complete eradication, late complications of treatment, late recurrence, and secondary cancer development. It is critical that facility design of cancer centers considers both acute and chronic cancer care.

Clinical Trials: With the rapid proliferation of new cancer drug therapies, the need for clinical trials and patient participants is growing as well. Forward-thinking facility leaders are creating space to house clinical trials, and according to the architectural consulting firm HDR, centers positioned to partner with pharmaceutical and medical device companies for clinical trials can realize significant revenue from these collaborations.

Shared Learnings: Rapidly integrating research learnings, evidence-based improvements, and shared expertise in diagnostics and treatment improves care quality, value, and outcomes. Accessing national and global information requires a robust health IT system, network capabilities, and virtual communications technology that support interaction among multi-disciplinary teams, facilities, and community and industry organizations.

Enabling Technologies

As medical practice models continue to evolve, technology enables providers to give cutting-edge, consistent, and quality care to patients. For example, molecular imaging is in the midst of a renaissance as recent advancements allow providers to visualize cancer cells from detection and diagnosis to treatment and monitoring. 

When it comes to the selection and acquisition of cancer center imaging technology, healthcare providers should weigh several factors, including the type and complexity of cancers being treated, forecasted volume growth and capacity needs, space requirements, community resources, and cost. Organizational leaders should collaborate closely with their providers and clinicians to chart a technology roadmap that aligns with the clinical focus, planned growth, and needs of the patient population it will serve. 

Considerations & Insights:
Acquisition Staging & Timing: Diagnostic (such as imaging) and treatment technology acquisition requires significant upfront planning to assess both current and projected future needs. Center leadership should be forward thinking regarding the timing and staging of equipment acquisition and align purchases to forecasted volume growth. This will optimize technology utilization as well as fund acquisitions in part with revenues generated through that utilization. 

Space & Placement Planning: Over the life of the center, an organization will acquire new or upgraded equipment to meet the demands of the program. The design plan should include the construction of shell space(s) and appropriate cable drops to accommodate additional equipment and avoid potentially costly and disruptive construction activities in the future. Designers should also consider building out retractable walls and designing hallways, corridors, and receiving areas to minimize future reconstruction costs. Additionally, planners should consider placing large, heavy equipment at ground level and around the perimeter of the building to ease placement of both new and replacement equipment in the future.

Equipment Selection: Not all equipment is created equal. Consider equipment selections that minimize replacement requirements and allow for upgrades, which are often less disruptive and costly. For example, some MRI systems (including GE HealthCare’s MRI systems) can be in-field upgraded around an existing magnet – eliminating the demolition to remove and the reconstruction after bringing in a new magnet. A robust software upgrade program may also reduce the need for or frequency of physical upgrades or replacements.

Specialty Pharmacy: With the growth of specialty oncology drugs, pharmaceutical facilities are an important consideration. Whether you decide to create an onsite compounding pharmacy or simply draw doses, consider the right space and location to provide services and allow Oncology and Hematology Pharmacists to be an integral part of the care team. 

Enabling Remote Care: As previously discussed, treating patients “where they are” is an important feature in care delivery. Leaders should implement the necessary technology infrastructure to support telemedicine, remote patient monitoring, and other virtual connectivity requirements. 

Additional Center Design Considerations

Well-designed cancer centers incorporate features, in addition to those above, that enhance the care delivery experience of its patients, family members, and staff. Providing information and education resources, wellness and nutritional services, and other amenities are essential elements in caring for patients during their treatment, recovery, and beyond. 

Considerations & Insights:
Learning Centers: Many facilities provide patients, staff, and the public with educational and research materials on a range of oncology care topics, including standard and alternative treatment therapies, family support, nutrition, survivorship, and others. Staff are often available at these centers to assist patients and the public to navigate these resources. 

Retail Outlets: Patients undergoing cancer treatment often experience significant changes to their physical appearance, and the availability of cosmetic and prosthetic products can ease the impact of those changes. The Dana-Farber Cancer Institute in Boston features the “Friends Place” retail shop where patients can purchase a range of products to enhance their physical appearance during and following treatment. 

Staff Respite: Delivering care to cancer patients is physically and emotionally demanding work. Leading healthcare facility architects recommend designing respite areas for providers and nurses that contain biophilic features, comfortable furnishings, warm and calm lighting, and other amenities that provide a welcoming and comfortable setting for staff to relax and refresh. 

Navigating the Center Design Phase

Based on current industry standards, the completion of a new cancer center may take up to five years, with planning and design activities requiring at least two years to complete. It is imperative that the facility planning and design process is conducted in a thoughtful and intentional manner, as it will be likely be a home for your community’s cancer care for the next 20-30 years.

Organizational leaders involved with planning and design oversight should consider the following principles that successful cancer center leadership have adopted in their planning and design process. 

1. Form a steering committee whose responsibilities will include overseeing planning and design activities as well as ensuring that project timelines and milestones are well-defined, are effectively communicated, achieve agreed-to outcomes, and are completed within budget. 

2. Ensure participation and engagement with the right stakeholders. These should include cancer patients and their families, community voices, organizational leadership, care providers, nurses, and technicians who can provide valuable insights and recommendations into the facility design based on their care experience. Stakeholders should be engaged through all phases of center design, including visits to established cancer centers that can provide the group with insights into best practices. 

3. Consider acquiring space and modular building materials during this phase to mock-up floor layout, patient and family treatment rooms, technology rooms, and other spaces to test flows and experiences.

4. Anticipate the future program needs and select a physical site that will accommodate future growth.

Conclusion

A well-designed cancer center seamlessly integrates patient care and technologies in a care-centric fashion to achieve a high level of patient, provider, and staff satisfaction, and efficient patient navigation and workflow processes that result in the best possible patient outcomes. It requires a forward-looking vision that anticipates the everchanging oncology care landscape and fosters a design approach among leaders, providers, staff, and patients that adapts to those changes to successfully accommodate new treatments and technologies as they move into the future.

 

References
1. Predicting future cancer incidence by Age, Race, Ethnicity, and Sex, Garner, Smith Ludmir, et al., Journal of Geriatric Oncology, January 2023 
2. Systematic Review of Emerging Models of Cancer Care Implications for the Health Industry, Journal of Integrative Oncology, July 2017. 
3. Chambers SK, Meng X, Youl P, Aitken J, Dunn J, et al. (2012) A five-year prospective study of quality of life after colorectal cancer. Qual Life Res 21: 1551-1564 
4. National Cancer Institute Community Oncology Research Program: NCORP Structure (2016) National Cancer Institute. 
5. Kash B, McKahan M, Mack S, Nanda U (2017) Systematic Review of Emerging Models of Cancer Care: Implications for the Health Industry. J Integr Oncol 6: 196. 
6. Cancer Facts & Figures (2016) American Cancer Society 
7. Leonard L. Berry, PhD, MBA et al., “Using Evidence to Design Cancer Facilities,” American College of Medical Quality: (2020) 1-8 
8. Michael Roughan, “10 Developments Driving the Fundamental Shift in Cancer Center Design”, HDR, January 3, 2022