How’d I’d design a cancer center, from an oncologist

People coming in and out of a cancer center are experiencing extreme and often divergent emotions. Newcomers are inevitably anxious, potentially disassociating, and leaving with either the worst news of their life or possibly euphoric relief.

For the veterans, they are used to the environment but spend so much time as to sacrifice normative and pleasurable routine parts of their lives. Their variability of visits range from routine check-ins, to getting good or bad news from scans, to a long day of treatment leading to a week of fatigue, nausea, and pain.

The people that work in a cancer center have challenges. Spending up to 40 hours a week adjacent to extreme feelings and high stakes creates intensity and juxtaposition; an interplay between regular life stress and conscious or unconscious existential considerations about death and dying.

As for caregivers and loved ones, the sentiments and needs will run the gamut. Firmly sandwiched in the reality of various life roles, they may be missing a work deadline or a rushing to pick a kid up from school.

We have some in complete fight of flight, some relieved and joyous with a new perspective on the importance of love and life. Others are thinking about lunch or scrolling TikTok. It’s safe to say most people would rather be somewhere else.

Waiting rooms would not have TVs or loud music, rather soft white noise or calming nature sounds. Color palette would focus on cool and healing blues and greens. Circulating staff would be armed with information and updates, all patients would know what the next step in the triage process was- who and what they were waiting on at a given moment. No one would worry that a trip to the bathroom could lead to missing the call to go back to see the doctor.

Small spaces would be tucked amidst waiting and treatment areas, so people could have private conversations, moments to collect their thoughts or find buffer temporarily before going back into public. Sleep and work pods with sound proofing would be available for caregivers or those with long treatments, serial procedures, or hours of long monitoring for clinical trials.

Healthy food and snacks would be available and free or at subsidized cost (pharma would be an excellent partner to subsidize healthy food and snacks in a cancer center). Water stations, electrolyte powders, smoothies, juices would be available at every treatment area. Cafeterias or and kiosks would offer wraps, sandwiches, bowls, soups. Snacks like nights and fruit would be passed around as would good quality coffee and tea.

Warm blankets and eye coverings would be available in treatment, along with individuals offering aromatherapy, guided meditation and hand/foot massage…(we train nurses to do this as a part of our Integrative Oncology Nurse Ambassador program).

A gift shop selling soft throws, pillows, cards, and other kindnesses would be available for patients who want a pick me up or caregivers who need a way to say what can’t always easily be said, I love you, I’m sorry, I wish this wasn’t happening.

There would be space to meaningful support and sustain lifestyle change before, during, or after a cancer diagnosis. Having this within the cancer center would underscore its importance and promote it from “value add” to non-negotiable. (This is what we hope for with our Wellness and Integrative Oncology program).

A functional gym with availability of individual exercise therapists to advise and on-ramp patients to exercise on their own terms. Counseling about nutrition that goes beyond “just get in calories” and establishes that obesity as a risk factor for cancer. Services for integrative modalities like acupuncture and yoga, also cost subsidized, so that people have options beyond medications to manage side effects and to create ownership and agency within their own bodies.

Tools to process, track, and organize information would be a part of the cancer center. Data stations to suggest apps for tracking, to provide appointment summaries, double check that next appointments are in patient portals and calendars and provide tools to remind patients who to call if things go wrong. Clarity around the care team, who is the nurse, nurse practitioner, what are the off hours and where do calls get routed, which hospital to go to and how to quickly provide information so that new team knows what is. Electronic medical records and patient apps should do this but there are reasons these fail and those that are not digitally savvy. Safety nets to provide clarity in various ways should be the punctuation at the end of a visit.

And on exit, those same smiling faces should be back. To get the car, to offer a bottle of water for the road to make sure you didn’t forget your phone, your sweater and to say, “see you next time.”