The Art and Science of Hope: Transforming the Future of Cancer Care.

On the 1-2 February 2023 at The New Spine Building, Liverpool, The Royal College of Physicians, and Salus TV held “The Cancer Care by Design, International Symposium”. The Art and Science of Hope: Transforming the Future of Care.

Dr Robert G MacDonald was supported by the ARC NWC to virtually attend and report about the Symposium as a Public Advisor. This blog account has been aided by Sian Cunningham, Darren Charles, Mark Gabbay, Ruth Ball and Selina Wallis of The ARC NWC and was inspired by the writings and influence of Professor Dr John Ashton and Beatrice Frankel. (However, all my own personal ‘none specialist’ Public Advisor opinions are mine).

The Symposium was an important opportunity to explore and share international and local knowledge on the future design and development of cancer care facilities, services, technology and environmental design.

What is Cancer ?
Cancer is the second leading cause of death globally, accounting for more than 19 million cases and almost 10 million deaths in 2020. Thousands of children develop Cancer each year at great cost to all health services. The burden of the illness falls heavily on society at every level, impacting individuals, families, communities and public health systems.

My own Mother died of Cancer and for me the whole Symposium became a personal learning process. I kept asking myself what is Cancer ? My mother’s Cancer started behind her right eye and rapidly spread through her whole body (metastasis). Unfortunately, the medical profession never really explained to my mother or I what and why the Cancer had developed and spread so quickly. We were kept in the dark too the very end and as Maggie Keswick Jencks said doctors are not very good (or trained) at passing on bad news. Cancer is the disease that most of us fear as any other and my Mum screamed down the phone in terror at the news. Awareness of Cancer changed in the twentieth century and between 1900 and 1940, Cancer jumped from eighth place to second place ( just behind heart disease) as a cause of death and it has cast a long shadow over our perceptions ever since. Half of men over sixty and three quarters over seventy, for instance, have prostate Cancer at death without even being aware of it.

The Spine Building: The venue of The Symposium was The New Royal College of Physicians Spine building. It prompts the question, can Good buildings, such as The Spine, positively help improve wellbeing and patient experiences ? Does the surrounding built and green environment play its role in stimulating and helping the healing process. It was encouraging to see that all the recently designed healthcare facilities presented considered more than just the diagnostics and treatment of Cancer through medical technology and equipment. Importantly, they also gave us Hope through design.

Underpinning the Symposium was the question how can we learn to design new Cancer care facilities based on International experience, local knowledge and from those people actually experiencing Cancer. It seems more and more people are talking about their experience of Cancer and The Symposium was a clear indication of such Public awareness.
Globally, large numbers of people are dying with Cancer, or “The Big C” as John Wayne once called the stigma. Some people, such as Maggie Keswick Jencks responded to her living experience and established a substantial charitable trust fund to design and build many therapeutic and beautiful new “Maggies” Cancer care facilities. The father of Haydn Robert’s, Adam wrote The Book “Nineteen Insights Learned from a 19 Year Old with Cancer “ about his son whose short life profoundly changed all around him. The Symposium was very well connected with Internet voices and experiences including people living with Throat and Neck and oesophageal Cancers.

This symposium showed me that more design Information, knowledge and education about the disease is vital. At Aintree Liverpool University Hospital the reception is next to the coffee shop and there are shelves full of really useful MacMillan informative green and blue guides about Cancer Support. We can find out that our cells are tiny building blocks that make up the body’s organs and tissues. Sometimes signals within our body tell our cells to grow and when to divide to make new cells; this is how our our bodies grow and heal. These cells become damaged or are no longer needed. When this happens, the cell gets a signal from the body to stop working and die. Sometimes, these signals can go wrong and the cell becomes abnormal. The abnormal cell may keep dividing to make more and more abnormal cells. These can form a lump, called a tumour. Not all tumours are Cancer but doctors can tell if a tumour is Cancer by taking a biopsy and my Mother was sent for a revealing biopsy at a large general hospital. Sadly, she returned home without any more understanding of the bad news about her tumour.

Speaking as an ARC NWC Public Advisor and an Architect the question for me for was what kind of lives do people experiencing Cancer want to live during their remaining days ? Can the design of architecture, interior design, green public space and private balcony gardens help people living with Cancer ? In other words, does design actually matter and can physical design improve “shorter lives for the better ? “ Can helpful living greenery, healthy plants and a variety of trees be brought into the heart and core of a Cancer Care facility ? It seems to me that sitting and chatting in the spring, winter, autumn or summer sunshine is beneficial for most of us ?The Symposium demonstrated to me that the quality of clinical care and the patient experience can actually be enhanced through innovation in better design and planning of Cancer care facilities.

There were a number of really well demonstrated and visually illustrated case studies represented buildings at the Cancer Care by Design Symposium. From the patients perspective Natural Daylight is vital in Cancer care buildings and in all the new buildings designing in daylight is important. Guys Cancer Centre in London Is by AECOM and is a collaborative team smart response therapeutic design. It sets out to lift the building out of the ground and brings Cancer design “into the light” beyond the basement or the ‘dungeons’ of the building, our positive Lived Experiences tell us all that daylight and sunlight are important and uplifting.

Getting Natural light inside a Cancer Care Radiotherapy radiology treatment room is a good design idea and objective. The new cross sectional atrium of The New Clatter bridge successful facility is all about getting light down into the darkness.

At The Liverpool University Hospital Aintree The Radiology Scan Suite is hidden in a secret box and perhaps the inner waiting room could be more inspiring ? This does not need to be so uninspiring, for example this space could be designed to be less clinical by using sunshine yellow, verdant green and sky blue surfaces and more indoor plants that can survive indoors. The seating does not need to be noisy metallic or cold metal but perhaps natural wood with warmer textile finishes. The floor and small tables could be natural and the ceiling could even be sky blue. The doors and surrounding frames might be proper and door signs need not be chrome or stainless steel. At Aintree University Hospital there are many internal courtyards along the very long corridors with some wonderful new bedding plants, wooden benches and trees but unfortunately the access doors are firmly locked most of the time.

The eleven story Clatter-bridge Cancer Care Centre, designed by BDP is attached to the New Royal Hospital Liverpool and it steps back with a series of accessible balconies overlooking the Liverpool skyline. The balconies allow day light to penetrate the internal spaces and rooms.

There are now many small Maggies Cancer Care buildings including The Maggies which is on the Wirral, Merseyside and this natural brick facility was privately funded and inspired by The Morgan Foundation.

Maggies Visionary Experiences of Design for Cancer Care are the origin of Maggie’s Cancer Care Facilities and for me are probably the most special and well developed series of unique, sensitive and responsive cancer care facilities in Europe. Before passing on, due to Cancer, Maggie Keswick Jencks wrote her seminal and now inspirational “A View from the Front Line”. When Maggie spoke from her Lived experience she said “ Waiting areas can finish you off.” Large General hospitals are just not patient friendly. Illness shrinks the patients confidence and arriving at a huge hospital can be a time of unnecessary anxiety. Just finding your way around hospitals can be exhausting. Unfortunately the NHS has to be obsessed with cutting time waiting but waiting in itself in itself is not so bad- it’s the under designed environments in that count.

Overhead (sometimes) even neon lighting, interior spaces with no views out and miserable seating against walls all contribute to extreme mental and physical stress. Patients might arrive with hope but soon they start to wilt.

The Maggies Facilities create positive use of their special environments. Sitting in a pleasant, but by by no means expensive room, with thoughtful lighting, a view out to trees or up to the sky, bird sounds, soft chairs and sofas arranged in more domestic groupings can be an opportunity for patients to relax and talk, away from home worries and cares.

Perhaps even an ‘old fashioned ladies room’ is a more domestic and none clinical model – not partitioned toilets in a row ( it seems to me that general hospital toilets are far too hot and narrow ) but with their own hand basins and a proper doors in a frame- privacy spaces for crying, water for washing the face and even showers that actually function with correct body temperatures that are user friendly, mirrors for facing the outside world again. There could be a tea or coffee machine including herbal teas and while waiting a small cancer care library with reading booklets. A bowl of fruit and a vase of fresh flowers can uplift the spirits.

The usual GP reception has mostly clinical information and a TV but perhaps something to cheer waiting up and on a video laughter library might be “Anatomy of an Illness”, which makes a good case for laughter not only as escape but as a therapy to relax the patient whilst waiting.

At the moment, our Lived Experiences suggest that many clinical hospital environments say too the patient, in effect ‘How you feel is unimportant, You are not of value, Fit in with us, not with you,’ Maggie said with very little effort and money this could be changed to something like: Welcome ! and try not too worry. We are here to reassure you, and your treatment will be good and helpful to you. Why shouldn’t patients use creative time spent at a hospital?

My own lived personal experiences of Bi-Polar and visiting The Royal College of Surgeons, Physic Gardens with Prof Dr John Ashton, Finsbury Health Centre and the Peckham Pioneering Health Centre and The Maggies Charring Cross in London were all spiritually uplifting. These projects have all the ingredients of Maggies visions. Healthy hopeful architecture should be an art in its own right and not just paintings on a long corridor wall.

Charring Cross Maggie’s was designed by a proven and excellent team collaborative practice of architects (Sir Richard Rogers and others ). The plan is a perfect square, it’s a cheerful Mediterranean orange painted building that floats on a sea of lavender. A suspended roof lets light into the heart of the square and at the centre there is a kitchen table with tea mugs and a kettle. A welcoming place to make a drink, talk publicly or in private rooms. Comfy chairs with garden views and window seats sponsored by The George Harrison Family.

At the International Symposium there were high profile Professorial presentations about oncology in The Hebrew University School of Medicine Isreal; Science and The Community University of Liverpool and The Architecture of Hope at the Maggies UK. Other international project exemplars were from The New Calgary Cancer Centre and The Integrated Oncology Centre of The University Hospital of Liege Belgium.

If we want to see how far Cancer Therapies, Design for Hope and Care have come in recent years, we can visit the new Princess Maxima Centre in Utrecht or Alder Hay Childrens Hospital in Liverpool. Princess Maxima Centre is the largest childrens Cancer hospital in Europe and is a combination of several University hospitals.

Alder Hey Hospital was actually co-designed by a Childrens Design Panel, chaired by a young architectural student Jack Hutton. The artist Lucy Casson designed and made a wonderful collection of creatures and birds all roosting around the waiting atrium space. In the Childrens anaesthetic waiting space there is a large digital wall mounted fish tank. The corridor walls are painted with farm animals and the children can actually hear their recorded sounds. After an anaesthetic and procedure the children return to meet their family and friends for a meal or breakfast of cornflakes !
Cancer and Complementary Therapies:-
Are complementary therapies relevant and available to people Living with Cancer ? Are they safe ? Do they actually help and what kind of environments are the best therapeutic places for Complementary treatments ? Generally, Conventional medical treatments are given or delivered in clinical white medical spaces such as operation theatres, surgeries, radiotherapy, chemotherapy, hormonal therapies and directional targeted clinical spaces. Whilst these treatments, cannot cure a Cancer they often help people live longer and reduce their symptoms. During their extended life time people might choose to use additional complementary treatments.

People can choose to use complementary therapies if available with, or as well as, conventional medical treatments. Complementary therapies might improve physical, mental or emotional health whilst Living with Cancer. Some patients have said that complementary therapies help them to manage the physical side effects of Cancer. The patient might feel better and have an improved quality of life, feel less stressed, tense and anxious, keep better, cope with symptoms and cope with some side effects.

Some complementary therapies can be done as part of a group and this can be a very good way to meet people with similar Living Cancer Experiences and in a positive Lived Environment. There are Mind Body therapies that are part of support for people with Cancer. These might involve relaxation, meditation, hypnotherapy, art therapy, musical therapy, The Alternative Gerson Diets and movement such as tai chi and yoga. There are now Apps and CDs for use in groups or individually in the domestic environment. Some patients recommend art therapy groups because it doesn’t matter if you can draw or not. The designed environment, such as MerseyCare “Life Rooms” are really good because they are like being a child again, the participant can do what they like and create whatever they want to…

Dr Robert G MacDonald Public Advisor, ARC NWC.