The complexity of cancer care
Everyone is likely to be affected by cancer in some way, at some time. That is why when I guide the construction of a cancer center, I think, “How could I make this building the best place for my mother, sister, or friend to receive treatment if there were ever a need?” In approaching a cancer center project, I make the most of my extensive construction-management experience, but just as importantly, I do all I can to make sure patients get accurate, top-notch treatment in the most comfortable, convenient setting possible. Factors that come into play to achieve this goal include knowing how to work with the companies that deliver and install highly technical cancer-fighting equipment, creating the highest-quality building to accommodate cancer treatment, and making patient comfort the highest priority.
A firm understanding
A major factor that separates the construction of a cancer care center from other healthcare construction is its focus on the thickness of the floors and walls that keep the radiation contained. The equipment's weight and its relationship to building materials are also major considerations.
Understanding the dynamics of concrete comes into play when constructing the tall, thick walls designed to contain radiation. Walls up to 7' thick and 16' high require precise concrete management to meet the size, curing, and radiation-protection requirements the first time. To accomplish this, the walls are poured in a sequence that allows lower portions to cure before more layers are added.
Pouring concrete also requires skill because of the science involved. The process of concrete curing is called hydration. When concrete hydrates, it creates heat. If the hydration process isn't properly managed, the concrete will heat too quickly and then shrink, weaken, and crack, compromising the linear accelerator vault's function of retaining radiation. Also, when pouring this massive amount of concrete, excessive pressure is placed on the concrete-forming system which, if improperly handled, will cause form failure and compromise the construction workers’ safety, as well as the integrity of the vault.
Before any cancer care construction begins, there must be a solid foundation on which to build. Take, for example, St. Francis Hospital's Reiman Center for Cancer Care in Franklin, Wisconsin. Because of the center's location on top of a previously landfilled quarry, a traditional foundation system could not be used. The traditional system would not be able to support the cancer care addition, particularly the heavy concrete walls necessary to construct the linear accelerator vault. Those walls require a substantial bearing base. To make sure the structure was properly supported, 36 caissons—more than 800 lineal feet of 3'-diameter concrete columns—were installed to bridge through the weak quarry fill, going all the way down to the virgin, stable quarry floor. To accomplish this, caissons were drilled through landfill, working through such debris as old tires, curbs, and machinery.
Being ready for Varian
Timing is everything in construction. This rule of thumb is even more evident when working with Varian Medical Systems, a leading manufacturer of radiation therapy equipment. Varian has crews that travel throughout the world installing equipment, and if a facility is not ready in the two-week window allotted for installation, that project is put at the end of Varian's list. The Cancer Center operator doesn't want to wait for a second chance.
During the construction of Oconomowoc Memorial Hospital's Regional Cancer Center in Oconomowoc, Wisconsin, much planning and effort were undertaken to successfully adjust the construction schedule to ensure that the project would be ready for Varian's installation crew. The construction team scheduled the linear accelerator and the simulator areas ahead of the supportive areas by 12 weeks, allowing ample time for equipment installation and testing.
Customizing the construction
As more hospitals add cancer treatment centers to their existing buildings, construction firms are learning better ways to build alongside these functioning healthcare facilities. When CG Schmidt was constructing the Radiation Oncology addition at Waukesha Memorial Hospital in Waukesha, Wisconsin, we made the best of the site's tight layout. A new linear accelerator had to be located in the hospital's basement. The only way for the construction team to access the section of the basement where the unit would be located was by digging a 35'-deep hole in the hospital's front entry, two floors above the basement.
Normally an excavation hole of this depth would span 35' across, in this case requiring the removal of half the hospital's main driveway. However, to minimize disruptions, our team used a 4′ × 15′ trench box to reduce the span of the excavation hole by about half, saving all but about 8' of the driveway. Also, to accommodate the hospital's schedule, construction took place from 5 a.m. to noon, because patients were treated with the hospital's existing linear accelerator from noon on.
A design for healing
Minimizing disruption is a step in the right direction toward patient comfort. When distraught patients enter cancer centers, they don't want to be surrounded by an institutional feel, which is why a shift in design began in the early 1990s. Cancer treatment centers began to soften their features, catering to patients’ bodies and minds.
The Reiman Center for Cancer Care exemplifies this. Its goal is to promote a healing environment, and to that end, it has sought extensive input from cancer survivors—including the director of the St. Francis Foundation, Jane Hodnik.
The survivors’ personal knowledge of the treatment process led to a design that includes a healing garden, a resource library, an aquarium, and soothing music and videos. The center also features backlit panels displaying photographs of natural scenery on the ceiling above the linear accelerator, so patients aren't forced to count tiles while going through radiation therapy.
While constructing the Reiman Center, our staff was exposed to patient needs that go beyond physical health and gained a better understanding of the impact survivors’ input can have on a cancer care center. We have retained this knowledge and taken opportunities to incorporate it into other cancer care projects. Although there are unpleasant situations in life that cannot be foreseen, by constructing high-quality cancer care facilities, we have learned techniques to help our company and future clients make life a little more pleasant for those who need it most. HD