Controlled studies confirm that contact with the natural environment can alleviate stress, relax blood pressure, and even reduce the need for pain medication. So it isn’t surprising that many designers strive to organize outpatient cancer centers around natural vistas.

Cancer outpatients are a distinct group: well enough to travel for chemotherapy or radiation therapy, but physically and emotionally debilitated by their illness. Many are tired, unsteady, nauseous, or in pain, and often experience anxiety, depression, or fear. Deprived of control of their daily lives, they’re forced to repeatedly visit the same building for many hours each day, for weeks at a time. The natural world offers a varied, therapeutic respite from this repetitive experience.

In suburban and rural areas, a cancer center can easily be surrounded by a garden or a grove of trees. But in urban areas—or on densely developed hospital campuses—the available vistas may be the side of a building, the air handling units on a rooftop, or a sea of parked cars.

With the healing effects of nature in mind, four cancer centers in densely developed settings were developed with a focus on making patients and staff feel as if they’re close to the natural world. Approaches included creating miniature gardens, discreetly screening unattractive views, taking advantage of roofscapes, engaging distant glimpses of the landscape, and making connections with nature.

AtlantiCare Oncology Institute
The AtlantiCare Oncology Institute in Egg Harbor Township, N.J., is a 40,000-square-foot cancer center literally surrounded by parking lots: To accommodate all its patients on the limited site, AtlantiCare maximized the building’s floor area and parking, thus reducing the available green space. To create a natural environment, designers looked beyond the surrounding asphalt, a few hundred yards south of the building, to a standing grove of pine trees that blocks the view of neighboring houses. Since that was the only existing connection with nature, it was important to find a way to capture it.

To engage the view of those trees and to hide the parking lot, chemotherapy infusion stations were placed on the second floor facing south. Below the southern windows extends a green roof balcony over the driveway. The balcony has a “garden by the seashore” theme with pebbles, planters, and low plantings that block the view of the cars. Inside, sea grass in glass provides some privacy for the infusion stations while perpetuating the shore theme.

Patients receiving radiation come in briefly but regularly to the first-floor treatment room. Since there’s no view beyond the parking lot from the first floor, the view was instead blocked with a low 4-foot wall and plantings. While seated and receiving treatment, patients see a garden wall and distant treetops. 

To bring sunlight into the building, the building was separated in two. A 95-foot-wide, two-story space cuts through the building, allowing views of the same grove of trees, even from the extreme northern end of the facility. The view of the cars was concealed at the end of the lobby with a sculptural feature in the foreground. This solution also fills each floor with direct and indirect sunlight throughout the day.

Pocono Medical Center: Dale and Frances Hughes Cancer Center
Located in northeast Pennsylvania in East Stroudsburg, the 60,000-square-foot Hughes Cancer Center is one of multiple buildings on the campus of the Pocono Medical Center. A freestanding structure connected to the main hospital by an elevated walkway, the cancer center is surrounded by asphalt and concrete. To the north is a view of a hospital; to the south is a highway; to the east is a parking lot; and to the west is an office building. In the distance, however, are the Pocono Mountains, serving as inspiration for the natural elements of the design.

On two sides of the L-shaped building, low walls and trellises were used to block undesirable views; in the center, a garden was built. An engineered mountain stream that flows over boulders is a striking feature, and native plantings like birch trees, rhododendron, blueberry bushes, and hemlock frame the stream. As the stream flows toward the main lobby of the building, it appears to come indoors.

All the views from major waiting areas face into the garden. Not only is it beautiful to look at, but the stream also helps with wayfinding. When one emerges from the elevator on the second floor, the garden is in view, as it is from the waiting area. Patients on higher floors look out on a green roof that blocks the interstate, while allowing a view of the mountains.

SUNY Upstate Medical University Cancer Center
The brutal winters of Syracuse, N.Y., inspired the garden for the Upstate Medical University Cancer Center. Connected to the main hospital, the cancer center will occupy the bottom three floors of a five-story, 97,000-square-foot building when it’s complete in spring 2014.

A 150-foot-long roof garden is located above the first floor, where a public walkway connecting the cancer center to the cafeteria was also designed. Four-season plantings were used, like evergreens that will grow to 20 feet and trees with colored bark, so that the garden will be attractive throughout the year. Flowers, plants, and a small pergola enhance the tranquility of the vista. Patients receiving chemotherapy infusion treatments have a direct view to the garden, while tinted glass provides privacy from the public walkway. In addition to views of the garden trees, pediatric patients on the third floor can see the dynamic urban landscape of Syracuse. The design also takes advantage of the building’s location on the site to create a three-story atrium that brings sunlight indoors.

North Shore-Long Island Jewish Health System: Monter Cancer Center
At nearly a quarter-mile long, the 465,000-square-foot Monter Cancer Center building, a former 1940 factory that produced gyroscopes for bombers and battleships, was a challenge to reshape into an intimate, efficient facility with views of nature.

Like many factories of this vintage, the building was constructed with linear clerestory windows, 40 feet apart, that naturally light the interior. By designing a system of streets under the clerestories, with bamboo and fig trees embedded into the flooring, the large building is broken down into neighborhoods with pocket parks. Birch trees planted along the west side shield the harsh western summer sun.

Making the commitment
There’s no limit to the ways you can design nature into the experience of the cancer patient. Other strategies proven successful include green walls, green roofs, sunlight tubes, replica plantings, and even photographs of natural vistas. The natural environment appeals to all age groups and all cultures, particularly when one is sick; but nature must be maintained to be effective. For both indoor and outdoor gardens, ensure that the irrigation system functions efficiently, leaves are swept, and plantings are trimmed and replaced in a timely fashion.

Exposure to the natural environment benefits all patients, yet cancer outpatients in urban settings are especially appreciative.  “Just to sit here and see trees is beautiful,” said one chemotherapy patient recently, whose sentiments are shared by countless cancer outpatients in satisfaction surveys.  In urban or hospital campus environments, where views of nature are unexpected, the surprise
appearance of the natural world in a clinical setting is not only therapeutic but also brings cancer outpatients an added measure of delight and comfort.

Andrew Jarvis, AIA, LEED AP, is a principal at EwingCole in New York. He can be reached at