The design of INCA—one of the largest healthcare projects in South America—has many chapters. While these chapters are complex, its lessons can be told in two simple statements: Simple solutions often are best revealed in the face of complex problems, and building relationships nurtured by trust is key in any culture.



The Instituto Nacional De Cancer (INCA) is one of the largest cancer treatment providers in South America and offers multiple services in Brazil, including prevention, epidemiological surveillance, treatment, information, education, and research.

Similar to the National Institute of Health in the United States, INCA is a government-funded enterprise tasked with blending cutting-edge cancer treatment with research and prevention for the improvement of the health of citizens of Brazil. INCA has become a national and international model for cancer control.


A new campus for an important institution

In 2007, on its 70th anniversary, INCA began planning for its new campus in Rio de Janeiro. The objective was to do more than consolidate oncology services scattered throughout several locations in this thriving city. The intention was to create a new model for cancer care—one that was centered around translating research into practice within an environment focused on providing top-quality, efficient patient care.

INCA sought out international design experts that could help it transform its physical environment into a world-class oncology center. The process began with an international selection exercise to identify a team that could provide INCA with both a new image as well as a facility to take it well into the future. The American firm Cannon Design would team with the Brazilian firms RAF Arquitetura and MHA Engenharia to bring INCA both world-class design and healthcare expertise from its region.


The modernist tradition of Brazil architecture

Brazil is a country with a rich architectural heritage. Oscar Niemeyer and Roberto Burle Marx made a significant contribution to the 20th Century Modern movement. Niemeyer was one of the creators of Brasilia, the new capital of the country, and Marx transformed Rio de Janeiro with his parks, boulevards, and sidewalk pattern designs along the city’s beaches.

The architectural scene in Brazil today is vibrant as young architects continue designing in the modernist tradition. For an outsider designing in Brazil, the country’s architectural heritage represents an obligation; but because of Brazilians’ openness to fresh design ideas, it represents an opportunity as well.

Rio is a city made up of a number of neighborhoods, characterized by low-scale buildings, lush landscape, and busy street life. These neighborhoods are separated by natural topography consisting of large cone-like hills that, together with parks and wide landscaped avenues, give the city its unique character. The design team spent much time in Rio, speaking with the client, exchanging ideas among design team members, and analyzing the program and site. At the end of every visit, a promising concept continued to emerge.

Hospitals typically consist of large programmatic components that serve a myriad of inpatient and outpatient needs. The National Cancer Institute of Brazil was not an exception. As in the United States, the arrangement of the programmatic components is guided by functional needs and a desire for operational efficiency. In other words, the relationship between the departments follows a tried and proven planning model.

Frequently, the circumstances surrounding a project offer an impetus for a fresh look at the design problem. These external forces, in contrast to internal needs, often have a profound effect on the design concept. Some of these forces that influenced the design concept for the cancer institute are worth mentioning. For one thing, the building program was quite large, approximately 1.5 million square feet in total, including an existing structure that had to be incorporated into the complex.

We did not want the new building to appear large and oppressive, so breaking the building mass was imperative. Also, the site was situated in the downtown area with adjacent buildings varying in height and scale. This combined with a zoning mandate that required a percentage of the site to be dedicated to open space, made the context an important design consideration. Finally, local climate and the potential for extensive use of vegetation offered additional design opportunities.

The building concept that emerged took this highly complex building and organized it with a very simple solution. The idea was to capture an urban, open garden where there wasn’t one and wrap the functions around the space, which could then be used by the public. This type of green space is greatly lacking in the section of the city where INCA is located. The building is broken into two architecturally distinct components—a four-story-high base and the bed tower.

The base, which provides the enclosure for the garden, is clad in locally quarried stone. The bed tower, “floating” above the base, is light and transparent. The harvesting of natural light and shading of glass surfaces were important considerations of the building exterior treatment. Vertical and horizontal sun shades, depending on the orientation, were employed on the bed tower. Skylights were incorporated in the webby vertical structure, supporting the garden pergola—bringing natural light into the lower level of the complex, parking, and radiation treatment departments.

Diagnostic functions, treatment areas, and outpatient functions are located on the first levels facing the garden. A linear structure hovering above the entrance to the garden is dedicated to research. Every staff member and patient who enters the facility walks under this ceremonial bridge that connects the research pavilion with the patient care building. This “Bridge of Hope” is a visible element providing staff, physicians, and researchers the opportunity to reflect on the importance of their work; and it is a symbol to the patients and family members that the research occurring at this institution is directly impacting their care.


Uniqueness of working in Brazil

Working in Brazil carries with it some unique challenges for a U.S.-based architectural firm. Having team members fluent in Portuguese is almost a requirement, as English is frequently not a second language. Our team traveled to meetings with an interpreter, who facilitated the dialogue among the hospital’s administration, staff, and our designers. The delivery of healthcare is similar to the United States, but it is
unique in that Brazilian healthcare is provided by both government and private institutions.

There are, however, differences among the patients and clients. The government’s architectural selection process is one that would not easily allow a U.S.- based design firm to compete for a project on its own. When submitting qualifications, firms are required to provide a government certificate establishing their involvement in every project. There is no equivalent document in the United States that a firm could provide to authenticate its experience, thereby potentially negating any involvement a firm might have outside Brazil. Teams have to be creative in how they position their experience and qualifications in order to meet the requirements of the “Edital,” or request for proposal.


Building relationships of trust across cultures

Much of the success of this project is attributed to Cannon Design’s Brazilian associates, Flavio Kelner from RAF and Salim Lamha from MHA. These two individuals and their respective firms provided a powerful guiding hand in shaping the INCA opportunity. Political dynamics of the selection process aside, the project itself was an extraordinarily challenging architectural assignment that could have easily fallen prey to a myriad of obstacles. Our Brazilian partners were instrumental in challenging many preconceived ideas of project organization and governmental requirements to improve the final outcome. This included improving the zoning regulations for the project, which if not changed would have effectively dictated a five-story doughnut solution that would not have allowed a creation that proved to be both functional and beautiful.

The leadership of all firms involved found common ground in doing business based on trust, mutual respect, and integrity. There were many times when easy decisions could have been made that would have lead to a compromised solution. This is one instance where all parties—owner, architects, and engineers—fought diligently through language and cultural barriers in the spirit of creating something spectacular.


A design worth awarding

In July 2011, the project was awarded one of the most significant design awards in South America. INCA was the Master Award Winner in Brazil’s Grande Premio de Arquitetura Corporativa design competition—a program that earned more than 1,000 entries from across the country.

Jurors on the Grande Premio de Arquitetura Corporativa awards panel praised the design, calling INCA “an important contribution to Brazilian architecture.” The jurors go on to state that the “project’s architectural expression, combined with functional complexity, results in a sustainable solution that has minimal impact on the neighborhood.” It is an honor to receive this award in a country known for its contemporary architecture. We believe recognition like this for a hospital can raise the design profile of the building type for the entire country of Brazil and set a high standard for the future. HCD

Michael Pukszta, AIA, is a Principal at Cannon Design. He can be reached at


The designer’s viewpoint

Cannon Design's George A. Nikolajevich, FAIA, design principal, shares his thoughts and insights on the Instituto Nacional de Cancer project, on topics ranging from design challenges to cultural barriers. 



There were two challenges that influenced the design. The first one has to do with the relationship of a large, 1-million-square-foot complex to the urban context. The site is situated in downtown Rio de Janeiro and is surrounded by densely built city blocks. The blocks vary in height, which had an impact on how we have arranged large building components on the site.

The second challenge—which became an opportunity as well—had to do with the fact that Brazil has made a significant contribution to modern architecture. Brazilians appreciate good design. This posed an obligation, for us and our Brazilian partners, RAF Arquitetura, to come up with a design that contributes to Brazil’s modernist tradition. 



Geography did not significantly affect our method of design or the process. At the outset of the project, the design team spent a productive 10 days working with our partners in Rio. We and RAF share an interest in modern architecture. During our stay, we had a chance to get to know Rio, which is indeed a magical city.

Subconsciously, the environment must have had an influence on our design thinking. By the time we left Brazil, we had the concept for the building. During the following months, we continued exchanging drawings and ideas using electronic means. Flavio Kelner, the president of RAF, visited our offices in St. Louis once during that period. 


Unique design features

An important inspiration for the building concept came from the city’s zoning requirements, demanding that a significant percentage of the site be left open. In response to that demand, we decided to do something unconventional; we inserted a public open space in the heart of the complex. The residents from adjacent neighborhoods can use this space without interfering with the inner workings of the institution. 

Building components are arranged around this open space. To properly break up a potentially massive building, each component was treated differently. The heavily landscaped base—four floors dedicated to public functions—is seen as a vertical extension of the green space. Patient floors are arranged in a
linear, light, and transparent structure, which appears to be floating above the base. The research wing, dedicated to the search for a cancer cure, defines the entrance to the park. It is highly visible and represents, both for the public and patients, a symbol of hope.



We share with RAF an identical attitude toward architecture and this profession. During the collaboration, we were freely exchanging ideas and observations. We learned from our partners very quickly about various aspects of Brazilian culture, but, basically, we divided the assignments. We focused on the planning and design, and they focused on management. Kelner masterfully managed the project. In doing so, he helped the realization of the building concept as initially conceived. 

Brazilians are terrific hosts. As we were drawing in their office, they would constantly serve us espresso and a variety of uniquely Brazilian goodies. That, too, had an impact on the design!


—Todd Hutlock, Editor-in-Chief