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Cancer-center design has moved from rooms organized around machines to adaptable environments organized around complete care journeys. Richard Kobus, FACHA, FAIA, a senior principal and client leader at DLR Group, describes how proton therapy, immunotherapy, cellular therapy, theranostics and precision medicine expanded the technical brief, while patients and families pushed designers to improve daylight, wayfinding, privacy, access and spaces for recovery. His account, published by Building Design + Construction, shows a consistent lesson: the clinical answer changes with each breakthrough, but the human need to feel cared for does not.
How has cancer-center design changed over the last 40 years?
According to Kobus, early cancer centers were essentially equipment-led. The linear-accelerator vault could dictate the entire floor plan, and the infusion chair determined the treatment room. As therapies became more complex, that model became inadequate. Buildings now have to support multidisciplinary teams, accommodate changing equipment and workflows, and reduce the physical and emotional burden of treatment.
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The shift is not simply from old technology to new technology. It is from a single treatment event to an integrated continuum that can include diagnosis, surgery, radiation, systemic therapy, research, survivorship, prevention and family support. The projects Kobus recounts provide a four-decade map of that change.
What did equipment-led cancer centers get wrong?
Equipment remains essential, but making it the primary design driver can produce long walks, confusing circulation and rooms that serve a machine better than a person. A vault’s shielding, for example, is a non-negotiable engineering requirement; it should not automatically determine every public route, waiting area or support space around it.
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Early planning also tended to separate clinical functions that patients experience as one journey. A person may move from imaging to consultation to infusion or radiation in a single day. If each department is planned independently, families repeat registration, navigate unfamiliar corridors and spend more time moving through the building. Kobus’s later examples show designers treating those transitions as part of care quality.
Which treatment advances forced new building strategies?
Immunotherapy, proton therapy, theranostics, cellular therapy and precision medicine increased both clinical specialization and coordination. Their spaces may require different shielding, clean-room controls, imaging, laboratories, data infrastructure or staff adjacencies. Because the next therapy is not known when a building opens, flexibility has become a clinical requirement rather than an optional feature.
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Proton therapy made physics visible in the architecture
For the 1993 Mass General Hospital project in Boston, Kobus reports working with IBA on what he describes as the first commercial proton-therapy treatment center in the United States. Proton delivery required close coordination among clinicians, engineers and designers. The project demonstrated that a new treatment modality can alter structural, shielding and circulation decisions throughout a facility.
Integrated radiation therapy reduced institutional silos
Design began in 2006 for Penn Medicine’s Roberts Proton Therapy Center at the Perelman Center for Advanced Medicine in Philadelphia. Kobus describes it as the first academic medical center in the world to fully integrate proton and conventional radiation therapy in one facility. Penn’s later spoke locations extended that capability beyond the urban center, linking a central academic resource with care closer to patients.
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Future-proofing became part of the brief
A future-ready cancer center needs planned zones for equipment replacement, expansion and changing team relationships. Structural grids, floor-to-floor heights, loading routes, utility capacity and information systems can determine whether a new therapy fits without major disruption. No single layout guarantees adaptability; it must be coordinated from the earliest clinical, engineering and design decisions.
How did patients and families change design decisions?
Patient advocacy groups helped shape the 2007 Duke Cancer Center design in Durham. Their input addressed practical questions that technical planning can overlook: how far patients walk from parking to infusion, whether routes are intuitive, where privacy is possible and how families wait during long appointments.
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Participation also changes what “efficient” means. A shorter route, visible destination and a choice of waiting settings can conserve energy for treatment. Privacy may require acoustic control, carefully positioned check-in points and varied seating rather than a single large waiting room.
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Why is access part of cancer-care quality?
Advanced treatment has limited value when travel time, cost or disruption prevents people from using it. Penn’s spoke model and the 2019 OSF Cancer Institute and Proton Therapy Center in Peoria address that problem in different ways: one distributes capability from an academic hub, while the other brings advanced care to a community whose patients had historically traveled for hours.
The OSF project also broadened the program beyond treatment. Kobus describes a teaching kitchen, survivorship space and healing garden, connecting cancer care with wellness, prevention and life after treatment. Locating those services near treatment reduces the need for separate trips and acknowledges that recovery continues after the procedure or infusion ends.
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What can constrained sites learn from the Singapore project?
The 2014 National Cancer Centre Singapore commission involved more than 1.5 million square feet on a constrained urban site, according to DLR Group’s account in Building Design + Construction. Instead of treating density as purely a limitation, the design used a “central cavern” to bring shaded outdoor space, daylight and prevailing breezes into the building.
Disease-specific clinics were integrated with research laboratories, placing investigation and treatment in closer physical relationship. The lesson for other dense sites is not to copy a particular atrium, but to protect access to daylight, nature and clear orientation while arranging clinical and research functions so that collaboration is practical.
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How do the five projects compare?
| Project and year | Technology and integration | Participation and access | Recovery, survivorship or wellbeing |
|---|---|---|---|
| Mass General Hospital, Boston (1993) | Commercial proton therapy; physics required clinician, engineer and designer coordination. | Not stated in the account. | Not stated in the account. |
| Penn Medicine, Philadelphia (design began 2006) | Proton and conventional radiation therapy integrated in one academic facility; later spoke locations. | Spoke model addressed distance from the urban center. | Not stated in the account. |
| Duke Cancer Center, Durham (2007) | Clinical planning emphasized proximity and efficient movement. | Patient advocacy shaped wayfinding and parking-to-infusion distance. | Healing garden, rooftop terrace, resource room, natural light and choice. |
| National Cancer Centre Singapore (2014) | Disease-specific clinics integrated with research laboratories. | Urban-site response used a central organizing space. | Shaded outdoor space, daylight and prevailing breezes through the central cavern. |
| OSF Cancer Institute and Proton Therapy Center, Peoria (2019) | Advanced proton therapy located in a community setting. | Reduced the need for patients to travel hours for advanced care. | Teaching kitchen, survivorship space and healing garden. |
What should a new cancer center plan for now?
A practical brief should connect technical flexibility with an explicit human-experience strategy.
- Plan for change: reserve structural, utility and service capacity for equipment replacement and emerging therapies.
- Design the whole journey: map arrival, parking, registration, imaging, consultation, treatment and departure as one sequence.
- Coordinate disciplines early: clinicians, physicists, engineers, architects, researchers and operations leaders should resolve adjacencies together.
- Offer orientation and choice: use legible landmarks, daylight, varied waiting settings and clear privacy gradients.
- Bring care closer: evaluate hub-and-spoke or community locations when travel creates a barrier to treatment.
- Include life beyond treatment: provide survivorship, prevention, education, family and emotional-support spaces in the initial program.
- Make nature functional: gardens, terraces, shaded courtyards and outdoor air can support orientation and respite when integrated with safe clinical circulation.
Kobus’s governing principle is concise: “The clinical answer changes with every research breakthrough. The human answer does not.” The projects show how to apply that principle without freezing a building in one era: make the technical infrastructure replaceable, make the care journey understandable, and make room for the parts of cancer care that happen before and after treatment.
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What is a hub-and-spoke model in cancer care?
A hub-and-spoke model concentrates highly specialized services at a major center and places selected services or treatment locations closer to surrounding communities. Its value depends on clinical governance, referral coordination and reliable connections between locations; the physical distribution alone does not guarantee continuity.
How can designers measure whether a cancer center is easy to navigate?
They can map a first-time visitor’s route, count decision points, check sightlines to major destinations and review signage with patients and families who were not involved in design. Measures such as walking distance, missed turns and time from entry to registration can reveal problems before opening.
What spaces are commonly overlooked in oncology planning?
Family consultation rooms, quiet areas, staff decompression spaces, storage for mobile equipment and locations for education or peer support are often squeezed by treatment-room demand. Programming them early prevents corridors and waiting rooms from carrying functions they were never designed to support.
Why integrate research laboratories with disease-specific clinics?
Physical proximity can make collaboration, specimen movement and rapid discussion easier when clinical questions arise. The arrangement still requires clear access controls, biosafety separation and operational agreements so research activity does not compromise patient privacy or clinical throughput.
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