Healing Gardens for Cancer Patients

Lavisha Jaswani, Ar. Dhanashree Utagikar, Ar. Preeti Kale

Dr. D. Y. Patil College Of Architecture
Email: [email protected]
ABSTRACT Introduction:
Number of cancer patients keeps on increasing Cancer is a class of diseases in which a group of
every year and the number of specialist cells display uncontrolled growth (division
hospitals to treat them are inadequate and the beyond the normal limits), invasion (intrusion
existing hospitals don’t provide a healing on and destruction of adjacent tissues), and
atmosphere, rather a hospice environment. sometimes metastasis (spread to other
Dedicated cancer care facilities are not able to locations in the body via lymph or blood). The
tackle the cancer burden, as over 11 lakh problem of cancerous cell is caused by
patients are diagnosed every year. Many mutations or abnormal activation of the genes
patients have a negative outlook on cancer as which control cell division. When the genes are
there is a lack of healing facilities available, to abnormal they are called Oncogenes. Among
provide hope psychological benefits. The main public institutions, the large buildings and
purpose is to explore design solutions for an complicated intervening and surrounding
architectural cure for cancer, to provide areas of hospitals usually tend to be seen by
solutions that empower people to battle the public as removed from the urban context,
cancer, to illustrate the factors that contribute as spaces to be feared, which one only
to a positive user experience, those that accesses in emergencies or out of necessity.
detract from it, and why. The paper is based on However, this psychological perception of their
data provided by Indian Council of Medical distance and separation can be decreased by
Research, National Institute of Cancer today’s more hospitable approaches to their
Prevention and Research, case studies, content and design.
interviews. Both Qualitative and Quantitative
Healing Landscape:
research methodology is used in this paper in
the form of literature study, behavioral Traditional healing gardens are often found
analysis of the patients and doctors, case within or adjacent to indoor healthcare
studies of existing centers and observations. settings. Healing gardens can be found in
This paper attempts to quantify the various mental health hospitals, schools and centres
surveys conducted and analyses the data for the disabled, hospices and nursing homes;
presented in charts, tables, graphs and other however, possibly the most popular examples
figures to organize the results. This paper of healing gardens are found within or adjacent
discusses the broad perspective, since how one to hospitals and Alzheimer’s treatment
feels is abstract, some variables cannot be facilities. Healing Gardens meant for users that
quantified as it depends on an individual’s are specifically ill or disabled will be useful to
perception of space. Hence the methodology the extent that these special needs
used yields a wide range of different results. populations are present and able to physically
or at least visually access these sites. However,
Keywords: Healing landscape, oncology,
even within a healthcare setting, healing
Diagnostics, Supportive Care, User Experience
gardens are often used by a larger population
including staff and visitors as well as patients • To establish how the built form,
and/or residents. At a larger scale, some specifically Oncology healthcare
believe that any garden can be a healing facilities, impacts on User Experience
garden and that the general population can • To illustrate the factors that
find restorative benefits from such spaces, contribute to a positive user
regardless of physical health needs. Taken at experience, those that detract from it,
this scale, green spaces with restorative effects and why
should be easily accessible by the surrounding Scope:
population.
Cancer is the second leading cause
of death globally, and is responsible for an
estimated 9.6 million deaths in 2018. Globally,
about 1 in 6 deaths is due to cancer.
Approximately 70%
of deaths from cancer occur in low- and
middle-income countries. (According to WHO)

Estimated number of people living with the

disease in India is around 2.25 million and
every year, new cancer patients registered:
Over 11 lakhs. Oncologists say the number of
dedicated cancer care facilities will not be able
to tackle the burden in the future According to
ICMR-NICPR: The government has realized that
cancer burden is increasing and hospitals
treating it are meagre in number. There are
only 62 dedicated cancer care hospitals in the
RESEARCH QUESTION country, including both regional and national
facilities, according to the National Cancer
 How to improve psychological healing Grid. This is woefully inadequate as an
and promote physical healing of estimated 2.25 million people in India live with
cancer patients with the help of cancer as of March 2018, according to the
healing gardens. National Institute of Cancer Prevention and
 Design guidelines of a healing garden Research (NICPR).
for cancer patients
 Attempt to find out the relationship Limitations:
between the landscape elements and The paper is limited to the effect that healing
the psychology of cancer patients in landscape has only on cancer patients. Since
hospital design
how one feels is abstract, therefore methods
Aim and Objectives: like interviews introduces bias to the study.

Aim is to explore design solutions for an The paper is based on case studies from
architectural cure for cancer. different countries so user behavior may vary
Objective is to and not be similar in India.

• provide solutions that empower

patients to battle cancer.
Methodology effects on Stage I than II and more on II than III
and then IV.
The methodology used will be quantitative, in
the form of available data from ICMR-NICPR According to a report published by BMC
for measuring, ranking, categorizing, cancer, Experiencing the garden as a living
identifying patterns and making system allowed a metaphorical approach to
generalizations. Qualitative, in the form of reassembling old and integrating new life
interviews for contextualizing and interpreting components. Nature offered rich metaphors to
the perception of patients and doctors in depth capture these creative and adaptive processes.
insight. Mixed methods, allowing the For example, in the study, participants drew
conversion of some variables into quantitative symbolism from the gardens, which they
forms. related to their own state of being or more
specifically to their experiences of cancer and
The paper will also analyze the case studies of the so-called “cancer journey”. Being
existing centers to understand positive and ‘symbolic of life and renewal in the life cycle’,
negative factors catering to the patients’ nature inducted patients to the states of life
recovery. This will help to provide contextual they were confronting. For example, the
real-world knowledge about the behaviors, garden also provided participants with an
social structures and shared beliefs of the opportunity to be involved with the life cycle.
patients and doctors. Another methodology Maintaining enjoyable activities could
employed will be literature study, such as strengthen ties with normality and sustain
publications, research papers. positive health behavior like gardening.
Adopting new activities was helpful when
Literature Review:
attempting to break away from cancer related
Based on research by the Kaplans and Ulrich, it experiences. Nature activities including
could be argued that any garden is healing. gardening and dragon boating resulted in
However, to be defined as such, a healing physical benefits such as adopting healthier
garden should give a sense of restoration from diets, increased physical activity, improved
stress and have other positive influences on fitness, and loosened joints. Overall, benefits
patients, visitors and staff/caregivers. These
extended beyond the physical dimension and,
healing landscapes can be located in or
in participants own words, included: ‘buffer
outdoors, but to qualify as healing “gardens”
against stress’.
they should have real nature such as plants
and/or water features (Cooper-Marcus and
Barnes, 1999).

According to research conducted by Prof.

Musa Muhammad Aminu on the use of
landscape elements in hospital environment to
enhance the psychological recovery of cancer
patients, he concluded that there is 38%
decrease in psychological depression in cancer
patients that are exposed to landscape, even
within a short period of time.

He further conducted a stage wise study, which It is also important to remember that activities
showed that landscape elements have more in healthcare outdoor space can range all the
 way from completely passive to very active, for  Accessibility
example:  Places of privacy
 Seating encouraging interaction
• Viewing garden through window
 Contact with nature
• Sitting outside
• Dozing/napping/meditation/prayer Factors Hindering stress reduction and healing
• Gentle rehabilitation exercises in hospital gardens:
• Walking to preferred spot
• Eating/reading/doing paper work  Predominance of hardscape
outside  Ambiguous, abstract art.
• Taking a stroll  Intrusive mechanical sounds
• Child playing in garden  Lack of privacy, places to sit.
• Raised bed gardening  Lack of choice
• Vigorous walking  Lack of shade
• Sports.  Feeling of insecurity or risk
 Crowding.
Factors Supportive of stress reduction and
healing in hospitals:

 Convenient way finding to garden

List of plants used for treatment of chronic inflammation/cancers

S/n Plant names Family Local Plant Use

o names part used
01 Cochlospermu Cochlospermacea Rawaya Root Antiinflammatory/anticanc
m tinctorium e er
A. Rich
02 Cissus ibuensis Ampelidaceae Daddori Leaves Antiinflammatory/skin
Hook
03 Bridelia Euphorbiaceae Kirnii Stem bark Skin cancer
ferrugineae
Benth
04 Euphorbia lateri Euphorbiaceae Fidda Stem Cancer/reduce bleeding and
.ora Schum. & Sartse relieve of pains after
Thonn. circumcisions
05 Desmodium Fabaceae Dangere Leaves Many cancers
velutinum Willd e
06 Annona Annonaceae Gwandar Stem Skin cancer/leukemia
senegalensis daji bark/leave
Pers s
07 Vismia Hypericaceae Kiska Leaves Cancer
guineensis Linn. wali

Case Studies: CASE STUDY 1 The healing garden at VCU Massey Cancer
Center offers patients, family members and
Massey Cancer Center, Virginia, US medical staff a chance to be around nature and
to escape, if for only a little while, the stress
and stimulation of a clinical environment. The
garden offers another aspect of healing that the drug vinblastine; and autumn crocus,
goes along with medicine but is different from which makes a substance tested against
medicine. These are the benefits of nature that leukemia.
come from plants and wonderful light and the
trickling of water. For a sick patient, a stressed
relative or a tired nurse, the garden will be a
temporary place of peace in the midst of
dealing with illness and pain. Perhaps it will
mean the difference between a bad day and a
hopefulday.

Fig no. 3- Massey Cancer Center

But most of the plants come from everyday

life, and the healing aspect is intended to come
from this very familiarity.

Fig no. 1- Massey Cancer Center According to the landscape architect, "The
focus is on life rather than illness," and that
plants with strong scents are absent because
some cancer treatments increase sensitivity to
them.

CASE STUDY 2

Healing Garden at Mount Zion Clinical

Cancer Center, San Francisco, California
Fig no. 2- Massey Cancer Center
This large medical center is located in the heart
The restorative power of gardens is an ancient
of san Francisco, at the intersection of two
idea that still has therapeutic power. The
busy streets, Sutter and Divisadero. Across
Healing Garden is growing shade trees,
Sutter from the main high rise building is a one
perennials, evergreens, shrubs, vines and
story women health center. This building and
groundcovers. Water sculptures and a tranquil
the courtyard garden hidden within it were
pool add to the atmosphere. Views from the
once the home of the hospital’s clinical center.
garden are framed by bronze screens that
The center has since moved across the street
borrow design elements such as birds and
to the main building, but the garden remains
reeds from the nearby Egyptian Building, which
and is included here as a case study of an
was the original medical school built in 1845.
exemplary garden for cancer patient.
The garden has plants with anti-cancer
This courtyard garden is bounded by hospital
properties, including the yew tree, which was
buildings and a commercial property, roughly
the original source of the drug paclitaxel;
half of the garden still receives direct sunlight
Madagascar periwinkle, which is used to make
at noon. Plants were chosen to provide blooms
throughout the year and to provide a variety of
green hues. There is a small fountain to screen
out noise from a nearby street and many
wooden benches, tables and moveable chairs.

Fig no. 5- Mount Zion Clinical Cancer Center

The gardenesque style of this garden

comprises curvilinear pathways of
decomposed granite that border planting beds
filled with a great variety of annuals and
Fig no. 4- Mount Zion Clinical Cancer Center perennials, including white blooming
impatiens, hydrangeas, and Japanese
The garden was once a mostly-hardscaped anemone in the shady half of the garden and
courtyard, designed by Tommy Church. An the colourful blooms of roses, begonia,
artist-patient at the center provided the idea penstemon, pansies, lavender. The plants have
and effort to redesign the space into a more
been chosen to provide blooms throughout
garden-like setting. During the design process the year, as well as to offer a variety of shades
workshops were held where patients and staff of green. Attractive wooden garden benches
provided suggestions on the necessary garden with backs and arms, a number of round
elements. There were also a number of tile- wooden tables with movable chairs, and a
making workshops where patients added their curvilinear stone seating wall provides a
survival stories to tiles with imprints of Asian variety of places to sit in the sun or shade.
plant specimens used in cancer treatment.
These tiles made up the wall of the indoor CASE STUDY 3
corridor that passes by the garden; the tiles are
one element of permanence next to a The Mary & Al Schneider Healing Garden,
constantly changing garden. This garden has Cleveland, USA
been quite successful with patients, staff and The Mary & Al Schneider Healing Garden was
visitors. It is a green oasis within the hospital designed as an integral part of the new
complex and gains much of its popularity Seidman Cancer Center. The garden creates an
through the community process that is was experience of respite for cancer patients, staff
created from. and families – an “Island” designed to both
calm and delight one’s senses in the core of
downtown Cleveland. Requests were made for
creating a sense of calm for visitors who want
to recharge and rejuvenate yet also provide a
sense of whimsy, of being able to touch rocks,
allowing those journeying with cancer
something to hang onto and feel the rock’s
strength, of being able to find a place of both organized programs by hospital staff, and
respite, to inspire by quotations, having an self-initiated walks by any who visit the garden.
open space to breathe, a place to be away from Visitors can walk the labyrinth alone, or guided
busy streets yet a part of the urban fabric. walks are available. The path around the
labyrinth has large sculptures that represent
earth, air, fire and water.

The lower area of cafe tables and chairs,

accessible by ramp or steps, becomes a place
to sit and meet, to move a chair into sunshine
or shade; to enjoy a sense of respite, or savor
one’s lunch. The healing garden, which is about
one-third of an acre, isn't visible from the
street. A wall separates the setting from hectic
Euclid Avenue. But the public, whether visiting
Fig no. 6- The labyrinth
Seidman or not, is welcome inside the garden,
which is accessible from the intersection of
Euclid and University Hospitals Drive.

Fig no. 7- Representation of elements of earth-

fire
Fig no. 8- lower area of café tables and chairs,
As one enters the garden, one becomes aware
accessible by ramp
of entering “somewhere else instead”. One
begins to feel transported as one eases down
the accessible pathway into the subtly walled
garden.

Below the busy corner of UH Drive and Euclid

Avenue, the garden becomes a “green oasis”.
Immersed under a canopy of trees, providing
shade in summer months, the accessible
pathway leads into a walled garden inspired by
the elements of earth, fire, wind and water. Fig no. 9- Inspirational quotes along the way
One arrives at the carved granite labyrinth to and The large rock seat at left is veined in a
find its opening beckoning an invitation; the way that suggests an angel .
labyrinth is a walking meditation tool engaging
the right brain. It provides opportunities for
Overview:

Case study I: Massey Cancer Center, Virginia, USA

Case Study II: Healing Garden at Mount Zion Clinical Cancer Center, San Francisco, California

Case Study III: Mary & Al Schneider Healing Garden, Cleveland, USA

Comparative Analysis:

Case Study framework Physical Factors Sense of control Natural

Name Distraction

Massey The healing garden The Healing Garden Most of the For a sick patient,
Cancer offers patients, is growing shade plants come from a stressed
Center family members trees, perennials, everyday life, and relative or a tired
and medical staff a evergreens, shrubs, the healing nurse, the garden
chance to be vines and aspect is will be a
around nature and groundcovers. intended to come temporary place
to escape, if for Water sculptures from this very of peace in the
only a little while, and a tranquil pool familiarity. midst of dealing
the stress and add to the with illness and
stimulation of a atmosphere. Views The focus is on pain. Perhaps it
clinical from the garden are life rather than will mean the
environment. The framed by bronze illness and that difference
garden offers screens that borrow plants with between a bad
strong scents are
another aspect of design elements day and a hopeful
healing that goes such as birds and absent because
day.
along with reeds from the some cancer
medicine but is nearby Egyptian treatments
increase
different from Building, which was
medicine. the original medical sensitivity to
school built in 1845. them.

Healing This courtyard The gardenesque There were also a The typical
Garden at garden is bounded style of this garden number of tile- scenario on a
Mount Zion by hospital comprises making summer day is,
Clinical buildings and a curvilinear workshops people come into
commercial pathways of where patients the garden to eat
property, roughly decomposed added their lunch, wait for an
Cancer half of the garden granite that border survival stories to appointment,
Center still receives direct planting beds filled tiles with hold small staff
sunlight at noon. with a great variety imprints of Asian meetings, sit or
Plants were chosen of annuals and plant specimens quietly talk with
to provide blooms perennials, used in cancer a family member,
throughout the including white treatment. These do paperwork or
year and to provide blooming tiles made up the relax in the sun.
a variety of green impatiens, wall of the indoor So the garden
hues. hydrangeas, and corridor that does a good job
Japanese anemone passes by the in distracting
in the shady half of garden; people from the
the garden and the monotonous life
colourful blooms of of treatments.
roses, begonia,
penstemon,
pansies, lavender.

Mary & Al The Mary & Al Integrated into the The garden The garden
Schneider Schneider Healing Schneider Healing creates an creates a sense of
Healing Garden was Garden at Seidman experience of calm for visitors
Garden designed as an Cancer Center, is a respite for cancer who want to
integral part of the labyrinth in 11 patients, staff recharge and
new Seidman circuit Chartres and families – an rejuvenate yet
Cancer Center. The pattern. It is “Island” designed also provide a
garden, which is constructed of 948 to both calm and sense of whimsy;
about one-third of pieces of honed cut delight one’s of being able to
an acre, isn't granite and is senses in the core touch rocks,
visible from the surrounded by an 8- of downtown allowing those
street. A wall foot-wide Cleveland. journeying with
separates the bluestone path. A cancer something
setting from hectic snowmelt system to hang onto and
Euclid Avenue. But keeps the pattern feel the rock’s
the public, free of ice and snow strength, of being
whether visiting enabling able to find a
Seidman or not, is accessibility of place of respite,
welcome inside people of all ages to inspire by
the garden, which and stages, quotations,
is accessible from wheelchairs and IV having an open
the intersection of poles. space to breathe,
Euclid and a place to be
University away from busy
Hospitals Drive. streets yet a part
of the urban
fabric.
Design guidelines: stressful experience. Nearby access to natural
landscape or a garden can enhance people’s
Accessibility: People of all ages and abilities ability to deal with stress and thus potentially
need to be able to enter and move around in improve health outcomes.
the garden. Paths must be wide enough for
two wheelchairs to pass (minimum of six feet), It is important to recognize that “healing” is
they should be smooth and wide enough for a not synonymous with “cure.” A garden cannot
patient on a bed or gurney to be wheeled into cure cancer, but it can do the following:
the garden, paving joints should be narrow
 Facilitate stress reduction which helps
enough so as not to catch a cane, the wheels of
the body reach a more balanced state
a walker or an IV-pole.
 Help a patient summon up their own
Familiarity: When feeling stressed, many seek inner healing resource
environments that are familiar and comforting.  Help a patient come to terms with an
A depressed person may be reluctant to leave incurable medical condition
their bed; an anxious person may seek the  Provide a setting where staff can
familiarity of home. Similarly, those in medical conduct physical therapy, horticultural
settings who are stressed from overwork, therapy, etc. with patients
illness, or anxiety need to have access to  Provide staff with a needed retreat
garden settings which are soothing in their from the stress of work
familiarity.  Provide a relaxed setting for patient-
visitor interaction away from the
Quiet: If a garden is to have therapeutic value
hospital interior.
in a medical setting, it needs to be quiet — a
complete contrast to the public A healing garden can have the effect of
announcements, TVs, and rattling trolleys of a awakening the senses, calming the mind,
hospital interior. People using the garden need reducing stress, and assisting a person to
to feel a sense of calm, and to be able to hear marshal their own inner healing resources. For
birdsong, wind chimes, or the sounds of a a garden to provide maximum therapeutic
fountain benefits, it needs to have a plentiful supply of
plant materials, some with distinctive seasonal
Comfort: Hospital patients often feel
changes; leaves or grass which move with the
vulnerable. Patients who are elderly, infirm or
slightest breeze; subtleties of colour, texture,
mobility-impaired need the reassurance of
and leaf shape especially where frail people
handrails, seating at frequent intervals
may move slowly looking down or where
(especially near the entry door), and paving
people may sit for long periods in one setting.
materials that do not cause excessive glare.
Trees can provide metaphors of solidity,
Patients, staff and visitors also need to feel
strength and permanence; perennials of
psychologically secure: a garden space needs
persistence and renewal; annuals of growth,
to feel and be safe, with some sense of
budding, blooming, seeding, decay, death and
enclosure and the absence of feeling that users
transformation. A healing garden should also
are in a “fishbowl,” being stared at.
provide views to the sky and changing cloud
Conclusion: formations, pools that reflect the sky or trees
and that can attract wildlife, reminding those
For a patient, visitor, or member of staff, in ill-health that life goes on, elements that
spending long hours in a hospital can be a feature the sight and sound of moving water,
and where possible, views to the horizon or to
landscape. The layout of the garden should be
such that walking or being pushed in a
wheelchair through the garden provides a
variety of open and closed views, experiences
of differing sub-spaces, even elements of
positive surprise or whimsy.

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