Armed with the latest in diagnostic and treatment facilities, the MSKCC center aims to take on breast cancer
The new Evelyn H. Lauder Breast Center of Memorial Sloan-Kettering Cancer Center (MSKCC) and the MSKCC Imaging Center provide cutting edge outpatient diagnostic and treatment services specifically for breast cancer, state-of-the-art diagnostic imaging services and medical and administrative office and support space. Worldwide, breast cancer is the most common type of non-skin cancer in women. In the United States, it is the second most common cancer, and the second most common cause of cancer death (after lung cancer).
Clearly, MSKCC’s new facility must be effective in the diagnosis and treatment of this prevalent and potentially fatal disease. To become the most effective center in the United States in the early diagnosis and treatment of breast cancer, MSKCC and their design team completely rethought how to best deliver the myriad of medical services required when tackling cancer, in particular breast cancer. The overarching goal was to design an environment that first and foremost enhances the patient experience during the long ordeal that is cancer care.
The project programme and organizational planning were fine tuned to create an environment that facilitates the most efficient, stress-free delivery of breast cancer care for patients and a safe and effective environment for clinical staff. From the outset, the institution’s desire for an outpatient setting, distinct from the main hospital, further influenced the 220,000 sf building’s massing and exterior expression as a good neighbour, contextually blending with nearby residential buildings on Manhattan’s Upper East Side.
The building’s programme effectively uses the required zoning envelope of Manhattan’s Upper East Side with a required setback at 85 ft and sky exposure plane to express the building’s programme. The lower six levels house the clinical programme with an expressive, tartan grid of translucent, vision and spandrel glass.
The second setback volume includes levels 7-10, which house the academic medical offices within a brick volume with floor-to-ceiling punched windows that express each individual doctor comprising the entire team of physicians tackling cancer care. The top setback volume, levels 12-15, surmount the mechanical floor and house administrative offices for the institution in a light, all glass volume that blends into the sky.
The building’s palette of warm brick with human-scaled, punch windows complimented by a judicious use of glass curtain wall relates both to its residential context, as well as technologically advanced purpose. The building speaks both to home and hospitality as well as science and technology, effectively tying itself to the neighbourhood and main hospital campus two blocks away.
Imaging services require all modalities in close proximity to each other. This increases efficiencies of infrastructure, staffing and patient use. The design team was able to place all the imaging equipment on the building’s 5th and 6th level because of the zoning mandated setback.
This setback allowed placement of roof hatches that provide critical access for MRI magnet replacement. This location provides natural day-lighting to all the machine spaces, further elevating the patient (and staff) experience from the typical series of basement rooms to naturally lit spaces with views to the outside. This was achieved by enveloping the MRIs with copper mesh RF shielding that is translucent at the exterior windows.
Cancer care is a team-based effort. To be most effective in early diagnosis and treatment of many cancers, particularly breast cancer, the patient often needs to consult with medical, surgical and radiation oncologists. With this facility, all disciplines are gathered under one roof allowing the patient to stay in a central location while their medical team comes to them.
The first six levels of the building are devoted to exam, treatment and diagnostic imaging spaces with all medical and academic offices located above. The building’s elevator core provides a public side and a separate staff and service side. This staff core efficiently links clinical and office levels providing a level of privacy and comfort for staff movement without the distraction of unscheduled patient and family interface. This promotes cross-discipline interaction and collaboration, but more importantly, a quick turnaround with diagnosis and discussion of possible treatment avenues.
Within this facility, it is possible to go for a routine mammography then undergo an MRI scan, or perform a highly technical needle biopsy to be analysed immediately by the radiation oncologist and then further discussed with the surgical oncology team. This cross-disciplinary environment fundamentally speeds the diagnosis and treatment discussion, thus effectively inhibiting early stage cancer detection from elevating to the more difficult to cure later stage.
Because cancer care can often last several months or upward to a year, the design for the clinical spaces was based upon a hospitality model, with high-end finishes and concierge-like care. The building provides 36,000 sf of examination and consultation rooms used in a 'hoteling' manner and arranged to minimize patient travel and stress while enhancing comfort, privacy and dignity. Centrally located check-in and check-out areas move the patient’s administrative, post-examination medication and follow-up discussion outside of the critical examination spaces. This improves patient flow and increases through-put.
Team work space for the familiar faces of one’s medical team – nurse, physician and practice assistants as well as research and academic fellows - are arranged to greet the patient as she enters the cluster. For more effective imaging services, a series of gowned waiting areas are spread throughout the two imaging floors. This is quite effective in maintaining patient flow, privacy and comfort.