Architecture | Thesis Report

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care by Rajkumar Gopalbhai Babariya Enrollment No. 201603101710003 A thesis submitted in partial fulfillment of the requirements for the degree of

BACHELOR OF ARCHITECTURE [B.Arch.]

Raman Bhakta School of Architecture Uka Tarsadia University, Maliba Campus 2020-21 Thesis Guide: Ar. Manan Gandhi

Assistant Professor Raman Bhakta School of Architecture Uka Tarsadia University

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CERTIFICATE This is to certify that Mr. Rajkumar Babariya has submitted the Final Thesis Report on the subject: “Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care” as a mandatory requirement for completion of the Bachelor of Architecture programme at the Raman Bhakta School of Architecture, Uka Tarsadia University for the academic year 2020–21.

His work is found to be satisfactory.

_____________________________ Ar. Manan Gandhi

Assistant Professor Raman Bhakta School of Architecture Uka Tarsadia University

_____________________________

_____________________________

Ar. Hatim Khapra

Ar. Sumesh Modi

Thesis Coordinator Raman Bhakta School of Architecture Uka Tarsadia University

Director Raman Bhakta School of Architecture Uka Tarsadia University

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

DISCLAIMER This document describes work undertaken as part of a programme of study at the Raman Bhakta School of Architecture, Uka Tarsadia University. All views, opinions and statements expressed therein remain the sole responsibility of the author, and do not necessarily represent those of the institute.

Name of the Student: Mr. Rajkumar Gopalbhai Babariya Enrolment No.: 201603101710003

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

ACKNOWLEDGEMENT First and Foremost, I would like to thank all the professors at Raman Bhakta School of Architecture, Uka Tarsadia University who has helped me throughout my academic endeavour.

I would like to extend my sincere gratitude to my Thesis guide Ar. Manan Gandhi.

Without their assistance and dedicated involvement in every step throughout the process, this paper would have never been accomplished. I would like to thank you for supporting, understanding and mentoring over this past five years.

Beside my Guide, I am deeply grateful to Ar. Punita Mehta, for her insightful comments, suggestions and hard questions at every stage of thesis. In addition, I would also like to thank Ar. Jaydutt Vaishnav, for his support, knowledge and mentoring throughout my internship period, which has really helped me in my academic curricula.

Moreover, I would like to thank my fellow batch mates, my seniors and friends – Meet, Ruchit, Keval, Harshil, Arpit, Harshit and Umang for being supportive and constant push to exceed my limits.

I also place on record, my sense of gratitude to one and all, who directly or indirectly, have lent their hand in this venture.

Finally, I must express my very profound gratitude to my parents for providing unfailing support and continuous encouragement throughout my years of study. This accomplishment would not have been possible without them.

Rajkumar Babariya

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

TABLE OF CONTENT CERTIFICATE ............................................................................................................. i DISCLAIMER............................................................................................................... i ACKNOWLEDGEMENT ...........................................................................................ii TABLE OF CONTENT............................................................................................. iii TABLE OF FIGURES ................................................................................................. v GLOSSARY................................................................................................................. ix ABSTRACT ................................................................................................................ 10  STAGE 01: - INTRODUCTION .................................................................. 11 •

BACKGROUND OF THE PROJECT................................................. 12

•

AIMS AND OBJECTIVES ................................................................. 12

•

PROBLEM STATEMENT .................................................................. 13

•

SCOPE AND BACKGROUND RESEARCH .................................... 14

•

ARTICES AND FACTS ...................................................................... 15

•

RESEARCH QUESTIONS ................................................................. 18

•

RESEARCH METHODOLOGY......................................................... 18

 STAGE 02: - CASE STUDY ......................................................................... 19 •

KARUNASHRAYA: Home for terminally ill ..................................... 20

•

URBAN HOSPICE .............................................................................. 24

•

TATA MEDICAL CENTER cancer hospital and research centre ...... 26

•

MAGGIE’S CENTRE ......................................................................... 29

•

Lowy Cancer Research Centre............................................................. 33

 STAGE 03: - SITE INFORMATION .......................................................... 37 •

SITE SELECTION CRITERIA ........................................................... 38

•

SITE IDENTIFICATION .................................................................... 42

•

CONTEXTUAL STUDY .................................................................... 44

•

FINAL SITE AND ANALYSIS .......................................................... 47

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SITE PHOTOS..................................................................................... 49

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PROGRAMME DEVELOPMENT ..................................................... 51

 STAGE 04: - DESIGN DEVELOPMENT ................................................... 53 •

CONCEPTUAL INTRODUCTION .................................................... 54

•

CONCEPTUAL ZONING ................................................................... 56

•

CONCEPTUAL IDEAS ...................................................................... 57

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DESIGN DEVELOPMENT - 01 ......................................................... 62 iii

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

•

DESIGN DEVELOPMENT - 02 ......................................................... 67

 STAGE 05: - FINAL DESIGN...................................................................... 71 •

MASTER PLAN .................................................................................. 72

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ISONOMETRIC SITE EXPLANATION............................................ 75

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AXONOMETRIC DIAGRAM ............................................................ 76

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SITE SECTIONS AND ELEVATIONS ............................................. 77

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PATIENT’S WARD ............................................................................ 80

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WALL SECTION ................................................................................ 89

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DIAGNOSIS ........................................................................................ 90

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RESEARCH CENTRE ........................................................................ 93

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KITCHEN/MESS & OPEN AIR DINNING ....................................... 96

•

MULTIFUNCTIONAL AREA ........................................................... 99

 STAGE 06: - CONCLUSION ..................................................................... 105  STAGE 07: - BIBLIOGRAPHY ................................................................. 107

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

TABLE OF FIGURES Figure 1. Role play of palliative care ........................................................................... 13 Figure 2. Classification for palliative care and hospice ............................................... 14 Figure 3. Two ways of healing .................................................................................... 14 Figure 4. Report of the economic times ....................................................................... 15 Figure 5. Incident and Mortality raio_worldwide ........................................................ 15 Figure 6. Health expenditure ratio of India .................................................................. 16 Figure 7. Article on evidence based design ................................................................. 16 Figure 8. Recovery ratio through surroundings ........................................................... 17 Figure 9. Optimal healing environment diagram ......................................................... 17 Figure 10. Research methodology diagram ................................................................. 18 Figure 11. Current location .......................................................................................... 20 Figure 12. Accessibility map ....................................................................................... 20 Figure 13. Outer ring road map.................................................................................... 20 Figure 14. Elevations ................................................................................................... 21 Figure 15. Site Plan ...................................................................................................... 21 Figure 16. Typical section through ward ..................................................................... 21 Figure 17. Waterbody view.......................................................................................... 22 Figure 18. Bird eye view from court ............................................................................ 22 Figure 19. Circulation diagram .................................................................................... 23 Figure 20. Built/Unbuilt and visibility diagram ........................................................... 23 Figure 21. Area Specification diagram ........................................................................ 23 Figure 22. Bird eye view .............................................................................................. 24 Figure 23. Front Elevation showing proximity of the site ........................................... 24 Figure 24. Ground floor plan ....................................................................................... 25 Figure 25. First floor plan ............................................................................................ 25 Figure 26. Current Location......................................................................................... 26 Figure 27. Site plan ...................................................................................................... 26 Figure 28. Ground floor plan ....................................................................................... 27 Figure 29. First floor plan ............................................................................................ 27 Figure 30. Second floor plan........................................................................................ 27 Figure 31.view from pathways .................................................................................... 28 Figure 32. Bird eye view .............................................................................................. 28 Figure 33. Site section.................................................................................................. 28 Figure 34. Site elevation .............................................................................................. 28 Figure 35. Section showing proper ventilation ............................................................ 28 Figure 36.Proximity of the site .................................................................................... 29 Figure 37. Plans at different levels .............................................................................. 29 Figure 38. Section showing connectivity with nature .................................................. 30 Figure 39. Indoor multilevel spaces ............................................................................. 30 Figure 40. Isometric structural diagram ....................................................................... 31 Figure 41. Sections....................................................................................................... 31 Figure 42. Connecting space diagram .......................................................................... 31 v

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 43. View from terrace gardens ......................................................................... 32 Figure 44. Section through site .................................................................................... 32 Figure 45. Lowry cancer research Centre .................................................................... 33 Figure 46. Site plan ...................................................................................................... 34 Figure 47. Elevation ..................................................................................................... 34 Figure 48. Section through research lab ...................................................................... 35 Figure 49. Floor plan.................................................................................................... 35 Figure 50. Research labs .............................................................................................. 36 Figure 51. All sites of cancer ....................................................................................... 38 Figure 52. All India incident rate ................................................................................. 38 Figure 53. Incident and mortality rate amongst gender ............................................... 39 Figure 54. Importance of palliative care ...................................................................... 39 Figure 55. All sites of cancer amongst male and female ............................................ 40 Figure 56. National health mission statement .............................................................. 41 Figure 57. List of regional cancer centers under this scheme ...................................... 41 Figure 58. Site location ................................................................................................ 42 Figure 59. Growth of Ahmedabad over the years ........................................................ 43 Figure 60. Expansion of roads and streets ................................................................... 43 Figure 61. Accessibility and connectivity.................................................................... 44 Figure 62. Landmarks and amenities ........................................................................... 44 Figure 63. Development plan 2021.............................................................................. 45 Figure 64. Bhat, Ahmedabad ....................................................................................... 46 Figure 65. TP scheme .................................................................................................. 46 Figure 66. Site photos .................................................................................................. 46 Figure 67. Site .............................................................................................................. 47 Figure 68. Site contours ............................................................................................... 47 Figure 69. Land use...................................................................................................... 48 Figure 70. Road connectivity ....................................................................................... 48 Figure 71. Figure and ground....................................................................................... 48 Figure 72.Proximity of the site .................................................................................... 49 Figure 73. Demographic data ....................................................................................... 50 Figure 74. Programmatic calculation ........................................................................... 51 Figure 75. Programmatic calculation ........................................................................... 52 Figure 76. Diagram of interconnections ...................................................................... 54 Figure 77. Design factors for architectural healing ..................................................... 55 Figure 78. Programmatic connection of spaces ........................................................... 56 Figure 79. Site zoning .................................................................................................. 56 Figure 80. River edge activity section ......................................................................... 57 Figure 81. Conceptual site section ............................................................................... 57 Figure 82. Section through ward with view ................................................................. 57 Figure 83. Section through ward .................................................................................. 58 Figure 84. View from ward towards the river.............................................................. 58 Figure 85. Section through meditation hall and buffer zone ....................................... 59 Figure 86. View from meditation hall.......................................................................... 59 Figure 87. View from yoga deck ................................................................................. 60 Figure 88. Space below ward area ............................................................................... 60 vi

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 89. Section of activity area and auditorium ...................................................... 61 Figure 90. Open vegetation area .................................................................................. 61 Figure 91. Design According to zoning ....................................................................... 62 Figure 92. Design development ideas .......................................................................... 63 Figure 93. Site Plan ...................................................................................................... 64 Figure 94. Site sections ................................................................................................ 64 Figure 95. Plan of wards .............................................................................................. 65 Figure 96. 3D views ..................................................................................................... 66 Figure 97. Site Layout_Ground floor........................................................................... 67 Figure 98. Site Layout @-3M ...................................................................................... 67 Figure 99. Site Layout @-6M ...................................................................................... 68 Figure 100. Site Sections ............................................................................................. 68 Figure 101. Site sections .............................................................................................. 69 Figure 102. Site Layout_Ground Floor ........................................................................ 72 Figure 103. Site Layout @-3M .................................................................................... 73 Figure 104. Site Layout @-6M .................................................................................... 74 Figure 105. Isometric Explanation............................................................................... 75 Figure 106. axonometric Diagram ............................................................................... 76 Figure 107. Site section_AA'_BB' ............................................................................... 77 Figure 108. Site Section_CC'_DD' .............................................................................. 78 Figure 109. Site section_EE' and Site Elevation.......................................................... 79 Figure 110. 6 Bed Unit ward........................................................................................ 80 Figure 111. Section Through ward .............................................................................. 81 Figure 112. Axonometric view and sections................................................................ 82 Figure 113. View from wards ...................................................................................... 83 Figure 114. View of river from inside the wards ......................................................... 84 Figure 115. Connection of Elevated Walkways with Wards ....................................... 84 Figure 116. 6 bed unit and section through wards ....................................................... 85 Figure 117. 2 bed unit ward and section ...................................................................... 86 Figure 118. views of 2 bed unit wards ......................................................................... 87 Figure 119. Axonometric view .................................................................................... 88 Figure 120. Stack ventilation and Staircase detail ....................................................... 88 Figure 121. Wall Section and Material Detail ............................................................. 89 Figure 122. Diagnosis area and sections ...................................................................... 90 Figure 123. Section and rooftop detail ......................................................................... 91 Figure 124. research Centre and section ...................................................................... 93 Figure 125. Axonometric view and sections................................................................ 94 Figure 126. Views from Research Centre .................................................................... 95 Figure 127. Section through kitchen and open air dinning .......................................... 96 Figure 128. Kitchen/mess and open air dinning .......................................................... 97 Figure 129. Common activity area............................................................................... 98 Figure 130. Section through auditorium and multifunction area ................................. 99 Figure 131. View from elevated walkways ............................................................... 100 Figure 132. View from Multifunctional area and elevated walkways ....................... 101 Figure 133. View from walkway and Ghats .............................................................. 102 Figure 134. Meditation hall facing river .................................................................... 103 vii

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 135. Fire escape route plan ............................................................................. 104 Figure 136. Site elevations ......................................................................................... 104

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

GLOSSARY Palliative care: Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Evidence based design: Evidence-based design is the process of constructing a building or physical environment based on scientific research to achieve the best possible outcomes.

Hospice care: Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

ABSTRACT The Thesis Topic Enhance the Current Condition of Cancer Disease and designing Focus On How to Develop Correlation Between Healing and Architecture.

Patient Having Cancer Is Disturbed Through Spiritual, Physical, Psychological and Social Problems, So Project Aims to Solve the Issues Related to Quality of Life and to Provide Care Centre Where Patient Could Heal Through Mind and to Provide a Research Centre for The Growth of Medical Intervention.

Palliative Care Is an Approach That Improves the Quality of Life of Patients and Their Families Facing the Problem Associated with Life-threatening Illness. ONLY 2%-3% People Have Access to Palliative Care and Pain Management in India. Only Two States Have Adopted Palliative Care Policies in India, They Are Kerala and Karnataka. We Have a National Programme for Palliative Care but Even Today Medical Students Do Not Learn Pain Management from The Educational Programme.

In my opinion, looking at the Current Cancer Cases in India It Becomes Very Essential to Study the Concept of Palliative Care and to Develop Correlation Between Care Taker, Patient, Family Member and Architectural Environment.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 01: - INTRODUCTION

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

BACKGROUND OF THE PROJECT Patient Having Cancer Is Disturbed Through Spiritual, Physical, Psychological and Social Problems, So Project Aims to Solve the Issues Related to Quality of Life and to Provide Care Centre Where Patient Could Heal Through Mind and to Provide a Research Centre for The Growth of Medical Intervention. So People Could Heal Through Surroundings by Developing Correlation with Mind and Environment Along with Treatment.

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

AIMS AND OBJECTIVES 1. Spaces can be designed in line with the healing process of patients.

2. To discover various facets of architecture viz-a- viz human psyche.

3. To study the concept of palliative care, to understand the relation of man and his environment.

4. To study how natural elements can be a catalyst in the healing environment.

5. To develop correlation between care taker, patient, family and architectural environment.

6. To give treatment not far from hospitals but away from crowded area on the outskirt neglecting pollution, traffic, congestion, noise, work pressure, so that patient could heal mentally through surroundings along with treatment.

7. Research Centre and training would be provided for the medical intervention and to give learning of cancer care practically.

8. To give accommodation to the family as well so that interaction and different types of activities could perform.

9. To create experiential, eco – friendly, interactive and learning spaces.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

PROBLEM STATEMENT There are more than 1 crore cancer patients in the world. Nearly 29 lakhs of them are in India.

1.

2.

3.

4.

5.

6.

7.

8.

People living with cancer in India (within five years of diagnosis): 1.8 million Number of new cases getting added every year: over 1 million Deaths due to cancer in 2018: 784,821 Total number of trained oncologists in the country (doctor-patient ratio of 1:2,000): 1,000 Total number of cardiologists in India (doctor-patient ratio of 1:1,125): 40,000 Total number of nephrologists in the country (doctor-patient ratio of 1:8,000): 1,500 Dedicated cancer hospitals in India: 27 General or multi-specialty ones providing care to cancer patients: above 300

Only 2%-3% people have access to palliative care and pain management in India. Only two states have adopted palliative care policies in India, they are Kerala and Karnataka.

We have A national programme for palliative care but even today medical students do not learn pain management from the curriculum.

India is not more aware about palliative care and mental healing system as it is growing in southern part of India. Also medical students are not educated with this type of healing care so built spaces has to address palliative care along with cancer research and training center which will provide learning for palliative care.

People in India with advanced life threatening illness are dying with needless pain and suffering. In India people are not accepting the fact that curative and uncurative diseases has to be cured differently and by receiving inappropriate medical care, such intervention makes the lives of these patients a living hell. Providing them with healing environment would help them live longer than expected.

Figure 1. Role play of palliative care

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

SCOPE AND BACKGROUND RESEARCH 1. A wide perspective of patient’s behavior, psychology, thoughts on spaces could be understand.

2. Up to what extent architectural spaces impact on human psych could be analyzed.

3. How social interaction plays vital role in changing patient’s health could be understand.

4. To understand how traditional way of healing and location for healing affect patient’s health.

5. Researcher could work in a better space along with patients and their family and could understand symptoms in a better way.

6. A learning opportunity for the medical students.

Figure 2. Classification for palliative care and hospice

Figure 3. Two ways of healing

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

ARTICES AND FACTS

Figure 4. Report of the economic times

India Has the Population of More Than 138 Crore and with This Much Population and Poverty, There Is Rapid Growth in Various Disease Including Cancer and Mental Disorder. In Both the Disease Patient Could Heal Through His/her Own Mental Strength but from The Fear of Huge Disease One Could Not Heal Himself Because of Fear in Mind. Patient Having Cancer Is Disturbed Through Spiritual, Physical, Psychological and Social Problems, So Therapeutic Healing Could Be Very Helpful Where Patient Could Heal Through Mind. People Could Heal Through Surroundings

by Developing Correlationith Mind and Environment.

Figure 5. Incident and Mortality raio_worldwide

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 6. Health expenditure ratio of India

Figure 7. Article on evidence based design

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 8. Recovery ratio through surroundings

It Has Been Proven by Professor Fred Gage, Who Work in The Building Designed by Louis Kahn, The Laboratory at The Salk Institute in San Diego (California), Has Conducted Studies Which Have Shown That an Environment Increases Person’s Brain Volume by Staggering 15%. There Are Maggie Centers in Hong Kong, Barcelona, United Kingdom Which Aims to Heal Cancer Patients Through Surrounding Architecture.

Thus Through Architecture and Surroundings Psychology of a Person Could Be Change and More Research Could Take Place at The Same Time.

Figure 9. Optimal healing environment diagram

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

RESEARCH QUESTIONS 1. Why Cancer Patients Need Awareness in India?

2. How Palliative Care Play Vital Role for Cancer Patients?

3. How Architecture Plays a Role in Bringing Hope to Cancer Patients?

4. In Which Condition This Intervention Works?

RESEARCH METHODOLOGY 1. To study the existing impact of cancer on human psyche.

2. To study exiting functional system of hospitals and emerging it into environment friendly for patients and analyzing the effective architectural solutions which are already being built.

3. To research how social interaction of patient with staff members, family, friends impact on human psychology.

4. To analyze how architectural space would impact on person’s brain through different theories and case studies.

5. Architecture being tertiary effect on human’s mind, this study aims on studying and researching on the psychological impact of space in human mind and improve the living conditions of the patients not only by improving the quality of space. Taking all that into consideration, project may accommodate all the necessary facilities along with the social and environmental interaction.

6. To understand the work of researcher’s and needful spaces to enhance the research for curing in better way.

7. Taking out the inferences by analyzing the existing practices at Hospitals and Care Centers from the conducted surveys of the Patients and incorporating all the required solutions in the design which may help in making the design more effective for Improving Patient’s Health

Figure 10. Research methodology diagram

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 02: - CASE STUDY

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

KARUNASHRAYA: Home for terminally ill Project name: karunashraya Bangalore hospice trust, Bangalore.

Location: old airport – varthur main road, kundalahalli gate, marathahalli, Bangalore.

Site area: 19,324 sq.m Architect: mindspace architects Figure 11. Current location

Figure 12. Accessibility map

Bangalore hospice trust is located on outskirt area of Bangalore, due to which it allows opportunity to be surrounded

by

natural

environment and it cut throat the noisy sound of day today life. in addition, location also favors Figure 13. Outer ring road map

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the

accessibility

through the site. | 20

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 14. Elevations

Figure 15. Site Plan

Figure 16. Typical section through ward

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

OBSERVATIONS It Has 5 Wards and Each Has 12 Beds.

Each Ward Is Arranged in A Way That It Get Astounding View of Waterbody and Green Space.

Medical Treatments for Curing the Disease Is Not Provided but The Nurses Take Care of the Patients by Providing Them with Basic Medical Support Like Morphine Is Given to Patients Suffering from Severe Pain and Also Regular Checkups Are Done.

Project Is Constructed in Area Where from Both the Side of the Site Noise Is Restricted.

PROGRAMME DRYING YARD - 40 sq.m LAUNDRY - 35 sq.m KITCHEN - 46 sq.m NURSE’S DINING - 36 sq.m PRAYER ROOM - 20 sq.m PARLOUR - 36 sq.m STORE - 18 sq.m AUDITORIUM - 95 sq.m MORGUE - 22 sq.m SERVANT’S QUARTER - 16 sq.m DENSE VEGETATION - 40 sq.m WARD - 100 sq.m NURSE STATION - 13 sq.m TOILET - 12 sq.m CORRIDOR - 1256 sq.m RECETION - 88 sq.m ADMINISTRATION - 50 sq.m DAY CARE - 35 sq.m COURT - 250 sq.m SINGLE BEDROOM - 14 sq.m DOUBLE BEDROOM - 12 sq.m MEDITATION - 40 sq.m TRUSTEE’S ROOM – 38 sq.m WATERBODY - 690 sq.m Rajkumar Babariya_201603101710003

Figure 17. Waterbody view

Figure 18. Bird eye view from court

SERVICES • Symptom management •

Physiotherapy assessment

•

Diversion therapy

•

Family counselling

•

Mobilisation

•

Pain management

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 19. Circulation diagram

Figure 20. Built/Unbuilt and visibility diagram

Figure 21. Area Specification diagram

LEGEND

INFERANCES • • • •

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Easy transportation as it is connected with airport and hospital.

It escalates sustainable approach as it uses solar panels, bio gas, water treatment etc.

Lacks in family accommodation and recreational area.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

URBAN HOSPICE Project name: urban hospice Location: Denmark Site area: 2250.0 sq.m Architect: nord architects Project year: 2016

Figure 22. Bird eye view

It is designed for the deaconess community, located in copenhagen, Denmark. The project replaces an existing hospice, and is designed to reflect and support the notion that healing architecture has a positive effect on palliative patients. The overall form and concept were heavily influenced by the complex site conditions and the proximity of the neighboring built context. The hospice accommodates capacity of 16 beds.

All the courtyard and the green space gives pleasuring experience to the patients as it is connected with common activities of the building.

Context shows the proximity with housing and historical buildings which reflects design challenge for the project.

Figure 23. Front Elevation showing proximity of the site

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 24. Ground floor plan

Figure 25. First floor plan

INFERANCES 1. It creates multiple courts and keep connected to nature at interconnected levels.

2. It lacks in multiple recreational area.

3. Rooms are accessible with narrow corridors, which isolate the patient and make no difference with hospitals.

4. Material and colors used gives warm feeling to the patient.

5. Lacks in accommodation for the family as it is crucial period for the patient along with family.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

TATA MEDICAL CENTER cancer hospital and research centre Project name: Tata medical centre Location: Kolkata, India.

Site area: 52,609 sq.m Architect: cannon design Project year: 2011 Figure 26. Current Location

Figure 27. Site plan

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 28. Ground floor plan

1. Rather than simply housing all programmatic components in one large boxlike building, a campus was designed by accommodating care delivery, research, academic, and support functions in separate yet linked structures.

2. These buildings surround a central courtyard that forms the heart of the campus, with gathering spaces and gardens that foster communication and interaction among patients, family, clinicians, researchers, faculty, and students.

INFERANCES

Figure 29. First floor plan

• • • • • • • • • •

Diagnostic Therapeutic Oncology Rehabilitation Palliative Care Inpatient Infection Control Research and Development Residential Block Premashraya

Figure 30. Second floor plan

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

INFERANCES

Figure 31.view from pathways

Figure 32. Bird eye view

1. Located in the outskirt area thus, it helps to remain isolate from crowd and types of pollutions.

2. It escalates sustainable approach as it uses solar panels, rain water harvesting, power plant etc.

3. Multiple integrated courts benefit natural ventilation and interacting space for the patients, family, researcher, doctors, and nurses.

4. Imparting more walkable space enhance different experiences. though building is 5. Even segregated by multiple courts many spaces didn’t get natural sunlight.

6. Rooms of the patient are through narrow passages which isolate the patient.

Figure 33. Site section

Figure 34. Site elevation

Figure 35. Section showing proper ventilation

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

MAGGIE’S CENTRE Project name: Maggie centre Location: Leeds, uk.

Site area: 1400 sq.m Architect: thomas heatherwick Project year: 2018 – 2020

Figure 36.Proximity of the site

Maggie’s Centre is a charity that provides free practical and emotional support for people with cancer. The Maggie’s center, located within the campus of St. James’s University Hospital in Leeds.

Figure 37. Plans at different levels

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 39. Indoor multilevel spaces

Figure 38. Section showing connectivity with nature

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Maggie's Leeds Is Designed as A Group of Three Large-scale Planters, Built On a Sloped Site, That Each Encloses a Counselling Room. These Surround The 'Heart' Of The Center - The Kitchen - As Well as More Social Spaces for Group Activities Including a Library and Exercise Room. Maggie's Leeds Uses Several 'Healthy' Materials and Energy-saving Techniques. The Building's Structure Is Built from A Prefabricated and Sustainably-sourced Spruce Timber System. Porous Materials Such as Lime Plaster Help to Maintain the Internal Humidity of The NaturallyVentilated Building.

Figure 40. Isometric structural diagram

Figure 41. Sections

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Figure 42. Connecting space diagram

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 43. View from terrace gardens

Figure 44. Section through site

INFERANCES 1. Located in the densely urban context of Leeds which serve a design challenge to inculcate such a rejuvenating environment.

2. Project is a part of the hospital beside which facilitate patient to access easily.

3. The central social gathering space is connected with the counseling rooms and other public space which offers further connectivity with the natural element.

4. The interconnected multiple levels give variant interaction amongst patients.

5. Project incorporates sustainable measures and has used different material such as spruce timber wood and porous lime plaster which enhance the aesthetic beauty.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Lowy Cancer Research Centre Project name: lowy cancer research centre Location : kensington, Australia site area: 17,000 sq.m Architect: lahznimmo architects + wilsons architects Project year: 2009

Figure 45. Lowry cancer research Centre

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 46. Site plan

This research facility is a joint venture between the university of nsw, faculty of medicine and the children’s cancer institute Australia (ccia), bringing together childhood and adult cancer research on the one site.

Four levels of generic microbiological research laboratories. One level of shared support laboratories including imaging and cancer genetics. One level for animal research. One level for administrative services. Shared common interaction areas which serve as a link to the adjacent wallace wurth medical sciences building

Figure 47. Elevation

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Figure 49. Floor plan

Figure 48. Section through research lab

The building by virtue of its function divides naturally into a more formal but flexible “laboratory box” containing labs, support space areas and floor by floor plant and then a more fluid “human strand” containing write up spaces and a variety of areas for break out and collaborative work. The main focal and social space in the building is an atrium space, which uses the metaphor of the “science knowledge bank”. This space looks directly in the laboratory floors and contains all vertical circulation, breakout and meeting spaces. The atrium forms a part of the “human strand” and connects on four levels via an occupied bridge link to the existing faculty of medicine building. This linking element physically connects the lift cores of the two buildings maximizing the potential for collaboration between the faculty of medicine and the research facility.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 50. Research labs

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 03: - SITE INFORMATION

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SITE SELECTION CRITERIA Palliative Care Inculcate an Environment Which Is Unlike to Hospital and Tries to Impart Various Kinds of Training, Activities and Workshops. More Focus Emphasis On Healing Environment, Interactive Activities, Workshops and So On. ONLY 2%-3% People Have Access to Palliative Care and Pain Management in India.

Only Two States Have Adopted Palliative Care Policies in India, They Are Kerala and Karnataka.

There Are Only 7 Institute in India Which Perform and Teach Palliative Care. At Present There Are Only 5 States Who Has Incorporated Such Institutes Are New Delhi, Andhra Pradesh, Maharashtra, Kerala, Telangana. Ahmedabad Stands 4th In Incident Rate of All Sites of Cancer After Delhi, Mumbai and Bangalore.

Incident Rate of Oral Cavity, Pharynx and Breast Cancer Is High After Cancer of Digestive System. Amongst All Sites of Cancer in Gujarat Prevalence of Oral and Breast Cancers Are in Higher Percentage.

Healing Environment Is a Sensitive Function as It Provides Patients with Various Opportunities of Rehabilitation. Therefore, The Site Selection for Such a Project Is Critical in Order to Provide the Maximum Advantage to The Patients.

It is important to avail the project which facilitate good transport, neglect the noise and air pollution and keep isolate from crowd, a quality of spaces which would ultimately help the patients to recover.

Site Selecting Criteria Focus On 1.

2.

3.

4.

Easy Accessibility to The Site.

Should Be Close to The Health Care Facility.

Quality of Space and Environment Around.

Focus On Treatment Which Is Not Available in That Area.

Figure 52. All India incident rate

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Figure 51. All sites of cancer

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 53. Incident and mortality rate amongst gender

Figure 54. Importance of palliative care

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 55. All sites of cancer amongst male and female

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 56. National health mission statement

Figure 57. List of regional cancer centers under this scheme

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

SITE IDENTIFICATION

Figure 58. Site location

The concerns about the project is to create a healing environment for the patients. The rationale behind selecting this site to keep the patients isolated from the dense crowd.

Site is located on the outskirt in village and major part is in agriculture zone and help to maintain a quality environment.

AHMEDABAD The site is located in the center of Gujarat as it could serve a good accessibility to all the major urban cities as well.

Under “health minister’s cancer patient fund” 27 dedicated cancer hospitals were developed and accordingly under “national health mission” assistance for tertiary care centers and palliative care centers are provided by government which would help to incorporate such institutes.

Thus site has opportunity as Gujarat cancer and research institute remain connected to the project. Along with that project facilitate a good accessibility as patient from different state could access easily because airport, brts gives easy access to the site.

Site is located in the bhat village which serves a river frontage and help to facilitate a quality environment which is needed for the intervention. Apart from that site allows easy access to Gandhinagar as well as gift city facilitate the program.

Site is beside the Gandhinagar – Ahmedabad state highway which connect further to sardar Patel ring road.

Medical students are only aware of the curative measure such as general surgery, ophthalmology, obstetrics and gynecology, however they do lack in providing treatment including oncology, cardiology, neurology. So intervention help to facilitate such services which patient could access easily in the urban context with better selfhealing environment.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 59. Growth of Ahmedabad over the years

Figure 60. Expansion of roads and streets

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CONTEXTUAL STUDY

Figure 61. Accessibility and connectivity

Figure 62. Landmarks and amenities

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 63. Development plan 2021

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 64. Bhat, Ahmedabad

Figure 65. TP scheme

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Figure 66. Site photos

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

FINAL SITE AND ANALYSIS Location: Bhat, Ahmedabad, Gujarat.

Site Area: 27,998 Sq.M Site Is Located On the Bank of River Sabarmati. Proximity of The Site Serves More Open Space and More Agricultural Zones Enhance the Environment and Reduce Pollution. There is 18m wide secondary road which further connect the site to Ahmedabad – Gandhinagar highway.

Figure 67. Site

• • •

The Site Is Located 48.5 Meter (159 Ft.) Above The Sea Level.

The Maximum, Average and Minimum Elevation On Site Is 178ft., 158ft and 140ft, Respectively.

Average Slope Is 5.6 Percent.

Figure 68. Site contours

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 69. Land use

Figure 70. Road connectivity

Figure 71. Figure and ground

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

SITE PHOTOS

Figure 72.Proximity of the site

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 73. Demographic data

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

PROGRAMME DEVELOPMENT

Figure 74. Programmatic calculation

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 75. Programmatic calculation

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 04: - DESIGN DEVELOPMENT

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

CONCEPTUAL INTRODUCTION

CANCER

PHYSIQUE

PALLIATIVE CARE

HEALING

PSYCHOLOGY

CANCER

HEALING ARCHITECTURE

Figure 76. Diagram of interconnections

Design concerns

Atmosphere for healing

1. Buffer space 2. Vehicle free movement 3. internal and external courts 4. Visibility with river 5. Segregated activities 6. More walkways 7. Outdoor activities 8. Centrally focused amenities 9. Interconnected multilevel 10. More transitional spaces 11. Connectivity: patient + family + nursing + researchers 12. Roof top gardens / vegetation

• • • • • • •

Calm, tranquil, quiet and peaceful Warm Cozy Intimate Sociable – the need for social interaction Gloomy Nostalgic

The Concept of Healing Architecture Can Be Achieved by Providing Various Elements in Building.

The Importance Of

• • • • •

• •

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COLOR SCALE LIGHT MATERIAL VISUAL CONNECTIVITY SOCIAL INTERACTION NATURE

Plays an Important Role In Mental And Psychological Development Of A Person

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SOUND VENTILATION MOVEMENT

VIEW

LIGHT

PRIVACY

Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 77. Design factors for architectural healing

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

CONCEPTUAL ZONING

Figure 78. Programmatic connection of spaces

Figure 79. Site zoning

All the sides are more prompt for buffer zone as to minimize the disturbance from the outside even after the development in future. Recreational activities are accumulated in the centre to have better interactions between patient, family, nurses and researchers. accommodation of the family and patients are together for avoiding feeling of homesickness. More connection within the spaces need to be facilitated.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

CONCEPTUAL IDEAS

Figure 80. River edge activity section

Figure 81. Conceptual site section

Figure 82. Section through ward with view

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 83. Section through ward

Figure 84. View from ward towards the river

Each and every wards are facing towards the river and the site itself has the contours that each ward has view from the open terrace towards the river. Connectivity of the nature within the building would play crucial role in healing. Thus, more trees are inculcated within the building. more transitional space would aid myriads of surprises.

Recreational spaces are segregated, so patient would forcefully have to move from one point to another and would have various experience through transitions.

River edge has to be treated in a way that multifunctional activities would take place at different times of the day. Connecting walkways would connect open terrace of the wards and open patios towards the river.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 85. Section through meditation hall and buffer zone

Figure 86. View from meditation hall

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 87. View from yoga deck

Figure 88. Space below ward area

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 89. Section of activity area and auditorium

Figure 90. Open vegetation area

Common activity area is to be accommodated having visual connection with the tree.

Water and sky and to defame the feeling of isolated. Having multiple contours on the site gives opportunity to create multilevel vegetation and walkway area for the patients.

River edge walkways would help patients to have walk in the evenings and nights and have a pleasant view of river Sabarmati. it would create an environment of Sabarmati riverfront walkways.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

DESIGN DEVELOPMENT - 01

Figure 91. Design According to zoning

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 92. Design development ideas

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 93. Site Plan

Figure 94. Site sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 95. Plan of wards

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 96. 3D views

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

DESIGN DEVELOPMENT - 02

Figure 97. Site Layout_Ground floor

Figure 98. Site Layout @-3M

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 99. Site Layout @-6M

Figure 100. Site Sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 101. Site sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 05: - FINAL DESIGN

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

MASTER PLAN

Figure 102. Site Layout_Ground Floor

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 103. Site Layout @-3M

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 104. Site Layout @-6M

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

ISONOMETRIC SITE EXPLANATION

Figure 105. Isometric Explanation

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

AXONOMETRIC DIAGRAM

Figure 106. axonometric Diagram

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

SITE SECTIONS AND ELEVATIONS

Figure 107. Site section_AA'_BB'

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 108. Site Section_CC'_DD'

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 109. Site section_EE' and Site Elevation

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

PATIENT’S WARD

Figure 110. 6 Bed Unit ward

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 111. Section Through ward

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 112. Axonometric view and sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 113. View from wards

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 114. View of river from inside the wards

Each and every individual ward are facing southern side towards river Sabarmati and natural contours on the site itself facilitate the view of river from each and every wards and even from the bed itself patient can have a stupendous view of river.

Every wards is connected to the elevated walkways which further connects the walkways to the open patios which in a ways help to have evening walks and chitchat in the evenings.

Figure 115. Connection of Elevated Walkways with Wards

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 116. 6 bed unit and section through wards

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 117. 2 bed unit ward and section

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 118. views of 2 bed unit wards

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 119. Axonometric view

Figure 120. Stack ventilation and Staircase detail

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

WALL SECTION

Figure 121. Wall Section and Material Detail

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DIAGNOSIS

Figure 122. Diagnosis area and sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 123. Section and rooftop detail

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

As the diagnosis area is in the centre it aids patients to be more connected within site as well as it serves more open and green space within it which will not make it feels like a hospital.

Rooftop garden servers more open green space and in a way hide the diagnosis area which will not overpower the patient from feeling of hospitals and facilitate more multifunctional activity.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

RESEARCH CENTRE

Figure 124. research Centre and section

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 125. Axonometric view and sections

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 126. Views from Research Centre

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

KITCHEN/MESS & OPEN AIR DINNING

Figure 127. Section through kitchen and open air dinning

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 128. Kitchen/mess and open air dinning

Dining area connects wards, research centre, common activity, and admin which escalate better social interaction. Open air dinning helps the patient to remain connect to nature even while having the meal. The entrance through kitchen is surrounded by lily pond and enhance the feeling of floating object and also serve an informal seating space within the entrance.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 129. Common activity area

A common gathering area enforce Researcher, Doctors, Patient, nurses and family member to gather at one place to have a better interaction.

Vertical louvers, trees and lily pond in the common activity area interact with each other with the help of light and shadow and creates a drama for the patients to revive fast and help Researchers to study and analyse the symptoms and cure the patient’s.

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

MULTIFUNCTIONAL AREA

Figure 130. Section through auditorium and multifunction area

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 131. View from elevated walkways

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 132. View from Multifunctional area and elevated walkways

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 133. View from walkway and Ghats

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 134. Meditation hall facing river

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

Figure 135. Fire escape route plan

Figure 136. Site elevations

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

STAGE 06: - CONCLUSION

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Cancer Care and Research Centre – A Comprehensive Environment for Palliative Care

I have referred to all the case studies and articles based on the palliative and hospice care facility. Looking to all those references and existing health care functionality regards to cancer care, I initiated the project incorporating all those design strategies that uses environmental and behavioural psychology to improve the experience, healing and curing process for both the patient and doctors.

The project uses scientifically-proven research on how light, surroundings and access to nature affect mental and physical well-being to inform design decisions throughout.

The whole project is designed keeping in mind the basic psychology of cancer patient for the disease and design further enhance the architecture paradigm to break the stereotype regarding the existing health care system.

Across the campus you’ll find street network and otlas which will interpret the feeling of rural area and facilitates better social communication, elevated walkways at multilevel, common activity area for the patient, family member, researchers, nurses and doctors, Ghats, open air dinning, buffer zone, green belt and recreation areas for yoga, and meditation. All of this is designed so that patient can heal through this disease effectively.

Such palliative care promotes more awareness in the society towards life threatening disease like cancer and also aids the aspirants to learn and analyse how to improve the health care system in a better way.

This project helped me to understand the relation between human and architecture.

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STAGE 07: - BIBLIOGRAPHY

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• • • • • • • • • • • • • • •

http://cancerindia.org.in/cancer-statistics/ https://www.who.int/ https://medium.com/the-omnivore/how-architecture-plays-a-role-inbringing-hope-to-cancer-patients-a33aa223015 https://www.researchgate.net/publication/257353321_Healing_Architectu re https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care https://www.cancer.net/coping-with-cancer/physical-emotional-andsocial-effects-cancer/what-palliative-care https://www.e-architect.com/articles/placeboarchitecture#:~:text=Twenty%20years%20ago%20Roger%20Ulrich,and %20take%20fewer%20pain%20killers. https://www.mohfw.gov.in/ https://www.business-standard.com/article/current-affairs/india-has-1-8mn-cancer-patients-but-only-one-oncologist-to-treat-every-2-000114052401140_1.html https://www.charlesjencks.com/maggie-s-centres https://www.biospectrumindia.com/news/22/11136/assam-govt-tatatrusts-operationalise-cancer-care-foundation.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493213/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445485/ http://tmcepi.gov.in/IARCHub.jsp https://ascopubs.org/doi/full/10.1200/GO.20.00122

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