Cancer center set to expand; Hopkins consolidating scattered facilities in two modern buildings; Advances in care, research

THE BALTIMORE SUN

The Johns Hopkins Cancer Center will soon leave its cramped, outdated quarters for a pair of spacious buildings that are designed for a new era of cancer research and treatment.

Standing on opposite sides of North Broadway, the $125 million clinical center and $59 million research building will open at a time of mounting competition among hospitals and explosive growth in scientists' understanding of the disease.

The nine-story clinical tower, with 132 patient beds and room for hundreds of outpatients, will be formally dedicated tomorrow at ceremonies in its tall, airy atrium. It will open to patients in January. In December, scientists will begin setting up laboratories in the 10-story research building, which has room for more than 400 researchers.

"The medical and scientific advances have had us bursting at the seams," said Dr. Martin Abeloff, director of the cancer center. "This is an opportunity to introduce all sorts of new treatments and respond to the demands imposed by this very fierce disease we call cancer."

Although Hopkins is one of the most advanced cancer centers in the nation, receiving the third-highest amount of federal funding, doctors and nurses say their facilities became outmoded soon after they opened in 1977.

Scientists in cramped laboratories are careful not to jostle each other while carrying delicate specimens. Tiles in a research building that was once a grocery store come unglued because the floor is saturated with animal fat. Patients have been known to stand in hallways or sit on the floor before appointments.

"I have no idea what the new building will be like, but anything will be an improvement," said Bettye Balland Griffin, who has kidney cancer. The White Marsh woman said the existing center's dingy walls and cramped rooms make patients who are ill and anxious feel worse.

Though the cancer center occupies a four-story building off the main hospital lobby, laboratories and patient rooms are also scattered across the sprawling medical campus in East Baltimore. With the opening of the new center, activities will be concentrated in the two buildings.

They are named the Harry and Jeanette Weinberg Building and the Bunting-Blaustein Cancer Research Building, in recognition of foundations that made large donations.

Patients and scientists

The new center, which also received $45 million in state funding, should ease the stress on patients who are now herded from one building to another for different services.

Also, by concentrating scientists under one roof, the research center should provide more opportunities for discussions -- both planned and accidental -- that stimulate ideas.

"It might sound trivial, but it's not," said Dr. Bert Vogelstein, who runs a cancer genetics laboratory. "If you're seeing someone in the hall, the chances for productive interactions just multiply."

The buildings were planned with the help of nurses, doctors and scientists.

For the clinical center, nurses insisted on privacy curtains that could be drawn around beds, though all the rooms are private. In the research building, labs were designed to suit the preferences of scientists who run them. One researcher likes to have his staff of 25 people work in a large open lab; another likes his staff divided among several laboratories.

While there will be more room for patients, the new clinical center will open with one fewer bed, a reflection of the shift to outpatient care. The number of hospital beds could decline in years to come.

The hospital already treats some of its bone marrow transplant patients on an outpatient basis and has designed the clinical center with contiguous wings for inpatients and outpatients. The building was designed so that inpatient rooms can be converted into clinic space as the practice is more widely embraced.

It is one of many features recommended by Gina Szymanski, a nurse manager who was brought into the planning process four years ago but who says she has been imagining new layouts since she came to Hopkins.

"For me, the gestation has been going on for 18 years," she said.

Decades of change

Large centers devoted to cancer are a relatively new phenomenon. "When I was training in Boston in the late 1960s, the idea of a coordinated, comprehensive cancer center wasn't a glimmer in anyone's mind," said Abeloff. "For most people, if you had cancer, you were ashamed to talk about it."

The words weren't used. Physicians just avoided it, and getting multitudes of specialists together was very difficult."

In the years after Hopkins built its first oncology center, cancer became "something that truly came out of the closet," he said, and the demand for treatment exploded. The ability to diagnose cancers early also meant patients were getting therapy more readily.

The past decade has also seen breakthroughs in research, with scientists gaining insights into the origins of the disease. This has spawned research into novel ways that cancers might someday be treated: gene therapies, cancer vaccines and drugs that starve tumors by depriving them of their blood supply.

As oncology has grown, so has the demand for laboratory space. Twelve years ago, Hopkins became so pressed for space that it purchased Brown's Market, a neighborhood grocery store, and turned it over to cancer research. The building is a dizzying maze of partitions, offices and laboratories.

Dr. Stephen Baylin, associate director of cancer research, says that with the new center, the program will finally have room to expand its force of talented young researchers.

"Until now, the first thing I ask myself in hiring someone is whether I have the bench where that person can work," Baylin said, "We're at a critical juncture. There are many things we can try. It's a matter of having the space, good people and the support."

Hopkins is one of 36 "comprehensive cancer centers" recognized by the National Cancer Institute.

To earn the designation, the centers, which conduct some of the most important clinical trials in the country, must have a high concentration of doctors engaged in cutting-edge research, treatment and education.

The designation gives medical centers an advantage in attracting federal funds. Hopkins will receive $45 million from the National Cancer Institute this year, trailing only the Fred Hutchinson Cancer Research Center in Seattle and the M. D. Anderson Cancer Center in Houston.

Local competition

Despite its national prominence, Hopkins is facing stiff competition from community hospitals that are luring cancer patients to plush facilities away from the central city.

In Towson, the Greater Baltimore Medical Center offers bone marrow transplants and is considering building a dedicated cancer building. In June, Sinai Hospital opened a cancer institute where physicians conduct stem cell transplants -- another expensive, high-tech procedure.

"They want to get into the most profitable lines," said Russell Frank of RAFrank Associates, a consulting firm that advises health care organizations on how to attract patients.

The rivalry can be intense, and some community hospitals argue that they offer equivalent care and focus more on patients than a research institution such as Hopkins.

The University of Maryland's Greenebaum Cancer Center has recruited about a dozen top physicians during the past few years, and that expertise has drawn patients. The number of patient visits has increased by a third during the past 18 months, and the center is planning an expansion that will double its space.

At Hopkins, designers included features to ease the strain on cancer patients and their families. Rooms have expansive windows that provide natural light and views of the city. Waiting areas offer stuffed chairs and love seats. Hallways are painted warm colors.

"The building will be a part of therapy, a marked contrast to what our building is now," said Abeloff.

While praising the Hopkins staff, patients have criticized the current facilities, describing parking as terrible, examination rooms as cramped and clinics as depressing. To reach MRI and CT scanners, patients have to march down a long, dimly lighted corridor often littered with food trays.

"They do the best they can," Griffin, the kidney patient, said of the staff. "But everybody is smushed in there together."

Szymanski, who manages 40 nurses, works out of an 8-by-9-foot office packed with computers, file cabinets and cardboard boxes. It is also where nurses hang their coats and pick up their mail, and where Szymanski talks to families struggling to cope with relatives' illnesses.

In the new building, Szymanski will have a private office, and the nurses a locker room and lounge. Families will have sitting areas near the hospital rooms where they can have private conversations.

Hopkins originally envisioned one building for patient care and research but quickly realized that such a facility would lack the needed space. Dr. Georgia Vogelsang, who treats patients with leukemia and lymphoma, said splitting the laboratories from the hospital space was a necessary compromise.

"There's no question that cancer research has exploded, and it's continuing to explode in terms of new findings and treatments that are becoming available," she said. "The new therapies really do require specific research areas -- and facilities where we can give therapies back to the patients."

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