From walls to wonder: Talking about spaces tailored for adolescents and young adults with cancer

Introduction

Adolescents and young adults (AYA) with cancer constitute a unique group of patients whose clinical characteristics and psychosocial needs differ substantially from those of pediatric patients or older adults. ¹ In recent years, the international scientific community has gradually recognized the specificities of these patients and the challenges necessary to provide them with the best possible therapies and the greatest chances of recovery, as well as a comprehensive management of their care pathway aimed at addressing not only their illness but also their lives.^{2 -6}

It is often said that AYA patients stay in a sort of “middle-heart” between the world of pediatric oncology and that of adult oncology. ⁷ Neither pediatric healthcare models nor adult ones are entirely capable of meeting their particular characteristics (ranging from their specific epidemiology to genetic and biological aspects, from a complex psychosocial sphere to clinical challenges such as difficulty in accessing referral centers and therapeutic protocols).^{5 -11} This perspective has led experts to consider the unification of forces, ideas, and resources of the two scientific communities - pediatric and adult - as crucial. At the European level, this vision, supported by the collaboration between the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE), ⁵ is now reinforced by the creation of a specific Network of Expertise (NoE) dedicated to AYA with cancer, developed as part of the Joint Action on Networks of Expertise (JANE) program promoted by the European Commission. ¹²

In Italy, AIOM (Associazione Italiana di Oncologia Medica) and AIEOP (Associazione Italiana di Oncologia ed Ematologia Pediatrica) established the AIOM-AIEOP Working Group in 2021 dedicated to AYA.^{13 -17} Among the various activities being carried out by the AIOM-AIEOP Working Group is the effort to define the essential requirements that care centers should ideally have to best address AYA patients. Among these essential requirements, along with other crucial aspects, is the issue of providing young patients with an age-specific environment designed around their needs (Table 1).

OPEN IN VIEWER

Table 1.

The structural and functional characteristics (“minimal essential requirements”) that a center should have for the proper clinical management of AYA patients, as defined by the AIOM-AIEOP Working Group.

Essential Characteristics
1	A patient-centered care model, focused on the needs of the patient, with their active involvement in decision-making and disease management.
2	Flexibility regarding age limits for admission to the center (absence of administrative barriers related to being under or over the legal adult age).
3	Multidisciplinary management of AYA patients, with the direct or indirect involvement of both the pediatric oncologist and the adult oncologist in multidisciplinary meetings and patient management.
4	Adequate adherence to oncology care standards for this patient group (treatment protocols for various malignancies, access to clinical trials).
5	Dedicated staff for the management of AYA patients, both during treatment and post-treatment, with particular attention to: a) Age-specific clinical psychology support; b) Social worker; c) Educator (youth worker); d) Support for school/university/work integration
6	Training programs for medical, nursing, and support staff on the specific diseases and needs of AYA patients.
7	Dedicated spaces tailored to the specific needs of patients in this age group (adequate privacy, areas for dedicated activities).
8	Development of specialized projects (social, educational, recreational).
9	Genetic counseling program.
10	Fertility preservation program.
11	Follow-up program for long-term management and issues.
12	Palliative care services tailored to the specific needs of patients in this age group.
13	Collaboration with national and international cooperative groups dedicated to adolescent and young adult patients.

The theme of hospital spaces designed and built taking into account the needs of young patients was one of the subjects of the conference held in February 2025 in Milan by the AIOM-AIEOP Working Group (“There is time. . . for the cure”, promoted by Fondazione Menarini). The specific session, entitled “When architecture meets oncology: The great beauty?” aimed to explore the concept of beauty in hospital environments, how hospitals can have patient-friendly architecture, and consequently the impact that this vision can have on the well-being of patients (as well as healthcare professionals). The symposium, attended by many professional and patients, was promoted and organized by Carlo Alfredo Clerici, clinical psychologist at the Istituto Nazionale dei Tumori, associate professor in clinical psychology at University of Milan, and section editor of Tumori Journal. He was one of the founders of the national programs addressing the topics of AYA patients with cancer. Carlo Alfredo Clerici passed away prematurely a few days before the conference, leaving a huge void in the entire Italian scientific community and among the many friends who loved him and who became the professionals they are thanks to him. This paper is clearly inspired by his ideas and is dedicated to him, with great affection and gratitude.

Local projects in Italian centers

In Italy, several centers have launched projects specifically dedicated to AYA patients. Up until ten years ago, only two pioneering initiatives existed: the Youth Area at the Centro di Riferimento Oncologico (CRO) in Aviano ¹⁸ and the Youth Project at the Istituto Nazionale dei Tumori in Milan.^{19 -24} However, the landscape has significantly improved over the last decade. ²⁵ Today, many pediatric oncology centers affiliated with AIEOP have dedicated spaces and initiatives for AYA patients. ²⁶

In the field of adult oncology, the situation is different - so far, the only established initiative is the AYA Project at Humanitas Research Hospital in Rozzano-Milan. ²⁷ However, things are changing, and since the creation of the AIOM-AIEOP Working Group, different medical oncology centers are starting to develop pathways to define AYA-specific projects.

Most AYA projects in Italy aim to improve the quality of life of young patients by promoting a holistic approach that prioritizes their overall well-being, focusing on their lives beyond illness. These projects share many common features, centered around two key aspects. The first is the creation of an age-specific environment within hospital wards, designed around young people's needs.^28,29 These spaces can take various forms: social activity areas, multifunctional rooms, soundproofed music rooms, study rooms, and gyms. These facilities are typically developed with the support of local parents' associations (for example, the Fondazione Bianca Garavaglia which supports the Milan Youth Project), or partially funded by charities such as Fondazione Umberto Veronesi, which has been running the "Easy Room" project in collaboration with Fondazione De Agostini for several years. ²⁵

The second common key element is the organization of special creative and artistic activities or workshops, covering photography, music, novel writing, fashion design, and more. These initiatives provide young patients with innovative ways to express their needs and share their stories.^{20 -24,26,30 -32}

Several projects have been implemented in recent years, including, most recently, a nationwide photography project involving over 100 young patients from 12 different centers. This project is being showcased through various traveling exhibitions across Italy. The first exhibition took place in February 2025 at the University of Milan, under the title “The Beauty of Imperfection”. Through photography, the project explores the search for beauty - an imperfect beauty - from the perspective of young patients undergoing treatment. This initiative highlights an essential truth: if AYA patients are in some way special patients, then they need special places to receive the best care. As the introduction to the exhibition states:

Places built with colorful bricks, green like forests and yellow like lemons; places where there is room for the best therapy protocol, but also for the meaning of existence, love, sex, the desire to rebel, fear, the need to have a destiny and take control of it. Places where one can move lightly, even amidst things that are anything but light. Moving with hope. Because when there is room for colors and beauty, there is room for hope. There is room for the normality of life.

In this way, hospitals become more than just places of care: they become places that create beauty, that produce culture.

Spaces tailored for young patients

When you spend a lot of time in the hospital, you realize that what makes the difference is normality, the normality you used to take for granted, like the green of the trees, the sunlight, or the scent of wood. (Anna, 27 years old, breast cancer)

The humanization of care - an approach that considers the patient as a person to be cared for holistically rather than merely as a disease to be treated - also involves rethinking the spaces and environments dedicated to healthcare. This means designing spaces where key elements include aesthetic appeal and decor, which also encompasses cleanliness, accessibility (such as parking and facilities for users), clarity of necessary information, and the comfort of waiting rooms, which should be organized, well-lit, and enriched with decorative elements like paintings and ornamental plants. Similarly, hospital rooms should meet specific criteria to ensure well-being and privacy, and there should always be common areas to encourage socialization.^33,34

These principles should apply to all healthcare facilities, whether designed for adults or children, with specific adaptations according to the needs of different users. For instance, children should be welcomed into colorful and joyful environments, with cartoons, child-friendly furniture, and dedicated play areas. However, these concepts become even more crucial for AYA patients, who face illness and treatments during a particularly delicate phase of their development.

The presence of spaces designed according to the needs of young patients has a significant impact on their psychological well-being.^{35 -37} This principle is supported by Environmental Psychology, a discipline that studies the interactions between humans and the built environment, analyzing how physical and spatial characteristics (such as lighting and colors used) can influence psychological and behavioral processes, affecting patients' mood and overall well-being.^{36 -40} Two relevant theories in this field are the Stress Recovery Theory (SRT), ⁴¹ and the Attention Restoration Theory (ART). ⁴² SRT suggests that natural environments have the ability to reduce stress and improve psychophysiological well-being. According to this theory, exposure to natural landscapes facilitates a faster recovery from stress, triggering a series of beneficial physiological and psychological responses. ⁴¹ ART, on the other hand, proposes that exposure to nature helps restore cognitive abilities and reduce mental fatigue, providing a non-invasive stimulus that aids in replenishing attentional resources. ⁴²

Compared to patients of other age groups, AYA patients have specific needs related to privacy and social interaction. In terms of space, the ideal setup includes private rooms (ensuring privacy) and recreational areas that are welcoming, designed with vibrant colors but without childish symbols—such as cartoon characters on the walls, which are typical of pediatric wards. These spaces should include areas for leisure activities (watching movies or listening to music), spaces for accommodating visiting friends, and possibly a gym or an accessible kitchen, allowing patients to maintain a sense of normalcy during hospitalization.^35,43-48

Designing hospital spaces for young patients

From an architectural perspective, we believe that spaces for AYA patients should be designed with one key principle in mind, the concept of “non-disconnection”, i.e. maintaining a connection to everyday life.

A cancer diagnosis abruptly disrupts a young person’s normal life, separating them from their social circles, education, and relationships. Traditional hospital environments often amplify this sense of disconnection and discontinuity, feeling sterile, impersonal, and completely removed from everyday life.

The challenge is to design spaces that minimize this disruption and instead foster a sense of continuity. Hospital environments should enable young patients to maintain their routines, providing a sense of normality and stability while preserving the rhythm of their daily lives.

To achieve this, hospital design should incorporate informal social spaces - places that resemble those young people would naturally gather in outside the hospital. These spaces should be:

Examples include study areas, tech-friendly workstations, creative activity spaces, and flexible layouts that adapt to different needs. This could take the form of modular seating, cozy lounge areas, informal gathering spots, and multifunctional rooms for shared activities.

There is extensive research on the importance of welcoming spaces, and in recent years, certifications like the WELL Standard have emerged to define best practices, particularly in workplace design. The concept of Human Delight emphasizes the emotional and sensory experience of spaces, recognizing that a well-designed environment plays a crucial role in psychological well-being.^49,50

Key design strategies include using natural and dynamic lighting to create inviting spaces, incorporating warm colors and natural materials for a home-like atmosphere, and integrating greenery and outdoor connections to enhance comfort. This can be achieved through large windows, lighting that mimics natural daylight patterns, carefully chosen color schemes for their psychological impact, and both real and artistic representations of natural elements.

Another inspiring idea is the concept of integrating art into hospital spaces. A notable example in Italy is the “Care and Beauty” project by the Humanitas Research Institutes, which has transformed their hospitals’ environments - waiting rooms, hallways, and common areas - by displaying high-resolution, large-scale reproductions of iconic Italian artworks. These include masterpieces by Piero del Pollaiolo, Canaletto, Botticelli, and others, sourced from Milan’s renowned Poldi Pezzoli Museum and Pinacoteca di Brera. By bringing these masterpieces into everyday hospital life, the project creates a bridge between art and people - patients, caregivers, and healthcare professionals - turning art into a powerful medium for communication and empathy. Art and beauty become a source of comfort, offering support both to those undergoing treatment and to those who work in the hospital every day.

Bringing art into hospitals - whether through dedicated spaces or by offering patients the chance to participate in creative and artistic experiences - plays a crucial role in young people’s well-being. ⁵¹ It stimulates imagination and cognitive processes such as attention, memory, and abstract thinking, promotes skill development and social interaction (helping to reduce the isolation that often comes with illness and hospitalization), and facilitates emotional expression and the evocation of feelings.^{51 -53}

A hospital that integrates welcoming environments and artistic interventions can become a more human-centered place of care, helping patients maintain a sense of normalcy and continuity with their lives - lives that, in this way, do not remain solely outside but are also brought within. As the firsthand experiences of hospitalized patients show, every detail can make a difference in the healing process and in the quality of life during treatment. "Walking into the hospital and seeing one of my drawings hanging on the wall felt like stepping into my own room. . ." (Giulia, 17 years old, speaking about the Pediatrics ward where she is being treated for rhabdomyosarcoma).

Conclusion

This paper aims to broadcast an important message, which we like to think of as a message from Carlo Alfredo Clerici: today, it is of fundamental importance to design hospital environments in a way that promotes the continuity of patients’ lives, focusing on aspects of functionality but also on aesthetics. Beauty in healthcare settings should not be considered a luxury but an essential part of the right to health, which includes the overall well-being of the patient. If we acknowledge a right to health, then we must also recognize a right to beauty. Healthcare systems must begin to embrace architecture, culture, and the arts as fundamental elements of a truly integrated approach to care.

Of course, these ideals face challenges in the real world, where logistical constraints (such as available space) and financial limitations must be considered. But beyond these practical obstacles, the real issue is “vision”: understanding the true value of this integrated approach. The goal should be to make it a standard of care, not an exception or an added luxury.

In this regard, the work of the AIOM-AIEOP Working Group plays a crucial role in raising awareness about the importance of beauty and culture in healthcare, as highlighted in the recent conference organized in collaboration with Fondazione Menarini. The group’s efforts focus on fostering dialogue among professionals from different fields (doctors, architects, artists, and social workers) and, most importantly, on defining the minimal essential requirements for AYA centers, ensuring that patient-centered spaces become an integral part of cancer care.

"Let's talk about it".