Although this form of cancer affects both sexes, there is nonetheless a prevalence of male cancer patients aged between 45 and 65 years old. These men, who are often the main bread winners of their family, are struck in the prime of their life.

What has caused such an increase in the number of oral cancer cases? Medical specialists have observed that 80% to 90% of oral cancer patients in Taiwan have the habit of chewing betel nuts, which are often used to increase the capacity to work, causing a hot sensation in the body and heightened alertness. In fact, the international medical community generally considers betel nut to be a carcinogen and according to research carried out in Taiwan, the probability that betel nut chewers develop mouth cancer is 28 times higher than the general population. The probability becomes 89 times higher when chewing betel nut is combined with smoking, and 123 times higher when alcohol is also added to the mix.

Implications for oral cancer patients
Fortunately, the remission rate for this type of cancer is high, thanks to multidisciplinary cancer therapy: ablative surgery, reconstructive surgery, radiation therapy, and/or chemotherapy. But this often comes at a cost. Indeed, according to medical specialists, close to half of oral cancer patients will need to undergo ablative surgery which will result in facial disfigurement causing speech impairment, deglutition and mastication problems, oral secretions management difficulties, etc.

Apart from stress resulting from these major physical changes, patients also have to deal with emotional stress resulting from the loss of control over their daily life, worries about medical treatments, fear of rejection due to their disfigurement, fear of death, etc.

In addition, oral cancer patients face social pressure. Because they have difficulty speaking, they will have less social interactions. And because their condition limits their ability to work, they might face financial difficulties.

Sunshine’s approach
As an organization working with burn survivors and people with facial disfigurement since 1981, Sunshine Foundation understands how the facial disfigurement of oral cancer patients will affect their physical and psychological functions, their social skills and their financial or employment situation. That is why starting in 2005, and following careful research, Sunshine Foundation initiated its oral cancer program. Following a two-pronged approach, Sunshine Foundation:

- Rehabilitation services for oral cancer patients
Oral cancer patients who had to undergo surgery face an arduous road towards recovery. Sunshine Foundation has organized a multidisciplinary team composed of physical therapists, social workers, dieticians, speech therapists and nurses to provide support and services adapted to their needs. These services include:

Physical rehabilitation:
- Physical therapy and massage exercises: Our physical therapists teach patients and their caregivers how to do physical therapy exercises and massage to diminish the feeling of discomfort and stiffness around the maxillofacial area, as well as improve functions (deglutition, mobility of the jaw, etc.)
- Maxillofacial prosthesis information: Ablative surgery will sometimes take away important portions of the maxillofacial area, making procedures like skin grafting ineffective. Sunshine Foundation provides patients with information and links to resources on maxillofacial prosthesis and reconstructive surgery.

Speech therapy: A speech therapist visits patients to help them improve their speech and pronunciation, which was affected following medical treatment.

Nursing services: A specialized nurse visits patients to provide services such as:
- Wound care following cancer treatment
- Oral hygiene: Poor oral hygiene following cancer treatment is often the cause of cancer relapse. Patients are taught how to maintain good oral hygiene, and they are monitored to detect any anomaly or sign of relapse.
- Tracheotomy/intubation care: Oral cancer treatment will cause the neck to swell, which in turn can cause suffocation. That is why tracheotomy is often used to facilitate breathing. Also, nasogastric intubation will be used to facilitate feeding. In order to reduce risks of infection, patients and caregivers are taught how to clean the tubes.

Dietician services: A dietician will visit patients to evaluate and adjust their caloric intake during the different stages of the recovery process.

Psychological services: Oral cancer patients might feel anger or depressed because of their limited physical capacities, they sometimes also feel anxiety towards death or a possible relapse. Sunshine Foundation social workers can assess the needs of patients and arrange for psychological counseling or participation in peer support groups.

Financial support: Since oral cancer patients are often the main bread winners for their family, the disease will cause important financial strain. The financial situation of patients is evaluated by social workers who can then direct patients to appropriate financial aid resources (ex: subsidies for medical care, dietary supplements, transportation, etc.).

Social adaptation services: Cancer treatment will often result in limited speech ability, facial disfigurement, limited physical capacities, etc. All of this will influence patients’ ability to communicate with others and diminish opportunities for social interaction. Social workers will evaluate each case and organize activities to encourage interaction such as local cancer survivor meetings, the creation of family support groups or peer support groups, etc.

Family services: The families of oral cancer patients must also deal with tremendous pressure. Family members, who generally are the main caregivers, accompany the patient throughout the recovery process, dealing with the patient’s emotions, stress and pressure, and often forgetting their own needs. Social workers will design activities for family members and caregivers to meet and share experiences, support and encourage each other, and learn how to also take care of themselves.

- Prevention work
In order to raise awareness about oral cancer and how it is tied to the habit of chewing betel nut, Sunshine Foundation carries out prevention work in schools and in communities, partnering with school officials, teachers, local associations and health centers. Ultimately, it is hoped that awareness campaigns will contribute to educating the public about preventing and/or detecting oral cancer, as well as discourage at-risk groups from chewing betel nut.

To support its prevention work, the Foundation has developed material targeted to different audiences, which include public service announcements and short films, online games, brochures, etc. A special section with information and resources on oral cancer has also been created on the Sunshine Online website http://online.sunshine.org.tw/oral/. Sunshine Foundation also shares its prevention campaign methods with schools and communities so that they can replicate the work themselves.

The Foundation has also enlisted the help of oral cancer survivors who now join education activities as speakers, sharing their experiences to teach others about the dangers of betel nut.