Oral cancer rehabilitation and prevention::Sunshine Social Welfare Foundation

Oral cancer - A pressing issue

Oral cancer prevalence has been on the rise in Taiwan over the years, with disastrous consequences.

Oral cancer is among the ten major causes of death in Taiwan, ranking fourth as cause of death in men.
About 2,694 people die of oral cancer in Taiwan every year.
Figures for 2005 show that 35 adults per 100,000 will develop oral cancer (as opposed to 10.5 in the US), and the incidence rate grows by 5% each year.
As many as 90% of oral cancer patients habitually chew betel nut. Betel nut chewers are 28 times more likely to get oral cancer than non-chewers (123 times more likely if they also smoke and drink alcohol).

The impact of oral cancer at an individual level includes:

Physical functions: Facial disfigurement caused by cancer treatment (radiation and ablative surgery) resulting in speech impairment, deglutition and mastication problems, difficulties controlling oral secretions, pain and discomfort of neck and maxiofacial areas, physical weakness due to poor nutrition.
Psychological functions: Psychological distress caused by a changed appearance and changed role (from breadwinner to cancer patient), emotional stress linked to dealing with cancer and fear of recurrence, social anxiety and reduced social interactions because of physical impairments and disfigurement.
Social functions: Changes in interpersonal relations, loss of breadwinning role in the family, financial difficulties caused by inability to return to work due to the illness, etc.

At a broader social level, oral cancer survivors might encounter prejudice and discrimination not only because of their different appearance, but also because of the social stigma associated with chewing betel nut.

Starting in 2005, Sunshine Foundation initiated its oral cancer program, which follows a two-pronged approach:

Carry out prevention to reduce the incidence of oral cancer linked to the habit of chewing betel nut.
Provide direct services to oral cancer survivors to maintain their quality of life and dignity.

Supporting physical recovery

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.)

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.

A specialized nurse visits clients at home to provide services such as wound care following cancer treatment and oral hygiene. Educational seminars are also organized.

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Eliminating barriers to recovery

Since oral cancer patients are often the main bread winners for their family, the disease will cause important financial strain and result in high levels of anxiety. Furthermore, many oral cancer survivors are unable to eat solid food and must rely on liquid supplements as their main source of nutrition, which can be very costly. Financial difficulties will have a negative impact of the recovery of oral cancer survivors so their financial situation is evaluated by social workers who can arrange appropriate financial aid resources (ex: subsidies for medical care, dietary supplements, transportation, etc.).

Helping adjust to life after oral cancer

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. 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.

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. 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.