Problem description

Cancer is a serious illness that can be fatal and usually results in lifelong health

complications shortening the life span of a patient. Overall there were 8.2 million

deaths due to cancer and 14.1 million new cases worldwide in 2012, a year when the

most comprehensive global statistical report regarding this topic was conducted by

WHO (Fact Sheets by Cancer, n.d.). Cancer is a global health issue and, according to

the newest data of 2016, one out of seven deaths in the world is attributed to cancer

Cancer Facts & Figures 2016, n.d.). It is one of the most covered medical topics in

various journals and articles and is researched from different perspectives and

disciplines. Not only quantitative, but also qualitative research of cancer patients'

experience is becoming common since cancer affects many different aspects of a

patients' life.

Head and neck cancer refers to a carcinoma type of cancer and affects such areas

as the mouth, nose and throat, as well as the larynx, salivary glands and sinuses.

According to 2014 WHO data, head and neck squamous-cell carcinoma (HNSCC)

affected 550,000 people globally that year, with occurrence in males two to four times

higher than females (Union for International Cancer Control, 2014). The WHO report

also states that this cancer type occurrence is ranked sixth in the world. One of the

most common types of head and neck cancer is nasopharyngeal carcinoma (NPC); the

geographic center is situated in East Asia, and Taiwan is a region with high

occurrence.

This study will focus on the different forms of head and neck cancer of

Taiwanese patients. As to the overall head and neck cancer statistics in Taiwan, in

2014, 52,256 males and 11,996 females were diagnosed with one of the head and

neck cancer types, and the ratio of men to women is 5:1. Men aged 45-64 years old

have the highest rate of developing head and neck cancer (中華民國衛生福利部,

2017). Risk factors include unhealthy lifestyle habits, environmental factors, as well

as hereditary aspects and viruses. It is prevailing that carriers of HNSCC belong to the

low socioeconomic class as the majority of the people diagnosed with neck and head

cancer has one or a few unhealthy habits such as smoking, abuse of alcohol, or

chewing betel nut.

The National Health Insurance (NHI) system in Taiwan was established in 1995

and has been praised all over the world. It is well known that Taiwan's NHI is one of

the most affordable health insurance programs in the world, and at the same time it

provides very high-quality services. One of the reasons of this service quality lies in

the fact that in Taiwan only the students with the best academic achievements can

apply to medical universities. More than 90% of Taiwan's citizens have healthcare

insurance and as to the medical costs, NHI covers a substantial part of all medical

treatments. Therefore we can assume that patients in Taiwan receive a high level of

healthcare services and that, unlike many other countries, the financial burden is not

the prime problem for Taiwanese patients, including cancer patients. As a result, our

research settings – Taiwan – can provide us with the opportunity to focus on

researching patients' needs other than monetary.

For HNC patients, physical disabilities related to major life activities such as

eating and speaking are regarded as troublesome and depressive. Also, uncertainty

about future health circumstances, especially feelings of being at risk of relapse, is the

source of substantial psychological distress. These two aspects, physical and

psychological, in turn influence social life and thus aggravate the consequences of

being ill with cancer even more. However, the author believes that adequate and

timely information acquisition can to some degree prevent deterioration of physical

functions along with lessening negative psychological states such as anxiety and fear

about the future.

According to statistics, health information search is the third most popular online

activity after e-mailing and using a search engine (Zickuhr, K. 2010).

The U.S. Pew Research Center revealed that in 2013 "72% of internet users say they

looked online for health information of one kind or another within the past year" (Fox,

S., & Duggan, M., 2013). Another report showed that among healthcare consumers

"20% have joined a health-related forum or community" (Health 2.0 social media in

healthcare, n.d.), and yet another source indicated that "60% of doctors say social

media improves the quality of care delivered to patients" (Mollie Ottenhoff, 2012).

Research conducted in EU from 2010 to 2011 revealed that information on the

Internet was the second source of medical information after consulting physicians.

These facts indicate that there is a significant need for online medical or

wellness-related information.

However, there are several issues related to online medical information. First, the

quality of information presented online is inconsistent. While some websites provide

adequate and accurate medical information, there are also sites, which provides

grossly incorrect information. Second, the search for information can be

time-consuming and without helpful results due to the lack of clear classification of

information types, such as for search of information for different stages of cancer.

Third, the major type of online cancer-related information in Taiwan is general,

descriptive and educational. However, there is insufficient information about more

detailed treatments, lists of medical institutions, specialists, or food supplements

during recovery.

Finally, there is one more issue to discuss. The fact that HNC patients in Taiwan

are relatively aged and many are not used to the systematic search of information

online due to their socioeconomic status poses a problem for them searching

information online. In these cases, help from a patient's relatives or educational

interventions organized by medical institutions are needed.

The author acknowledges that the task of conducting the research in regard to

this healthcare issue in Taiwan is challenging. The challenge stems from two facts.

Firstly, Taiwan's healthcare environment is already highly developed and high quality

healthcare is accessible to the majority of citizens. Secondly, the study concentrates

on investigating patients’ needs from the best medical organization in Taiwan – NTU

Hospital, where services are already rather comprehensive and highly professional.

This implies that the hospital’s services and information provision are probably

already satisfactory, however the author is intrigued by the opportunity to discover

new findings of head and neck cancer patients' problems and needs in information

acquisition.