Tourism-Oncology - More Than A Treatment

University of South Florida (USF) M3 Publishing
Co-Editors
Dr. Levent Altınay
Business School, Oxford Brooks University, UK
Dr. Osman. M. Karatepe
Faculty of Tourism, Eastern Mediterranean University, North Cyprus
Dr. Muharrem Tuna
Faculty of Tourism, Ankara Haci Bayram Veli University, Turkey
ADVANCES IN MANAGING TOURISM ACROSS CONTINENTS

VOLUME 2
ISBN 978-1-955833-08-0
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/4
DOI: https://www.doi.org/10.5038/9781955833080
Buyuk and Akkus: Tourism-oncology: More than a treatment
Co-Editors
Dr. Levent Altınay
Business School, Oxford Brooks University, UK
Dr. Osman. M. Karatepe
Faculty of Tourism, Eastern Mediterranean University, North Cyprus
Dr. Muharrem Tuna
Faculty of Tourism, Ankara Haci Bayram Veli University, Turkey
ISBN 978-1-955833-08-0
*Authors are fully responsible for corrections of any typographical, copyrighted materials,
technical and content errors.
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Assistant Editors
Dr. Alaattin Başoda
Faculty of Tourism, Aksaray University, Turkey
Dr. Seden Doğan, Faculty of Tourism
Ondokuz Mayis University, Turkey
Dr. Muhittin Cavusoglu
The W. A. Franke College of Business, Northern Arizona University, USA
Editor Assistants
Gokhan Sener
Faculty of Tourism, Necmettin Erbakan University, Turkey
Basak Ozyurt
Faculty of Applied Science, Trakya University, Turkey
Ipek Itır Can
Faculty of Tourism, Anadolu University, Turkey
Sinan Baran Bayar
Institute of Social Sciences, Kirklareli University, Turkey
ISBN 978-1-955833-08-0
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/4
Tourism-Oncology: More Than a Treatment

Özge Büyük1 and Gülşah Akkuş2
1
Faculty of Tourism
Çanakkale Onsekiz Mart University, Turkey
2
Faculty of Tourism
İzmir Kâtip Çelebi University, Turkey
Abstract
Medical tourism is a growing global niche market all over the world. In this study, which intends
to assess the status of "tourism-oncology," texts obtained longitudinally from digital and social
media were analyzed for content. Tourism-oncology has evolved as an economic activity within
the context of medical tourism in Turkey. The research revealed that (i) oncology was among the
top five, (ii) lung cancer was the cancer type that results in the most travel, (iii) the user profiles
shared on social media were mostly those of travel agencies and health-consulting businesses,
(iv) Istanbul, Antalya, Ankara, Izmir, and Mugla were the destinations preferred by travelers
coming to Turkey for cancer treatment, and (v) the source markets were Azerbaijan, Iraq,
Tunisia, Georgia, Germany.
Keywords: health tourism, medical tourism, tourism-oncology
Recommended Citation: Büyük, Ö., & Akkuş, G. (2022). Tourism-oncology: More than a
treatment. In L. Altinay, O. M. Karatepe, & M. Tuna (Eds.), Advances in managing tourism
across continents (Vol. 2, pp. 1–10). USF M3 Publishing.
https://www.doi.org/10.5038/9781955833080
Introduction
Oncology is an inclusive term used for all types of cancer (Baykara, 2016). Cancer patients
benefit from foreign physicians and health institutions by going to other countries from time to
time during both their diagnosis and basic treatments and their complementary treatments; At the
same time, they participate in medical tourism activities, which are considered within the scope
of health tourism. Cancer treatment has been dealt with in very few studies in the context of
tourism (Gunter et al., 2010; Burki, 2019; Dreisbach et al., 2020), and generally, the positive and
quality-enhancing aspects of cancer patients' participation in tourism activities on the treatment
process (Yancey et al., 1994; Jackson & Rucks, 1995; Owens & Payne, 1999; Hunter-Jones,
2003; Hunter-Jones, 2005; Dean, 2012), the technical and bureaucratic problems experienced in
transferring cancer patients between countries (Gladwell & Bedini, 2004; Hunter-Jones, 2010),
the fact that patients with dual citizenship prefer their homeland for their treatment (Oh et al.,
2014; Pian, 2015; Taylor et al., 2015; Jang et al., 2021), and the negative effects of these visits
on the inhabitants (Wang et al., 2020; Huang et al., 2021) were emphasized.
This study, which has a descriptive research feature, will fill an important gap in terms of
revealing the relationship between the health sector and the tourism sector in the context of
cancer. There is no longitudinal study on medical tourism in the literature. Longitudinal data and
1
methods are important in that they measure current changes and allow for strong causal
interpretations (Menard, 1991). In addition, the use of large and up-to-date data pools such as
digital and social media also enables inferences about consumer behavior that are difficult to
notice at smaller scales (Çevik et al., 2015). The dissemination of knowledge also plays a
fundamental role in triggering large-scale collective action in human society (Nishi et al., 2016).
How information about health tourism and cancer patients' visits to Turkey is disseminated
through digital and social media is also discussed in this study.
Literature Review
Hunter-Jones (2005), emphasizing the content of health tourism, states that tourism activities for
health purposes and the activities of tourists who accidentally benefit from health services during
their travels should be separated from each other. Therefore, intentionally or unintentionally, but
purely for health purposes, touristic activities are included within the scope of organized health
tourism; travels that benefit from health services incidentally during the tourism activities are
counted among the directly arranged tourism activities. Medical tourism, which is one of the
organized health tourism activities, emerged as a result of the global commercialization of health
services (Hopkins et al., 2010; Ganguli & Ebrahim, 2017). Medical tourism is a type of tourism
in which individuals traveling for medical reasons participate. These planned tourism activities
are also evaluated in the category of classical medicine and include international planned travels
to benefit from some treatment services provided by health institutions and organizations with
the participation of doctors and other health personnel as well as tourism professionals (Topuz,
2012).
When defined in a broader framework, in addition to the travels of patients and their companions
to receive a certain treatment, the travels of doctors, nurses, and other healthcare professionals
for specific reasons such as obtaining/giving information, conducting research, and providing
treatment can also be considered as medical tourism. However, within the scope of this study,
tourism-oncology (cancer diagnosis and treatment tourism), which is formed by combining the
words tourism and oncology, is defined as "international travels made by patients to receive
medical help and necessary treatments within the scope of diagnosis and treatment of cancer
disease". All diagnosed/undiagnosed cancer patients who benefit not only from tourism
establishments but also from health establishments during their travels are tourism-oncology
tourists.
Turkey has been among the most preferred countries in medical tourism for the last ten years.
Among the reasons for preference, the quality of medical service, the provision of low-cost
health services, and the quality of health personnel come to the fore (Özçelik et al., 2021).
Turkey, which ranks 35th in the list of 46 global destinations according to the 2020-2021 World
Medical Tourism Index, ranks 30th in the world in the category of facility and service quality
(MIT, 2020). On the other hand, according to the Global Buyers Survey (MTA, 2017) published
by the Medical Tourism Association, which provides data on the trends and habits of those
traveling for medical reasons, 40% of the patients around the world traveled to the USA, 16% to
Germany and 12% to Turkey for their medical needs in 2016-2017. Turkey is in third place in
the list of the most preferred countries in this ranking. Considering the rankings, which may
change according to the years, it should be taken into account that, among other factors, the
Covid-19 pandemic and the measures taken may have an impact on the decrease in arrivals to
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/4 2
Turkey. Besides, Turkey is among the top ten countries with hospitals accredited by the
independent organization Joint Commission International (JCI), which provides services in
international accreditation services (Runnels & Carrera, 2012).
Methods
A qualitative approach was used in this study, which sought to assess the state of tourism-
oncology in Turkey as it arose as a lucrative industry within the context of medical travel. This
research, is longitudinal as it contains the entire archive of the last six years of the first 20
tourism news sites that make sectoral news in Turkey (digital media) and as it includes all the
messages posted on Twitter in the last quarter of the year (social media), deals with the tourism-
oncological visits to Turkey through their reflections in the press.
Sample
This study employs both digital and social media data. The top 20 tourism news sites were
selected via the Google search engine by screening with the keyword "tourism news sites".
Twitter was selected as a social media platform for this research.
Data Collection
The screenings made on the digital tourism media cover the ten years between 2011-2021, but
due to archival constraints, they were made retrospectively longitudinal for the last six years, for
20 news sites, and a total of 120 times. Relevant data were collected and coded between
September and December 2021, and a total of 1,144 texts (news-column-interview) were
obtained. Scans for social media were repeated weekly for 12 weeks from September to
December 2021, and 120 times for each headline and sign. A total of 2,989 Tweets were
obtained from 112 of these scans. Since the messages which are written to join a certain hashtag
on Twitter begin with the symbol “#” (Aladwani, 2015), on Twitter, both Turkish and English
keywords “sağlık turizmi”, “tıp turizmi”, “medikal turizm”, “health tourism”, “medical tourism”,
and “#sağlıkturizmi”, “#tıpturizmi”, “#medikalturizm”, “#healthtourism” and “#medicaltourism”
tags were searched. Since the study aims to shed light on the situation in Turkey through the
local (digital) media, the tweets were limited by selecting only among the Turkish ones. Social
media data include tweets posted at any time of the day for 90 days within the specified three-
month period. The data obtained through digital and social media were evaluated with content
analysis in the MaxQDA 2020 qualitative analysis program. Between September and December
2021, a total of 1,144 newspaper contents from digital media and 2,989 tweets from social media
were obtained regarding health tourism; 15,926 and 10,662 open codings were made,
respectively. On health tourism, “www.turkiyeturizm.com” (24.48%) produced the most content
while tweets with the expression "health tourism" (78.05%) were the most common. On the
subject of health tourism, the most content in digital media was produced by
“www.turkiyeturizm.com” (24.48%), while tweets with the expression “sağlık turizmi (health
tourism)” (78.05%) were the most common in social media.
Findings
In this section, the data obtained through digital and social media are presented in separate tables
and figures, but together to make a sound evaluation. Table 1 shows for which treatment the
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visitors come to Turkey. In the digital media codings, 293 documents containing the treatment
preferences of the visitors were found; It was determined that 20.48% of these documents were
related to oncology. In addition, only 293 of the 1144 texts obtained from digital media include
treatment types; in 851 of them, health tourism is mentioned without treatment. It was
determined that 34.78% of 69 documents (1338 tweets) containing treatment preferences among
social media messages were related to oncology. Therefore, oncology ranks first in the treatment
preferences of health tourists in both digital and social media analyses. There are 68 documents
on oncology in both data sets.
Table 1. Treatment Preferences of Medical Tourists
Digital Media Social Media
Treatment Preference f % Treatment Preference f %
Medical Aesthetic 238 23,24 Medical Aesthetic 649 48,51
General Surgery 163 15,92 Dental 211 15,77
Dental 101 9,86 Gynecology and Obstetrics 115 6,28
Orthopedics-Traumatology 81 7,91 Oncology 68 5,08
Oncology 68 6,64 Others 43 3,21
Cardiovascular Disease 50 4,88 Orthopedics-Traumatology 48 3,59
Eye Diseases 41 4,00 Internal Diseases 16 1,20
Gynecology and Obstetrics 54 5,27 Eye Diseases 51 3,81
Transplants 65 6,35 Cardiovascular Disease 34 2,54
Healthy Nutrition & Diet 40 3,91 Healthy Nutrition & Diet 73 5,46
Alternative Treatments 58 5,66 Transplants 20 1,49
Others 34 3,32 General Surgery 7 0,52
Internal Diseases 31 3,03 Alternative Treatments 3 0,22
Total 1.024 Total 1.338
Figure 1 shows the frequency distributions of tourists' oncological treatment preferences.

Accordingly, in digital media messages; cancer treatment (85.29%; f=58) is mostly mentioned
under the oncology main topic, followed by surgical oncology (5), radiation oncology (3), and
gynecological oncology (2), respectively. Similarly, social media produced content mostly about
cancer treatment (22.05%; f=15) and lung cancer (22.05%; f=15) on the same topic. This
situation coincides with the data of the Globocan (2020) report that lung cancer is the disease
associated with the most common cancer types and mortality rate in the world.
Figure 1. Frequency Distribution of Oncological Treatment Preferences
DIGITAL MEDIA SOCIAL MEDIA
Figure 2 shows the distribution of messages about tourism-oncology on social media according
to user profiles. Agencies (63.23%; f=43) were found to be the users who shared the most
messages on this subject and mostly sent messages about lung cancer (20.93%; f=9). Agencies
are followed by health agencies and consulting companies (23.52%; f=16). Health agencies and
consultancy companies shared mostly (37.5%; f=6) about lung cancer and leukemia. This result
reveals that agencies, which are the intermediaries of tourism enterprises, and consultancy
companies, which are the intermediaries of health institutions, emphasized this issue more.
Figure 2. Distribution of Tourism-Oncology in Social Media by User Profiles
The destinations preferred by oncological visitors for cancer diagnosis and treatment in both
digital and social media texts are shown in Figure 3. In the analysis of the overlap between
oncology sub-branches and destinations in digital media, connections were found only in cancer
treatment and surgical oncology sub-branches, and there was no data on destination preferences
for other oncology branches. While many cities, especially Istanbul, Antalya, Izmir, and Mugla,
stand out in digital media, the most common cancer treatment destinations were Istanbul
(25.86%; f=15) and Antalya (15.51%; f=9); Istanbul was preferred in surgical oncology. This
figure also shows that of the 16 patients who came to Istanbul for tourism-oncological purposes,
15 traveled for cancer treatment, and one for surgical oncology.
In social media, only two cities were associated with tourism-oncology: Ankara and Istanbul. In
the data set obtained from social media, Ankara is mostly associated with tumor and leukemia
treatment (17.64%; f=6); Istanbul (54.54%; f=6) stands out mostly with the treatment of lung
cancer. At this point, it can be stated that the data obtained through both media are
complementary. Digital media focuses more on destinations, while social media emphasizes
tourism-oncological diagnosis and treatment types through the two most preferred destinations.
Profiles and usage purposes of social media users can be shown as the reason for this situation.
As seen in Figure 3, those who use social media the most for tourism-oncological purposes are
travel agencies and health-consulting companies. In the social media data analysis (mostly by
these companies), it has been determined that the health tourism-related posts were mostly aimed
at providing information to tourists (75.68%; f=84) and commercial (65.77%; f=73). Therefore,
the reason tourism-oncology sub-types are more detailed may be due to the need of these
5
companies to provide more comprehensive information and promotion on Twitter, one of the
most preferred social media types by users.
Figure 3. Tourism-Oncology Destinations

DIGITAL MEDIA SOCIAL MEDIA
Figure 4 shows the frequency distributions of the countries sending patients to Turkey for
tourism-oncology purposes. Azerbaijan (41.66%; f=20) ranks first among the countries that send
the most health tourists in digital media. Although Tunisia (64.28%; f=9) ranks first in social
media, it is stated that five out of every 11 patients (45.45%; f=5) coming from Azerbaijan for
health tourism receive oncology treatment, so the data in both media are consistent. The
difference between the two media is likely to be due to the timeframe and databases on which the
analyzes are based. Six-year retrospective longitudinal data from digital media and quarterly
forward-looking longitudinal data from social media were analyzed. On the other hand, the
possibility that the more up-to-date and free structure of social media compared to digital media
may be reflected in the shares should also be taken into account.
Conclusions
As a result of this study, which was carried out to reveal the profile of tourism-oncology
movements within the scope of medical tourism, in digital and social media; (i) oncology was in
the top five (ii) tourism-oncological travels were mostly made due to lung cancer, iii) those who
share tourism-oncology on social media were predominantly travel agencies, and health agencies
and consultancy companies, iv) visitors coming to Turkey for tourism-oncological purposes
preferred İstanbul, Antalya, Ankara, Izmir, and Mugla, respectively, v) source markets were
Azerbaijan, Iraq, Tunisia, Georgia, Germany.
Figure 4. Frequency Distribution of Tourism-Oncology Markets

DIGITAL MEDIA
SOCIAL MEDIA
In tourism-oncological travels, Istanbul and Antalya come to the fore in digital media, and
Ankara and Istanbul in social media. It is possible for the rankings to change according to the
years and the platforms shared. However, when a holistic evaluation is made, studies in the
literature (Zengingönül et al., 2012; Barca, 2013; Çapar, 2018) indicate that the destinations that
come to the fore in terms of health tourism, in general, are the same cities, although their
rankings change. It can be stated that this is since these tourism-oncology destinations are the
largest cities in Turkey and have the most well-known and accredited public, private, and
medical school hospitals, thus creating a sense of trust in patients. The same is true for other
prominent provinces. For example, TÜRSAB (2014) points out in the tourism report that Antalya
ranks first among the cities visited for treatment in Turkey. According to Barca et al. (2013),
thanks to the development of technology, the quality of health services provided, especially in
the provinces of Istanbul, Ankara, and Izmir, has increased. According to Binler (2015),
7
international certificates and accreditation documents, which are shown as proof that health
institutions provide services with high-quality standards, positively affect the preferences of
health tourists. For example, one out of every five patients prefers accredited institutions (Sag
and Sengül, 2019). Studies conducted among patients who preferred to have their treatment in
Istanbul (Zengingönül et al., 2012; Çapar, 2018) determined that trust in doctors and health
personnel is among the motivation factors that have an impact on the choice of the city.
The Internet has an important role in the expansion and growth of the medical tourism industry,
as it is a portal that facilitates the exchange of information between patients, institutions-
organizations that provide diagnosis/treatment, and destinations (Reed, 2008). It is common
behavior among patients to communicate via internet pages containing medical information,
physicians, health institutions, individuals, institutions, and organizations that provide online
support. The fact that this opportunity is mostly provided free of charge, regardless of time and
geographical conditions, is often cited among the reasons for preference (Yılmaz, 2013). The
internet is important for cancer patients because it eliminates geographical borders especially
because of the time factor.
It is important that the Ministries of Health and Tourism prepare detailed statistics and reports on
the number of tourists coming for treatment. There is an important shortcoming regarding this
issue. It is of great importance to keep the records of the tourists traveling for medical tourism,
down to the details of the disease treated and the preferred destination, to report them, to carry
out studies on the subject, and to share the information obtained from the relevant studies with
the researchers and the public. Considering the global revenue of 7.2 billion dollars (THTC,
2018) from the medical tourism industry, which is expected to increase by 35% every year
(MTA, 2017), this rapidly growing niche market (Connel, 2006) will make a significant
contribution to its revenue by providing foreign exchange income. Comprehensive data support
to be provided by the ministries will create a healthy and holistic data pool that can be used by
both researchers conducting research in the field and entrepreneurs who will carry out planning
studies in the tourism sector. In this way, the scope of advertising, promotion, and marketing
activities on health tourism will expand, and therefore, the preference rate of health tourists for
Turkey will increase (Aksoy, 2016).
It can be stated that such descriptive studies fill an important gap in terms of determining the
situation and realizing its importance, especially since the Ministry of Health and the Ministry of
Tourism only share the statistics under general headings and cause the relevant information to be
incomplete. In addition to the few studies on the subject in the literature, the available resources
are limited to the reports published by NGOs and contain mostly regional information and data.
One of the limitations of the study is that the data obtained cannot be compared since the
statistics on the subject are not published. Another important limitation of the research is that the
research was only drawn from the archive of the last six years of digital tourism media and a
single social media for the last three months. To make a more comprehensive evaluation on this
subject, it is necessary to take into account the written / visual media along with other social
media platforms, and evaluations should be made not only for oncology but also for other sub-
types of medical tourism. This study is based on analyzes made on digital and social media
broadcasting on the internet. Therefore, it is an important study in terms of drawing a general
framework for the diagnosis and treatment preferences of cancer patients in Turkey within the
scope of medical tourism, and it fills an important gap in terms of revealing the relationship
between the health sector and the tourism sector in the context of cancer disease.
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Tourism-Oncology - More Than A Treatment

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University of South Florida (USF) M3 Publishing

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Tourism-Oncology: More Than a Treatment

Keywords: health tourism, medical tourism, tourism-oncology

Figure 1 shows the frequency distributions of tourists' oncological treatment preferences.

Figure 1. Frequency Distribution of Oncological Treatment Preferences

DIGITAL MEDIA SOCIAL MEDIA

Figure 2. Distribution of Tourism-Oncology in Social Media by User Profiles

Figure 3. Tourism-Oncology Destinations

Figure 4. Frequency Distribution of Tourism-Oncology Markets

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