Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Evaluation of the Satisfaction, Quality of Life and Anxiety Among Cancer Patients and Patient Relatives in the Radiotherapy Unit During the COVID-19 Pandemic: A Cross-Sectional Survey Study
COVID-19 Pandemisi Döneminde Radyoterapi Ünitesindeki Kanser Hastaları ve Hasta Yakınlarının Memnuniyeti,Yaşam Kalitesi ve Kaygılarının Değerlendirilmesi: Kesitsel Bir Anket Çalışması
İlknur ALSAN ÇETİNa , Bennur Zeynan DEVRANa , Türkan ŞÜKÜROVb, Mehmet Kutluhan AKARÇAYb , Zeynep Miray ONAYLARb , Esra Gül ANLARb , Meryem DEMİRb
aDepartment of Radiation Oncology, Marmara University Faculty of Medicine, İstanbul, Türkiye
bMarmara University Faculty of Medicine, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(3):294-301
doi: 10.5336/medsci.2023-97992
Article Language: EN
Full Text
ABSTRACT
Objective: It was aimed to investigate the psychological effects of the coronavirus disease-2019 (COVID-19) pandemic on cancer patients receiving radiotherapy and their relatives, as well as their satisfaction level and the effects of the pandemic on patients' quality of life. Material and Methods: 118 cancer patients who applied to our clinic between November 2021-February 2022 and 111 patients relatives were included in the study. The Short Form-36 Quality of Life Scale was only applied to patients, whereas the Hospital Anxiety and Depression Scale and COVID-19 Knowledge and Satisfaction survey were applied to both patients and their relatives. Results: A statistically significant difference was found between gender and anxiety and depression in females (p=0.009). While there was a significant difference between social functioning and age (p=0.042), no significant difference was found in other parameters. Comparison of anxiety levels among patient and patient relatives demonstrated that anxiety levels were significantly higher among patient relatives (p=0.044). Comparison of the quality of life among gender groups demonstrated that physical function was significantly higher among males compared to females (p=0.043). Comparison of the quality of life among different cancer types demonstrated that physical function was lower in the breast and gynecology cancer group than in the genito-urinary cancer group (p=0.020). Conclusion: It was determined that female gender was more inclined toward anxiety, social functioning was better in the old age group, patient relatives exhibited higher anxiety levels than patients, and physical function scores were higher in men than in women.

Keywords: COVID-19; quality of life; cancer; radiotherapy
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinin radyoterapi alan kanser hastaları ve yakınları üzerindeki psikolojik etkilerinin yanı sıra memnuniyet düzeylerinin ve pandeminin hastaların yaşam kalitelerine etkilerinin araştırılması amaçlandı. Gereç ve Yöntemler: Kasım 2021-Şubat 2022 tarihleri arasında kliniğimize başvuran 118 kanser hastası ve 111 hasta yakını çalışmaya dâhil edildi. Yaşam Kalitesi Ölçeği olan Kısa Form36 sadece hastalara uygulanırken, Hastane Anksiyete ve Depresyon Ölçeği ile COVID-19 Bilgi ve Memnuniyet Ölçeği ise hem hastalara hem de hasta yakınlarına uygulandı. Bulgular: Kadınlarda cinsiyet ile anksiyete ve depresyon arasında istatistiksel olarak anlamlı fark bulundu (p=0,009). Sosyal işlevsellik ile yaş arasında anlamlı fark varken (p=0,042), diğer parametrelerde anlamlı fark bulunmadı. Hasta ve hasta yakınlarının kaygı düzeylerinin karşılaştırılması, hasta yakınlarının kaygı düzeylerinin anlamlı olarak yüksek olduğunu gösterdi (p=0,044). Cinsiyet grupları arasında yaşam kalitesinin karşılaştırılması, fiziksel fonksiyonun erkeklerde kadınlara göre anlamlı olarak daha yüksek olduğunu gösterdi (p=0,043). Farklı kanser türleri arasında yaşam kalitesinin karşılaştırılması, fiziksel fonksiyonun meme ve jinekoloji kanseri grubunda genitoüriner kanser grubuna göre daha düşük olduğunu gösterdi (p=0,020). Sonuç: Kadın cinsiyetin kaygıya daha yatkın olduğu, sosyal işlevsellik yaşlı grupta daha iyi olduğu, hasta yakınlarının anksiyete düzeylerinin hastalara göre daha yüksek olduğu ve fiziksel işlev puanlarının erkeklerde kadınlara göre daha yüksek olduğu belirlendi.

Anahtar Kelimeler: COVID-19; yaşam kalitesi; kanser; radyoterapi
REFERENCES:
  1. Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci. 2020;57(6):365-88. [Crossref]  [PubMed] 
  2. World Health Organization. COVID 19 Public Health Emergency of International Concern (PHEIC): Global Research and Innovation Forum: Towards a Research Roadmap. 2020. [Link] 
  3. World Health Organization. Coronavirus disease 2019 (‎COVID-19)‎: situation report, 73. World Health Organization; 2020. [Link] 
  4. Sah GS, Shrestha G, Dhakal A, Mulmi R, Sapkota A, Poudel S. Knowledge, attitudes, and practices of cancer patients towards COVID-19: a cross-sectional study in Central Nepal. Cancer Manag Res. 2020;12:10173-80. [Crossref]  [PubMed]  [PMC] 
  5. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. [Crossref]  [PubMed]  [PMC] 
  6. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al; China Medical Treatment Expert Group for COVID-19. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020;180(8):1081-9. [Crossref]  [PubMed]  [PMC] 
  7. Wang Y, Duan Z, Ma Z, Mao Y, Li X, Wilson A, et al. Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic. Transl Psychiatry. 2020;10(1):263. [Crossref]  [PubMed]  [PMC] 
  8. Yu H, Zhou Z, Mo Q, Zhou X, Liu Y, Feng S. Prevalence of anxiety and depression among cancer patients during the COVID-19 pandemic: a systematic review and meta-analysis. Research Square. 2020:1-16. [Crossref] 
  9. Pinquart M, Duberstein PR. Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol. 2010;75(2):122-37. [Crossref]  [PubMed]  [PMC] 
  10. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20. [Crossref]  [PubMed]  [PMC] 
  11. Linden W, Vodermaier A, Mackenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord. 2012;141(2-3):343-51. [Crossref]  [PubMed] 
  12. Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L. Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life. Qual Life Res. 2005;14(8):1825-33. [Crossref]  [PubMed] 
  13. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415. [Crossref]  [PubMed] 
  14. Nardone V, Reginelli A, Vinciguerra C, Correale P, Calvanese MG, Falivene S, et al. Mood disorder in cancer patients undergoing radiotherapy during the COVID-19 outbreak. Front Psychol. 2021;12:568839. [Crossref]  [PubMed]  [PMC] 
  15. Ciążyńska M, Pabianek M, Szczepaniak K, Ułańska M, Skibińska M, Owczarek W, et al. Quality of life of cancer patients during coronavirus disease (COVID-19) pandemic. Psychooncology. 2020;29(9):1377-9. [Crossref]  [PubMed]  [PMC] 
  16. Ayubi E, Bashirian S, Khazaei S. Depression and anxiety among patients with cancer during COVID-19 pandemic: a systematic review and meta-analysis. J Gastrointest Cancer. 2021;52(2):499-507. [Crossref]  [PubMed]  [PMC] 
  17. Jayadevappa R, Schwartz JS, Chhatre S, Wein AJ, Malkowicz SB. Satisfaction with care: a measure of quality of care in prostate cancer patients. Med Decis Making. 2010;30(2):234-45. [Crossref]  [PubMed] 
  18. Muraj Z, Kwan M, Wake M, Tse K, Swanson LA. Assessing patient satisfaction in a radiation therapy department using a survey tool. J Med Imaging Radiat Sci. 2015;46(2):182-8. [Crossref]  [PubMed] 
  19. Desideri I, Francolini G, Ciccone LP, Stocchi G, Salvestrini V, Aquilano M, et al. Impact of COVID-19 on patient-doctor interaction in a complex radiation therapy facility. Support Care Cancer. 2021;29(6):2931-7. Erratum in: Support Care Cancer. 2022;30(2):1891-2. [Crossref]  [PubMed]  [PMC] 
  20. Unsar S, Erol O, Ozdemir O. Caregiving burden, depression, and anxiety in family caregivers of patients with cancer. Eur J Oncol Nurs. 2021;50:101882. [Crossref]  [PubMed] 
  21. Edwards B, Clarke V. The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety. Psychooncology. 2004;13(8):562-76. [Crossref]  [PubMed] 
  22. Wang H, Zhao F, Wang X, Chen X. To Tell or Not: The Chinese doctors' dilemma on disclosure of a cancer diagnosis to the patient. Iran J Public Health. 2018;47(11):1773-4. [PubMed]  [PMC] 
  23. Fumis RR, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One. 2015;10(1):e0115332. [Crossref]  [PubMed]  [PMC] 
  24. Tsukamoto R, Kataoka Y, Mino K, Ishibashi N, Shibata M, Matsuo H, et al. Gender differences in anxiety among COVID-19 inpatients under isolation: a questionnaire survey during the first and second waves of the COVID-19 pandemic in Japan. Front Public Health. 2021;9:708965. [Crossref]  [PubMed]  [PMC] 
  25. Parás-Bravo P, Paz-Zulueta M, Boixadera-Planas E, Fradejas-Sastre V, Palacios-Ce-a D, et al. Cancer patients and anxiety: a gender perspective. Int J Environ Res Public Health. 2020;17(4):1302. [Crossref]  [PubMed]  [PMC] 
  26. Ptacek JT, Smith RE, Dodge KL. Gender differences in coping with stress: When stressor and appraisals do not differ. Personality and Social Psychology Bulletin. 1994;20(4):421-30. [Crossref] 
  27. Guida JL, Holt CL, Dallal CM, He X, Gold R, Liu H. Social relationships and functional impairment in aging cancer survivors: a longitudinal social network study. Gerontologist. 2020;60(4):607-16. [Crossref]  [PubMed]  [PMC] 
  28. Mor V, Allen S, Malin M. The psychosocial impact of cancer on older versus younger patients and their families. Cancer. 1994;74(7 Suppl):2118-27. [Crossref]  [PubMed] 
  29. Quansah F, Hagan JE Jr, Ankomah F, Srem-Sai M, Frimpong JB, Sambah F, et al. Relationship Between COVID-19 Related knowledge and anxiety among university students: exploring the moderating roles of school climate and coping strategies. Front Psychol. 2022;13:820288. [Crossref]  [PubMed]  [PMC] 
  30. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729. [Crossref]  [PubMed]  [PMC] 
  31. Gupta D, Rodeghier M, Lis CG. Patient satisfaction with service quality in an oncology setting: implications for prognosis in non-small cell lung cancer. Int J Qual Health Care. 2013;25(6):696-703. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com