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Thank you for telling us about your lung cancer journey!
Your story will be helpful for patients like you – and will improve public awareness of lung cancer and its effects.
Name of patient/survivor
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First Name
Last Name
Name of person completing form (if someone other than the patient)
First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
If you'd prefer to talk with us directly instead of filling out the form, we can set up a phone and/or video meeting! Just check this box, and skip to the end.
Yes, please email me.
Yes, please call me.
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What stage of lung cancer do you have?
Please Select
NSCLC stage 1
NSCLC stage 2
NSCLC stage 3
NSCLC stage 4
SCLC - limited stage
SCLC - extensive stage
Unknown
Have you had comprehensive biomarker testing?
Yes
No
Unsure
Please indicate any mutations the tumor tested positive for:
ALK
BRAF V600E
EGFR
HER2
KRAS
MET
NTRK
RET
ROS1
PD-L1 or PD-1 protein
When were you diagnosed with lung cancer? What events and symptoms led to your diagnosis?
Please describe any symptoms, testing circumstances, the emotions you experienced, and/or any other details you'd like to share.
What treatments have you had (or are currently undergoing)?
Surgery, chemotherapy, immunotherapy, targeted therapies, radiation, etc.
Have you participated in a clinical trial?
Yes
No
Please share any details about the trial(s).
Where has your treatment taken place?
Please enter hospital or clinic name.
How did you find and maintain hope throughout your treatment?
Who has supported you through this lung cancer journey? What did they do or say that was most helpful?
Where else did you find support?
Please list groups, organizations, communities
What do you wish you knew when you were first diagnosed with lung cancer? What advice would you give someone just starting treatment?
How did you learn about LCRF and its mission?
How have you connected with LCRF?
Ordered or downloaded educational materials
Attended webinars (such as: #TogetherSeparately, Scientific Symposium, oncogene partner events)
Attended in person event (such as: Free to Breathe Walk, LCRF Together Chicago, LCRF Together DC, Elliot's Legacy, Evening of Innovation gala)
Participated in LCRF's Lung Cancer Community Facebook group
Visited LCRF.org
Called or emailed LCRF's Lung Cancer Support Line
Other
What other type of connection did you make?
What impact have these activities had on your lung cancer journey?
Did we miss anything? Please share any other comments.
Please provide a photo (or several) of yourself!
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