Cancer Health_Fall_2023

Wellness and You

Wellness encompasses various aspects of your health and well-being. This includes your physical, mental, emotional, social, spiritual, occupational and intellectual health. Cancer Health wants to know how you maintain wellness in your life while living with cancer.
How long have you been living with cancer?

Less than a year5–10 years1–5 yearsMore than 10 yearsI am now cancer-free.
How would you rate your overall wellness since your cancer diagnosis?

ExcellentGoodFairPoor
To what extent has cancer impacted your physical well-being?

ExtremelyModeratelySlightlyNot at all
Have you made any lifestyle changes to improve your physical health since your diagnosis?

YesNo
To what extent has cancer impacted your emotional well-being?

ExtremelyModeratelySlightlyNot at all
Are you able to discuss your emotional concerns with your health care team?

YesNo
Do you have a good support network?

YesNo
Do you find healthy ways to manage your stress?

YesNo
Does spirituality or faith play a role in your wellness journey?

YesNo
Do you maintain a healthy work-life balance?

YesNo
Do you regularly find ways to stimulate and challenge yourself mentally?

YesNo
Do you regularly take time to unwind and relax?

YesNo
What year were you born?
What is your gender?

MaleFemaleTransgenderOther
What is your current level of education?

Some high schoolHigh school graduateSome collegeBachelor’s degree or higher
What is your annual household income?

Less than $15,000$15,000–$34,999$35,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 or more
What is your ethnicity? (Check all that apply.)

American Indian/Alaska NativeArab/Middle EasternAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhiteOther
What is your ZIP code?
Please verify that you are human*
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Wellness and You