Cancer Health_Winter_2018

Your Cancer Care
It’s estimated that around 1.6 million people in the United States will be diagnosed with cancer this year and about 40 percent of people will be diagnosed with cancer at some point in their life. Cancer Health wants to know how cancer affects you.
1) Have you ever been diagnosed with cancer?

YesNo
2) Has anyone in your family been diagnosed with cancer?

YesNo
3) If you have been diagnosed with cancer, what type was it?
4) How was your cancer discovered?

I had a routine cancer screening.I felt an unusual lump.I had cancer-related symptoms.I went to my health care provider for something unrelated.Other
5) Where are you in the diagnosis and treatment process?

I have not yet started treatment.I am currently on treatment.I have finished treatment, and I have no evidence of cancer.I have finished treatment, but the cancer is still present or has come back.
6) What type of treatment have you received? (Check all that apply.)

SurgeryChemotherapyRadiation therapyTargeted therapyImmunotherapy
7) What side effects have you experienced from your treatment? (Check all that apply.)

AnemiaChange in moodCognitive changesConstipationDiarrheaFatigueFertility problemsFeverHair lossInfectionsLoss of appetiteNausea/vomitingPainSleep problemsSwelling (edema)Other
8) Where do you get information about cancer treatment options? (Check all that apply.)

Health care providerFamily or friendsSupport groupsHealth publicationsHealth websitesCancer websites
9) What types of support and services have you used? (Check all that apply.)

Counseling/therapySupport groupsOnline forumsHome health careHospice servicesFinancial assistanceTransportation assistanceOther
10) What year were you born?
11) What is your gender?

MaleFemaleTransgenderOther
12) What is your sexual orientation?

StraightGay/LesbianBisexualOther
13) What is your ethnicity? (Check all that apply.)

American Indian or Alaska NativeArab or Middle EasternAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
14) What is your zip code?
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Your Cancer Care