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* 1. How old was the patient when diagnosed with lung cancer?

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* 2. Is the patient currently receiving or has received chemotherapy in the past 3 years?

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* 3. Does/did the person experience side effects from his/her chemotherapy?

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* 4. Which of the following side effects is the patient experiencing or has experienced due to chemotherapy? Check all that apply.

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* 5. How much do you agree or disagree with the following: The patient finds/ found it difficult to take every dose of chemotherapy

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* 6. Which of the following reasons makes/ made it difficult for the patient to take chemotherapy? Check all that apply.

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* 7. How much do you agree or disagree with the following: Chemotherapy disturbs/disturbed the patient’s normal daily activities

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* 8. How much do you agree or disagree with the following: Chemotherapy disturbs/disturbed the patient’s family life

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* 9. How much do you agree or disagree with the following: Chemotherapy causes/ caused financial problems

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* 10. How much do you agree or disagree with the following: The administration of chemotherapy is/ was inconvenient

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