Cancer Survivorship

Cancer CAREpoint would like to learn more about cancer survivorship in Silicon Valley so we can develop programs to best meet the needs of cancer patients. All your responses will be confidential. The survey should take about 5 minutes to complete.  Thank you.

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* 1. What was your cancer diagnosis?

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* 2. Are you finished with active treatment? (we define active treatment as the initial round of treatment you received as opposed to maintenance treatment which is on-going)

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* 3. If yes, in what year did you finish active treatment?

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* 4. From the list below, please select the issues that have the greatest impact on your life as a result of your cancer diagnosis. Feel free to chose more than one answer.

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* 5. Of the issues you selected, select the three that matter to you most right now?

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* 6. Are you receiving support (emotional, psychological, financial and/or spiritual) from any of the following? Please feel free to choose more than one answer.

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* 7. Did you receive a written Survivorship Care Plan at the conclusion of your active treatment?

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* 8. If yes, who gave it to you?

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* 9. After you completed treatment how often was there follow-up with your health care professional (oncologist/doctor, nurse or social worker) about issues related to survivorship? (at any point during the first year following treatment). This can include follow-up through a phone call, email, text or visit.

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* 10. During your most recent visit, did you talk with your healthcare provider (oncologist/doctor, nurse or social worker) about any issues related to cancer survivorship?

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* 11. With what gender do you identify?

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* 12. Please select the ethnicity/race that best describes you:

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* 13. What is your approximate annual household income before taxes? (this information is confidential and helps us to make sure the respondents to this survey represent the different Silicon Valley income levels)

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* 14. Please select the age group that best describes you.

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* 15. Please select the education level that best describes you

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* 16. Please select the answer that best describes you

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* 17. Have you ever used Cancer CAREpoint support services?

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* 18. Have you participated in Cancer CAREpoint's 8-week Survivorship Workshop?

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* 19. What is your zip code?

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* 20. Do you have any additional comments about being a cancer survivor and your needs since you have completed active treatment that you would like to share?

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