CART T-Cell Therapy In Patients of Advanced Age Survey

Question Title

1. I attended this web program as a: (select one).

Patient

Caregiver

Family Member

Friend/Concerned Individual

Healthcare Professional

Community Member

LLS Staff

LLS Volunteer

Other (please specify)

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2. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

American Indian or Alaskan Native

Native Hawaiian or other Pacific Islander

White

Prefer not to disclose

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3. Are you Hispanic/Latino/a/x?

Yes

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4. What is your date of birth? (LLS is unable to correspond with minors.)

(MM/DD/YYYY)

Date

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5. Do you describe yourself as a man, a woman, or in some other way?

A Man

A Woman

Prefer not to answer

In some other way (with open text field)

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6. In what ZIP/Postal code is your home located?

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7. Have you or the patient been diagnosed with a blood cancer?

Yes

N/A

If no, please tell us the type of cancer with which you/patient were diagnosed:

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8. If yes, when were you/patient diagnosed?

(MM/DD/YYYY)

Date

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9. If yes, please tell us what type of blood cancer (check all that apply):

Non-Hodgkin lymphoma (NHL)

Mantle cell lymphoma (MCL)

Hodgkin lymphoma (HL)

Chronic lymphocytic leukemia (CLL)

Chronic myeloid leukemia (CML)

Acute lymphoblastic leukemia (ALL)

Acute myeloid leukemia (AML)

Myelodysplastic syndromes

Myeloproliferative neoplasms (MPN) (polycythemia vera, essential thrombocythemia, myelofibrosis)

Multiple myeloma

Other (please specify)

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10. Are you or the patient currently being treated?

Yes

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11. What treatments have you or the patient had? (check all that apply):

Combination drug therapy (chemotherapy)

Single Drug Therapy

Allogeneic stem cell transplant (donor)

Autologous stem cell transplant

CAR T- cell Therapy

Radiation therapy

Immunotherapy

Blood transfusions

Watch & Wait

N/A

Other (please specify)

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12. Are you presently in or have you ever participated in a clinical trial?

Yes

N/A

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13. As a result of participating in this program, to what extent do you agree to the following statements? (Select one answer for each)

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I am knowledgeable of which blood cancers benefit from CAR T-cell therapy.	I am knowledgeable of which blood cancers benefit from CAR T-cell therapy. Strongly Disagree	I am knowledgeable of which blood cancers benefit from CAR T-cell therapy. Disagree	I am knowledgeable of which blood cancers benefit from CAR T-cell therapy. Agree	I am knowledgeable of which blood cancers benefit from CAR T-cell therapy. Strongly Agree	I am knowledgeable of which blood cancers benefit from CAR T-cell therapy. N/A
I know when to discuss CAR T-cell therapy with my doctor.	I know when to discuss CAR T-cell therapy with my doctor. Strongly Disagree	I know when to discuss CAR T-cell therapy with my doctor. Disagree	I know when to discuss CAR T-cell therapy with my doctor. Agree	I know when to discuss CAR T-cell therapy with my doctor. Strongly Agree	I know when to discuss CAR T-cell therapy with my doctor. N/A
I know the factors to consider regarding CAR T-cell therapy for older adults .	I know the factors to consider regarding CAR T-cell therapy for older adults . Strongly Disagree	I know the factors to consider regarding CAR T-cell therapy for older adults . Disagree	I know the factors to consider regarding CAR T-cell therapy for older adults . Agree	I know the factors to consider regarding CAR T-cell therapy for older adults . Strongly Agree	I know the factors to consider regarding CAR T-cell therapy for older adults . N/A
I know the potential side effects of CAR T-cell therapy.	I know the potential side effects of CAR T-cell therapy. Strongly Disagree	I know the potential side effects of CAR T-cell therapy. Disagree	I know the potential side effects of CAR T-cell therapy. Agree	I know the potential side effects of CAR T-cell therapy. Strongly Agree	I know the potential side effects of CAR T-cell therapy. N/A

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14. Following this program, do you feel more prepared to discuss CAR T-cell therapy with your healthcare team?

Yes

N/A

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15. Which form(s) of cancer education do you most prefer?

Webcasts (live or pre-recorded)

Short videos

Podcasts

Booklets

Other (please specify)

CART T-Cell Therapy In Patients of Advanced Age

Question Title

1. I attended this web program as a: (select one).

Question Title

2. What is your race or ethnicity?

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3. Are you Hispanic/Latino/a/x?

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4. What is your date of birth? (LLS is unable to correspond with minors.)

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5. Do you describe yourself as a man, a woman, or in some other way?

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6. In what ZIP/Postal code is your home located?

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7. Have you or the patient been diagnosed with a blood cancer?

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8. If yes, when were you/patient diagnosed?

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9. If yes, please tell us what type of blood cancer (check all that apply):

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10. Are you or the patient currently being treated?

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11. What treatments have you or the patient had? (check all that apply):

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12. Are you presently in or have you ever participated in a clinical trial?

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13. As a result of participating in this program, to what extent do you agree to the following statements? (Select one answer for each)

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14. Following this program, do you feel more prepared to discuss CAR T-cell therapy with your healthcare team?

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15. Which form(s) of cancer education do you most prefer?

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16. Please describe any information you expected to get from this program but did not receive.

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17. Please give us any additional feedback about this program.

CART T-Cell Therapy In Patients of Advanced Age

Question Title

* 1. I attended this web program as a: (select one).

Question Title

* 2. What is your race or ethnicity?

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* 3. Are you Hispanic/Latino/a/x?

Question Title

* 4. What is your date of birth? (LLS is unable to correspond with minors.)

Question Title

* 5. Do you describe yourself as a man, a woman, or in some other way?

Question Title

* 6. In what ZIP/Postal code is your home located?

Question Title

* 7. Have you or the patient been diagnosed with a blood cancer?

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* 8. If yes, when were you/patient diagnosed?

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* 9. If yes, please tell us what type of blood cancer (check all that apply):

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* 10. Are you or the patient currently being treated?

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* 11. What treatments have you or the patient had? (check all that apply):

Question Title

* 12. Are you presently in or have you ever participated in a clinical trial?

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* 13. As a result of participating in this program, to what extent do you agree to the following statements? (Select one answer for each)

Question Title

* 14. Following this program, do you feel more prepared to discuss CAR T-cell therapy with your healthcare team?

Question Title

* 15. Which form(s) of cancer education do you most prefer?

Question Title

* 16. Please describe any information you expected to get from this program but did not receive.

Question Title

* 17. Please give us any additional feedback about this program.

1. I attended this web program as a: (select one).

2. What is your race or ethnicity?

3. Are you Hispanic/Latino/a/x?

4. What is your date of birth? (LLS is unable to correspond with minors.)

5. Do you describe yourself as a man, a woman, or in some other way?

6. In what ZIP/Postal code is your home located?

7. Have you or the patient been diagnosed with a blood cancer?

8. If yes, when were you/patient diagnosed?

9. If yes, please tell us what type of blood cancer (check all that apply):

10. Are you or the patient currently being treated?

11. What treatments have you or the patient had? (check all that apply):

12. Are you presently in or have you ever participated in a clinical trial?

13. As a result of participating in this program, to what extent do you agree to the following statements? (Select one answer for each)

14. Following this program, do you feel more prepared to discuss CAR T-cell therapy with your healthcare team?

15. Which form(s) of cancer education do you most prefer?

16. Please describe any information you expected to get from this program but did not receive.

17. Please give us any additional feedback about this program.