Abnormalities of the Immune System in Cancer Patients

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* 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?

(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):

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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. Is there a COVID-19 treatment/prophylaxis that you would like to find out more about?

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* 14. Please check true or false. As a result of this program

	True	False
I learned about infectious complications in patients with blood cancers with a focus on abnormalities in the immune system.	I learned about infectious complications in patients with blood cancers with a focus on abnormalities in the immune system. True	I learned about infectious complications in patients with blood cancers with a focus on abnormalities in the immune system. False
I learned about the current standard of practice to decrease infectious complications in patients with blood cancers.	I learned about the current standard of practice to decrease infectious complications in patients with blood cancers. True	I learned about the current standard of practice to decrease infectious complications in patients with blood cancers. False
I learned about special considerations for blood cancer patients regarding the COVID-19 pandemic.	I learned about special considerations for blood cancer patients regarding the COVID-19 pandemic. True	I learned about special considerations for blood cancer patients regarding the COVID-19 pandemic. False

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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)

Abnormalities of the Immune System in Cancer Patients

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

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* 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?

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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? (MM/DD/YYYY):

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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. Is there a COVID-19 treatment/prophylaxis that you would like to find out more about?

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* 14. Please check true or false. As a result of this program

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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.