Screen Reader Mode Icon

Finding A Clinical Trial For You

Please answer ALL of the questions related to the patient's care. We will use this information to assist in finding a clinical trial suited to their needs. 

Please allow for 3-5 business days for us to search for the appropriate clinical trial information. 

Question Title

* 1. What is the patient's full name ?

Question Title

* 2. What is the name and email address of the person requesting the search?

Question Title

* 3. What is the patient's phone number?

Question Title

* 4. What province does the patient live in?

Question Title

* 5. What is the patient's birth date?

Question Title

* 6. What is the date of the patient's diagnosis?

Date

Question Title

* 7. What is the distance that the patient is able to travel to participate in a clinical trial? 

NOTE:
-Keep in mind that clinical trials may require the patient to come in at least once a week. Each clinical trial is different. 
-Craig's Cause Pancreatic Cancer Society does have patient support grants to support travel to treatment.

Question Title

* 8. Are you willing/able to travel to the US? If yes, is there preferential city or geographical area you would like to go?

NOTE:
Many American clinical trials have many locations with different contact information. This will allow us to give you the contact info that  best suits you.

Question Title

* 9. Indicate if the patient is, ‘Interested in Phase I clinical trials’ or ‘Not interested in Phase I clinical trials.’

NOTE:
Phase I clinical trials test dosage and safety of the new treatment. These clinical trials are usually reserved for patients who have stopped responding to standard treatments.

Question Title

* 10. What type of pancreatic cancer has the patient been diagnosed with?

NOTE:
Is it adenocarcinoma (the most common type of pancreatic cancer), neuroendocrine (islet cell carcinoma), or something else?

Question Title

* 11. What is the patient's current stage of pancreatic cancer?

Question Title

* 12. If the patient's pancreatic cancer has spread, which organs has it spread to?

Question Title

* 13. Did the patient receive a surgical consult referral with a Hepato-Pancreato-Biliary (HPB) surgeon?

Question Title

* 14. Did the patient attend a surgical consult with a Hepato-Pancreato-Biliary surgeon?

Question Title

* 15. Did the patient receive a referral to a medical oncologist who specializes in pancreatic cancer treatment?

Question Title

* 16. Did the patient attend a medical oncologist appointment, with a medical oncologist who specializes in pancreatic cancer?

Question Title

* 17. List past and current treatments received and general time line/dates of treatment.

NOTE:
Include the names of all chemotherapy drugs, surgeries and other treatments received. If known, did your cancer progress on treatment?

Question Title

* 18. Has the patient undergone molecular profiling (analysis to identify specific genetic mutations or biomarkers) of their tumor? If so, please provide information regarding the results.

Question Title

* 19. Is the patient currently in treatment: Yes or No

Question Title

* 20. Has the pancreatic cancer caused any other health concerns (i.e. jaundice, venous thrombosis)?

Question Title

* 21. Was there any previous medical conditions prior to the cancer diagnoses?

Question Title

* 22. Anything else you would like to add?

0 of 22 answered
 

T