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. 

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

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* 2. What is the patient's email?

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

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

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

Date

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* 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.

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

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

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

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

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

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* 16. 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.

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* 17. 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.

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

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

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* 21. Anything else you would like to add?

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