Early Breast Cancer Patient Survey

Rethink Breast Cancer is looking for woman with HER2-positive early breast cancer and women who have been treated with Herceptin-Perjeta (pertuzumab-trastuzumab) combination therapy to talk about their experience.

The pan-Canadian Oncology Drug Review (pCODR) makes recommendations about whether the provincial health plans should pay for new cancer drugs. pCODR will soon be reviewing the use of Herceptin-Perjeta combination therapy to treat HER2-positive early breast cancer patients who are node-positive or hormone receptor-negative.

Rethink Breast Cancer will be making a submission to ensure that patient voices are represented and considered during the review process. We would like to speak with women about their experience with HER2-positive early breast cancer.

If you would like to share your experience, please complete the questions below.

We are also interested in speaking directly with women who have treatment experience with Herceptin-Perjeta combination therapy. Please contact Shawna Rich-Ginsberg at shawna@rethinkbreastcancer.com if you would be willing to participate in a 1-on-1 interview.

We would like to thank everyone for helping to ensure that patient experiences are represented in the cancer drug funding review process.

Please note that we welcome your input even if you haven't been treated with Perjeta.

* 1. Have you been diagnosed with HER2-positive early breast cancer?

* 2. If yes, is your cancer node-positive or hormone receptor-negative? (Please answer yes if the cancer fits either criterion.)

* 3. When were you diagnosed with breast cancer? (Please include month and year.)

* 4. Have you experienced any symptoms as a result of your breast cancer? (If you can, please try to focus on symptoms caused by the cancer rather than any treatments.)

* 5. On a scale of 1 (no impact) to 5 (very significant impact), how have the symptoms associated with breast cancer itself impacted the following areas of your life:

  1 2 3 4 5
Ability to work
Ability to travel
Ability to exercise
Ability to perform household chores
Ability to care for children
Ability to fulfill family obligations
Ability to spend time with family & friends

* 6. What treatment have you received since your diagnosis?

* 7. What side effects have you experienced as a result of treatment?

* 8. Have you had difficulties accessing cancer treatments?

* 9. Do you have financial challenges as a result of your breast cancer treatment?

* 10. Have you needed financial assistance due to the costs of breast cancer or its treatment?

* 11. On a scale of 1 (not important) to 5 (very important), how important are these outcomes for your breast cancer treatment?

  1 2 3 4 5
Controlling disease progression
Reducing symptoms
Maintaining quality of life
Managing side effects
Preventing recurrence

* 12. Have you been treated with Herceptin-Perjeta (pertuzumab-trastuzumab) combination therapy as an early breast cancer patient?

* 13. Have you received other drugs or therapies either before or after Herceptin-Perjeta? If yes, please identify them.

* 14. How long were you treated with Herceptin-Perjeta?

* 15. On a scale of 1 (much worse) to 5 (much better), how has your life changed on Herceptin-Perjeta compared to other therapies that you received?

  1 2 3 4 5
Metastatic cancer symptoms (i.e. bone pain)
Drug side effects
Maintaining quality of life
Controlling disease progression

* 16. Has your breast cancer recurred since you began treatment?

* 17. If yes, how long elapsed between no evidence of disease and recurrence?

* 18. How does the knowledge of your recurrence status make you feel?

* 19. Did you have any difficulty accessing Herceptin-Perjeta?

* 22. Would you be willing to accept drugs with more severe side effects for some medical benefit in initial treatment or would you prefer to begin with milder treatments before trying more severe options?

* 23. What country are you from?

* 24. If you are Canadian, what province are you from?

* 25. Would you be willing to participate in a telephone or face-to-face survey to discuss your experience with Herceptin-Perjeta?

* 26. If yes, please enter your email address or phone number below.