Summer 2026 CCSN Survey for Patient/Caregiver Input on Pre-Chemotherapy Myeloprotectant for Extensive Stage Small Cell Lung Cancer - trilaciclib

The pan-Canadian Oncology Drug Review invites patient groups to prepare and send in submissions so that individuals with lived experience, like you, can be heard. Please join us and have your voice included in this important submission process. All information provided will remain anonymous when used in the submission.

The purpose of this survey is to provide the Canadian Cancer Survivor Network and its partners with insights and perspectives about living with lung cancer from survivors, patients and caregivers in order to complete a patient evidence submission for new treatments that are under review in Canada.

The proposed indication is currently undergoing review at Health Canada, and is expected to be considered for a reimbursement review at Canada's Drug Agency and L’Institut national d’excellence en santé et en services sociaux (INESSS):

Trilaciclib (brand name = Cosela) for the prevention of chemotherapy-induced myelosuppression when administered as a component of platinum/etoposide- or topotecan-containing regimens for extensive-stage small cell lung cancer (ES-SCLC). ES-SCLC is also sometimes refered to as Metastatic Small Cell Lung Cancer.

If you are outside of this specification and feel you may also benefit from this treatment, we would like to hear from you as well. Your input could help inform what is desired from patients and caregivers in new and upcoming medications and treatments.

This survey should take approximately 30-35 minutes to complete and will remain open until end of day Sunday November 8, 2026.

Only questions marked with an asterisk are mandatory.

Please be sure to press the "Done" button a the end of the survey to ensure your answers are recorded.

Thank you for your participation!

BACKGROUND INFORMATION: PLEASE TELL US A LITTLE ABOUT YOURSELF

Question Title

1. In which country do you live? (Required.)

Canada

Not in Canada. I live in....

Question Title

2. If you are a resident of Canada, in which province or territory do you reside? (Required.)

Question Title

3. How would you describe your home's location relative to your nearest cancer treatment centre? (Required.)

Very far (i.e., remote)

Far (i.e., rural)

Somewhat far (i.e., suburban)

Near (i.e., urban)

Very near (i.e., within my neighbourhood)

Very far (i.e., remote)

Far (i.e., rural)

Somewhat far (i.e., suburban)

Near (i.e., urban)

Very near (i.e., within my neighbourhood)

Question Title

4. How would you identify your gender? (Required.)

Male

Female

Gender fluid

Non-Binary

Prefer not to answer

Describe:

Question Title

5. How would you identify your ethnicity? (Please check all that apply) (Required.)

Black (e.g., of Central or Southern African, Nigerian, Ghanian, African Canadian, Afro-Caribbean, etc. descent)

Hispanic/Latino/Latina/Latinx (e.g., of Central or Southern American, Mexican, Colombian, Argentinian, etc. descent)

East Asian (e.g., of Chinese, Japanese, Korean, etc. descent)

Southeast Asian (e.g., of Filipino, Vietnamese, Thai, etc. descent)

South Asian (e.g., of Indian, Pakistani, Bangladeshi, etc. descent)

Middle Eastern (e.g., of North African, Iranian, Egyptian, Israeli, etc. descent)

Indigenous to North America/Inuit/Métis/First Nations (e.g., of primarily North American descent)

White (e.g., of European, French, English, Polish, Italian, etc. descent)

Mixed/Biracial/Multiracial/Multi-select

Prefer Not to Answer

Describe:

Question Title

6. In what age category do you fall? (Required.)

under 18

18-29

30-39

40-49

50-59

60-69

70-79

80+

Question Title

7. At what age were you, or the person in your care, diagnosed with extensive-stage small cell lung cancer (ES-SCLC) also sometimes refered to as Metastatic Small Cell Lung Cancer?

Question Title

8. What is your relationship status? Please select all that apply.

Married or common-law

Widowed

Separated

Divorced

Dating

Single

Prefer not to say

Describe:

Question Title

9. Do you have any dependents? Please select all that apply.

Yes, infant/toddlers (under 5)

Yes, young children (6-12)

Yes, adolescents/teenagers (13-17)

Yes, adult children who need care (18+)

Yes, elderly family members

No, my children are all independent adults now

Describe:

Summer 2026 CCSN Survey for Patient/Caregiver Input on Pre-Chemotherapy Myeloprotectant for Extensive Stage Small Cell Lung Cancer - trilaciclib

Question Title

* 1. In which country do you live? (Required.)

Question Title

* 2. If you are a resident of Canada, in which province or territory do you reside? (Required.)

Question Title

* 3. How would you describe your home's location relative to your nearest cancer treatment centre? (Required.)

Question Title

* 4. How would you identify your gender? (Required.)

Question Title

* 5. How would you identify your ethnicity? (Please check all that apply) (Required.)

Question Title

* 6. In what age category do you fall? (Required.)

Question Title

* 7. At what age were you, or the person in your care, diagnosed with extensive-stage small cell lung cancer (ES-SCLC) also sometimes refered to as Metastatic Small Cell Lung Cancer?

Question Title

* 8. What is your relationship status? Please select all that apply.

Question Title

* 9. Do you have any dependents? Please select all that apply.

1. In which country do you live? (Required.)

2. If you are a resident of Canada, in which province or territory do you reside? (Required.)

3. How would you describe your home's location relative to your nearest cancer treatment centre? (Required.)

4. How would you identify your gender? (Required.)

5. How would you identify your ethnicity? (Please check all that apply) (Required.)

6. In what age category do you fall? (Required.)

7. At what age were you, or the person in your care, diagnosed with extensive-stage small cell lung cancer (ES-SCLC) also sometimes refered to as Metastatic Small Cell Lung Cancer?

8. What is your relationship status? Please select all that apply.

9. Do you have any dependents? Please select all that apply.