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CCA Annual Conference - CCA and Nutrition
1.
First Name
2.
Last Name
*
3.
Email
(Required.)
*
4.
What is the patient's gender?
(Required.)
Male
Female
Non binary
*
5.
What is the patient's race? [Select all that apply]
(Required.)
White or Caucasian
Black or African American
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Hispanic or Latino
Other (please specify)
*
6.
What was the year of cholangiocarcinoma diagnosis? (YYYY)
(Required.)
*
7.
What was the patient's age at the time of cholangiocarcinoma diagnosis?
(Required.)
*
8.
What is/was the type of cholangiocarcinoma that the patient had?
(Required.)
Intrahepatic cholangiocarcinoma
Cancer develops in the hepatic bile ducts or the smaller intrahepatic biliary ducts inside the liver
Perihilar extrahepatic cholangiocarcinoma
Cancer develops where the right and left hepatic ducts have joined and are leaving the liver
Distal extrahepatic cholangiocarcinoma
Cancer outside the liver after the right and left hepatic bile ducts have joined to form the common bile duct
Unsure
*
9.
Has the patient ever had a consultation with a nutritionist
before or after the cholangiocarcinoma diagnosis
?
(Required.)
No
Yes, only
before
the cholangiocarcinoma diagnosis
Yes, only
after
the cholangiocarcinoma diagnosis
Yes,
before and after
the cholangiocarcinoma diagnosis
*
10.
Before the cholangiocarcinoma diagnosis, the patient (Select all that apply)
(Required.)
Ate fruits
Ate vegetables
Ate meat (all types)
Ate red meat (beef and pork)
Ate poultry (chicken and turkey)
Ate cooked fish (all types)
Ate uncooked fish (sushi and sashimi)
Ate dairy products
Ate processed foods (prepackaged or prepared such as boxed mac and cheese, frozen meals)
Ate snack foods, sweets, and/or desserts (such as chips, snack cakes, and cookies high in salt, sugar, and/or fat)
Ate fast food (such as hamburgers, french fries, chicken nuggets, etc.)
Ate whole grains and legumes (high fiber bread and beans)
Ate organic items (fruits, vegetables, grains, legumes)
Drank diet soda or diet sports drinks
Drank regular (non-diet) soda or sports drinks
Drank sports/energy drinks
Used sugar substitute or ate “sugar-free” foods containing the sugar substitute
Other (please specify)
*
11.
Please select who is filling out the survey
(Required.)
Patient
Caregiver
Former caregiver for a patient who passed away
Current Progress,
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