The purpose of this survey is to provide Colon Cancer Canada the Canadian Cancer Survivor Network (CCSN) with insights and perspectives about living with and managing metastatic colorectal cancer from patients and caregivers in order to complete a patient evidence submission for regorafenib (Stivarga) for the treatment of patients with metastatic colorectal cancer (CRC) who have been previously treated with fluoropyrimidine-based chemotherapy, oxaliplatin, irinotecan, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy; for patients with ECOG status of ≤ 1.

THIS SURVEY will be open until noon on October 27, 2014 to enable us to submit our patient evidence submission will be submitted to the pan-Canadian Oncology Drug Review on October 31, 2014.

Thank you for your participation!

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* 1. What are the symptoms or problems you experience with advanced colorectal cancer that affect your day-to-day living and quality of life?

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* 2. Which of these symptoms are the most important to control. Please pick your top 5:

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* 3. What therapies/treatments are you currently using to treat your disease?

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* 4. How effective have the therapies/treatments listed in question 3 been at controlling common aspects of advanced colorectal? Please check all that apply.

  Very effective Somewhat effective Not very effective Not effective at all
FOLFOX
FOLFIRI
FLOX
CapeOx
Irinotecan
5-FU (Fluorouracil)
5-FU/leucovorin
Capecitabine (Xeloda)
Bevacizumab (Avastin)
Aflibercept (Zaltrap)
Cetuximab (Erbitux)
Panitumumab (Vectibix)
Regorafenib (Stivarga)

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* 5. What side effects have you have experienced?

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* 6. Which side effects are the most difficult to manage?

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* 7. Have you had problems accessing current treatment?

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* 8. Are there any needs in your current therapy that are not yet being met?

Expectations of a new drug: No experience with regorafenib (Stivarga)

Please complete these questions if you have NOT been treated with regorafenib (Stivarga)

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* 9. Based on the needs in question 8, how much of an improvement would be needed from the new drug to make it better than current treatment? Please describe.

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* 10. Which of the following issues would you hope that a new drug would address to manage your disease?

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* 11. What side effects would you be willing to tolerate?

Experiences with regorafenib (Stivarga)

Please complete these questions only if you have metastatic colorectal cancer (CRC) and have been previously treated with fluoropyrimidine-based chemotherapy, oxaliplatin, irinotecan, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy; for patients with ECOG status of ≤ 1.

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* 12. Please describe the positive and negative effects of regorafenib (Stivarga).

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* 13. What issues are better managed on regorafenib (Stivarga) than on your previous therapy?

  Yes No
Better able to control symptoms
Reduction in side effects from current medications or treatments
Ease of use
Stops disease progression

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* 14. If you are better able to control symptoms on regorafenib (Stivarga) than on your previous therapy, please describe which symptoms.

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* 15. If side effects are reduced on regorafenib (Stivarga) than on your previous therapy, please describe which side effects.

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* 16. If you found that Xofigo regorafenib (Stivarga) was easier to use than your previous therapy, please describe how it was easier to use.

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* 17. What adverse effects were caused by regorafenib (Stivarga)?

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* 18. Which adverse effects are acceptable and which ones are not?

  Acceptable Not acceptable
Fatigue
Diarrhea
Hot flashes
Other

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* 19. What expectations do you have for your long-term health and well-being as a result of taking regorafenib (Stivarga)?

Please complete the following if you are a caregiver (family member or friend).

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* 20. What challenges do you face in caring for your loved one with metastatic colorectal cancer?

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* 21. Please describe how you feel about these challenges.

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* 22. What are the most challenging adverse effects related to current therapy or treatment?
Please describe: (eg. Helping with fatigue, pain management, preparing meals, etc)

Thank you for your responses to these questions.

We appreciate your willingness to participate in this survey, which will help Colon Cancer Canada and the Canadian Cancer Survivor Network prepare our submission to the pan-Canadian Oncology Drug Review.

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