Please enter your case ID number. Your case ID number can be found in the top right-hand corner of the study letter under the Cancer Council Victoria logo as pictured in the image below.
Thank you for considering this request. To ensure that you are not contacted again about this research study, please enter your case ID number. Your case ID number can be found in the top right-hand corner of the study letter under the Cancer Council Victoria logo as pictured in the image below.
4 a) Below is a list of some health concerns or symptoms commonly experienced with lung cancer.
Please list all health concerns or symptoms you may have had before contacting a doctor, including if you were being investigated for another problem. If your health concerns or symptoms are not included in this list, just list the concerns you had.
- Cough
- Breathlessness
- Being short of breath
- Chest pain / Pain on breathing
- Coughing up blood / Blood in spit
- Unexplained weight loss
- Loss of appetite
- Fatigue
- Flu
- Pneumonia / chest infection
Please write down your best estimate of the date or if you cannot remember the exact date, you can fill in an approximate date.
Health concerns or symptoms before contacting a doctor
5. Approximately how long did you have health concerns or symptoms before contacting a doctor? Please think of the first visit to the doctor, not re-visits after that.
If you were being investigated for another problem, please think about how long you had the symptoms or concerns that led to these investigations.
If you cannot remember the exact date, you can fill in an approximate date.
9. How many times did you visit the following for the investigation of your health concerns/symptoms (or to investigate another problem) before your cancer was diagnosed?
Please write '0' if you did not visit the doctor or hospital department.
E.g. went straight to emergency department
If you cannot remember the exact date, you can fill in an approxiamte date.
Sometimes people will have several tests before a diagnosis of cancer is given. A doctor may need to take a sample of tissue, called a biopsy, or perform surgery, in order to make a definitive diagnosis.
If you cannot remember the exact date, you can fill in an approximate date.
14. When you were told you had cancer
Tests you may have had
Please answer the following questions about any tests you may have had, who ordered them and when you got the results.
You would have to stood in front of the x-ray machine and been told to hold your breath while the x-ray was taken.
A computerised tomography (CT) scan is a type of x-ray that gives a picture of organs or other structures including tumours or cancers. You would have had a liquid dye before the scan, in a drink and/or in an injection. You would have been lying on a table that moves slowly through the CT scanner.
Before a PET scan you would have been given a small injection of radioactive material. The scanner has a ring of detectors that surround the patient, and looks similar to a CT scanner. Imaging generally takes around 30 minutes.
A doctor will insert a flexible tube through your nose or mouth and down your windpipe. During the procedure the doctor will take a tissue sample.
A doctor will insert a flexible tube through your nose or mouth and down your windpipe. During the procedure the doctor will take a tissue sample.
A doctor will insert a flexible tube through your nose or mouth and down your windpipe. During the procedure the doctor will take a tissue sample.
Treatment
23. Have you had any of the following treatments for your cancer yet?
If so, can you please estimate the date this treatment started? If you cannot remember the exact date, you can fill in an approximate date.
(Give first date if series of treatments)
What hospital did you have surgery at?
(Give first date if series of treatments)
What hospital did you have chemotherapy at?
(Give first date if series of treatments)
What hospital did you have radiotherapy at?
(Give first date if series of treatments)
What hospital did you have this other treatment at?
Care coordination
25. The following questions ask about the care that you have received from all the health professionals who have been looking after you during your treatment for cancer.
These health professionals include your surgeon, GP and anyone else who has been involved in your care such as a care coordinator or cancer nurse, community nurses, a medical oncologist or radiation oncologist, physiotherapist, psychologist or counsellor.
Please select the best option that applies to you.
The following questions ask about your experience during your treatment for cancer.
For the next two questions, please select the number between 1 and 10 that best reflects your opinion of the care you received for your cancer.
In general:
About you
Please can you answer some more general questions about your health?
It would help us in interpreting your responses to this questionnaire to know about other health problems.
28. Before your cancer, had you been treated for any of the conditions below?
We would like to have a little more information about you.
The information you provide below will help us to understand the results of the survey in more detail.
34a. If you currently or used to smoke:
Required
Consent form
Please read the information below. If you require any clarification, please call Victoria White on 0423 035 159. Contact details can also be found on the information sheet.
Your responses are completely confidential and will not be passed to anyone involved in your treatment.
- I confirm that I have read the attached information sheet and I understand why the research is being done.
- I am willing for the team to request information from my GP to assist with the audit as described in the information sheet.
- I give permission for my details and any other relevant information from my medical records and the cancer registry to be passed onto the researchers and stored as described in the information sheet.
Required
Interested in talking further about your experiences?
The survey you have just completed aims to understand how people are diagnosed with their cancer.
We are also interested in understanding in more detail the experiences people have regarding their diagnosis and treatment, and what medical staff do or don’t do that may help people get through their treatment or make treatment more difficult. To help us understand these processes better, we are looking for a range of people to tell us more about their experiences.
If you would like to help or want to receive more information about what the project is about, please tick the relevant box below. If you tick “Yes” we will contact you with more information.
Finally, if your address is different from the one on the letter sent to you, can you please provide your current contact details below:
Thank you for considering this request. If you would prefer not to be contacted again, please provide your name and date of birth so we can remove your information from our mailing list.
Please provide an email address to receive a link back to your survey