Survey
index

Newsletter

CaringBridge

CaringBridge is a nonprofit organization offering free, personalized websites that allow people to stay in touch with family and friends during a health crisis, treatment and recovery.


Health Search



Brought to you by:
CancerMonthly.com
and
SurvivingMesothelioma.com


Translate

Take Our Survey

It cannot always be explained why one person develops cancer and another does not, or how a person responds to specific cancer treatments, or what determines the risk of cancer recurrence. Research shows that certain risk factors increase the chance that a person will develop or have a recurrence of cancer. Some of the most common risk factors for cancer include:

  • Growing older
  • Tobacco
  • Uninformed exposure to sunlight
  • Ionizing radiation
  • Certain chemicals and other substances
  • Some viruses and bacteria
  • Certain hormones
  • Family history of cancer
  • Alcohol
  • Poor diet (a healthy one includes balanced choices and very often supplements)
  • Lack of physical activity
  • Poor mental health
  • Being overweight

Many of these risk factors can be avoided. Others, such as family history, cannot. Over time, several factors may act together to cause normal cells to become cancerous. People can help protect themselves by staying away from known risk factors whenever possible. If you think you may be at risk for cancer, you should discuss this concern - and how to reduce your risk - with your practitioner and other informed persons. Remember, knowledge is power and hope is paramount!

Thank you for taking the time to take our survey! Your data will contribute to a better understanding of cancer occurence and the best approaches for prevention and treatment.

Full Name :

Email :

Phone :



1. Have you or a loved one ever dealt with cancer? (If “no” skip to #10.)

2. What is your/their gender?

3. What is your/their ethnicity?

4. What was the age when diagnosed?

5. What was the diagnosis?

6. What treatments were used, or are currently being used?

7. Did the person dealing with cancer experience fatigue?

8. Did the person dealing with cancer experience cachexia (loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite sometimes experienced in degenerative disease)?

9. Did the person dealing with cancer experience a diminished quality of life?

10. Do you feel your/your family's diet is well-balanced and directed at optimum health?

11. Does your/your family's dietary plan include the use of supplements?

12. If you/your family take supplements, which specific supplements are being used? Are these being used for specific purposes or for the goal of maximum nutritional support?

13. Does your/your family's lifestyle include consistent exercise, and if not, are there activities in which you/they participate?

14. Are steps being taken to decrease stress and the role it plays in your/your family's life?

15. Based on family history, are there genetic factors that may (along with other factors) put you at an increased risk for cancer?

16. If so, what are those specific genetic factors?

17. Are there other risk factors to which you feel you or your family are exposed?

18. Have you or a family member ever had a pet with cancer? If so, what treatments were used or are currently being used?

19. Have you, a family member or a pet ever used complimentary/alternative/integrative medicine as nutritional support during cancer and/or cancer treatment?

20. Have you ever supported a non-profit foundation to help those who suffer with cancer and whom cannot afford conventional or alternative treatments?

21. Would you like to donate and help or sponsor a family or sponsor a pet? (If yes, a member of the Foundation will contact you shortly or you can visit our Donate page.)

22. May we contact you again to participate in additional surveys?

23. Questions/Comments:


*All donations will go to families who cannot afford treatment and pet owners who cannot afford treatments, as well applied to ongoing research. Any and all donations are greatly appreciated and very much needed as those who need our help often depend on these donations for their survival. We thank you in advance.