Have you ever been diagnosed with cancer?
* must provide value
Yes
No
Did you feel fatigued during and/or after your treatment for cancer?
Yes
No
Unsure
Please rate your fatigue today* must provide value
Since being diagnosed with cancer, what is the highest level of fatigue you experienced?* must provide value
Have you received any guidance or treatment from a healthcare provider (excluding medications) for your cancer-related fatigue?* must provide value
Yes
No
Unsure
Who treated or provided you with guidance about your cancer-related fatigue? (check all that apply) Exercise Physiologist
Occupational Therapist
Physical Therapist
Speech-Language Pathologist
Medical Doctor
Nurse
Psychologist, psychiatrist &/or counselor
I don't know
Other
None of the above
If "other" for who treated you, please describe:* must provide value
What did you do to manage your cancer-related fatigue? (select all that apply)* must provide value
Talked to a health care provider
Managed it on my own
Which of the following treatments did you receive for your cancer-related fatigue?
(check all that apply)
* must provide value
Activities to help you in your day-to-day living (such as doing household chores or returning to hobbies and sports)
Learning how to complete a specific task in an easier way
Modifying where you live, work, &/or play to make tasks easier to do (i.e., grab bars, lighter golf club)
Supervised exercise (e.g., followed a personalized exercise program; attended an exercise class)
Energy conservation (i.e., parking closer to the door, prioritizing tasks)
Mindfulness (i.e., awareness of what you are doing)
Counseling
Meditation/Breathing & relaxation techniques
Art, music or dance
Yoga, Tai chi, Qi gong
Acupuncture/dry needling
Massage or other hands-on treatment
Heat or ice, electrical stimulation, ultrasound
Practicing good sleep habits
Assistive technology/devices
Other
If "other" for type of treatment, please describe* must provide value
Which of the following did you try for your cancer-related fatigue?
(check all that apply)
* must provide value
Activities to help you in your day-to-day living (such as doing household chores or returning to hobbies and sports)
Learning how to complete a specific task in an easier way
Modifying where you live, work, &/or play to make tasks easier to do (i.e., grab bars, lighter golf club)
Supervised exercise (e.g., followed a personalized exercise program; attended an exercise class)
Energy conservation (i.e., parking closer to the door, prioritizing tasks)
Mindfulness (i.e., awareness of what you are doing)
Counseling
Meditation/Breathing & relaxation techniques
Art, music or dance
Yoga, Tai chi, Qi gong
Acupuncture/dry needling
Massage or other hands-on treatment
Heat or ice, electrical stimulation, ultrasound
Practicing good sleep habits
Assistive technology/devices
Other
If "other" for type of treatment, please describe* must provide value
Think about the strategies you selected above, how helpful were they? (0 = it was not helpful, 10 = helped me a lot)* must provide value
What specifically helped improve the symptoms of your cancer-related fatigue?
What age group are you in?* must provide value
21- 34 years
35 - 44 years
45 - 54 years
55 - 64 years
65 and over
Prefer not to answer
With what sex do you identify?* must provide value
Female
Male
Prefer not to answer
Are you Hispanic, Latino or of Spanish origin?* must provide value
Yes
No
How would you describe yourself?* must provide value
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Two or more Races
Other
If selected "other", please describe:* must provide value
What country do you live in?* must provide value
United States
Other
If "other" country, please describe:* must provide value
What is your highest level of eduction?* must provide value
Did not complete high school
High school degree or equivalent
Some college
Bachelor's degree
Master's degree
Doctoral degree
What type(s) of cancer have you been diagnosed with? (check all that apply)* must provide value
Breast
Prostate
Lung/respiratory
Colorectal
Uterine
Bladder
Leukemia
Lymphoma
Other
If "other" type of cancer, please describe:* must provide value
How long has it been since your most recent cancer diagnosis? <1 year
1-5 years
6 or more years
Which statement currently applies to you and your cancer diagnosis?* must provide value
Diagnosed but have not started treatment yet
Currently receiving treatment (e.g., chemotherapy, radiation, immunotherapy, etc.)
On treatment break (i.e., a holiday) but not complete
Receiving hormonal therapy only
Completed all cancer treatment
Other
If "other", please describe:* must provide value
What types of cancer treatment have you received? (check all that apply)* must provide value
Surgery
Chemotherapy
Radiation Therapy
Immunotherapy
Hormonal Therapy
None
Other
If "other" type of cancer treatment, please describe:* must provide value