The following questions are about your experience with cancer. If you have not had cancer but your loved one has, you may answer the survey on their behalf.
Have you ever been diagnosed with cancer? Remember, if you have not had cancer but you are taking the survey for a loved one who has, answer "Yes" to this question.
Yes
No
With which of the following types of cancer have you been diagnosed? Please check all that apply.
Bladder Cancer
Breast Cancer
Colon/Rectal Cancer
Esophageal
Glioblastoma/Gliomas
Gynecological Cancer (e.g., ovary, uterus, cervix)
Head/neck Cancer (e.g., tonsil, throat, mouth)
Kidney Cancer
Leukemia
Lymphoma
Lung Cancer
Melanoma
Non-melanoma skin cancer (e.g. basal cell or squamous cell skin cancer)
Myeloma
Pancreas Cancer
Prostate Cancer
Other Cancer
What other cancer have you been diagnosed with?
Have you seen a clinician for cancer management within the last year?
Yes
No
Are you currently being treated by a clinician for Bladder Cancer ?
Yes
No
Are you currently being treated by a clinician for Breast Cancer ?
Yes
No
Are you currently being treated by a clinician for Colon/Rectal Cancer ?
Yes
No
Are you currently being treated by a clinician for Esophageal ?
Yes
No
Are you currently being treated by a clinician for Glioblastoma/Gliomas ?
Yes
No
Are you currently being treated by a clinician for Gynecological Cancer (e.g., ovary, uterus, cervix)?
Yes
No
Are you currently being treated by a clinician for Head/neck Cancer (e.g., tonsil, throat, mouth)?
Yes
No
Are you currently being treated by a clinician for Kidney Cancer ?
Yes
No
Are you currently being treated by a clinician for Leukemia ?
Yes
No
Are you currently being treated by a clinician for Lymphoma ?
Yes
No
Are you currently being treated by a clinician for Lung Cancer ?
Yes
No
Are you currently being treated by a clinician for Melanoma ?
Yes
No
Are you currently being treated by a clinician for Myeloma ?
Yes
No
Are you currently being treated by a clinician for Pancreas Cancer ?
Yes
No
Are you currently being treated by a clinician for Prostate Cancer ?
Yes
No
Are you currently being treated by a clinician for ______ ?
Yes
No
The following questions are about your current cancer and its treatment. What is your cancer stage?
Stage I
Stage II
Stage III
Stage IV (often referred to as "metastatic")
Don't know
What year was your cancer first diagnosed? If you do not know the exact year, your best guess is okay.
yyyy
Please indicate when (if at all) you have used the following therapies to treat your cancer:
Please specify what other therapies you have used to treat your cancer:
The following questions are about the therapies you have used (or are using) to treat your cancer.
When was your surgery ? If you've had multiple surgeries, when was your most recent one? If you do not know the exact year, your best guess is okay.
yyyy
When did you start receiving radiation ? If you do not know the exact year, your best guess is okay.
yyyy
When did you start chemotherapy ?
yyyy
When did you start Immunotherapy (IV medications such as nivolumab, pembrolizumab, ipilimumab and others)?
yyyy
When did you start Hormone-blocking pills or shots (e.g., anti-estrogren treatment for breast cancer, or anti-testosterone treatments for prostate cancer)?
yyyy
What was the name of the medication you used (or use) during your Hormone-blocking pills or shots treatment?
If unsure leave blank.
When did you start Intravenous Vitamin C infusion therapy?
yyyy
How often did (or do) you receive Vitamin C infusions ?
Daily
Weekly
Every other week
Monthly
Other
What other frequency did (or do) you receive Vitamin C infusions ?
Which of the following statements do you most agree with:
Vitamin C infusions have stopped the tumor from growing and/or caused a cancer antigen blood marker to remain stable.
Vitamin C infusions have shrunken the tumor and/or caused reduction in a cancer antigen blood marker
Vitamin C infusions have had no effect on the cancer
In an average month, approximately how much money did (or do) you spend on Vitamin C infusion therapy?
Less than $50 US Dollars
$50-$99 US Dollars
$100-$199 US Dollars
$200-$299 US Dollars
$300-$399 US Dollars
$400 US Dollars or more
Mebendazole/Fendbendazole Treatment
Were/are you taking mebendazole or fendbendazole?
I was/am taking mebendazole (Vermox).
I was/am taking fendbendazole (Panacur C).
I was/am taking both; mebendazole (Vermox) & fendbendazole (Panacur C).
When did you start taking oral mebendazole (Vermox)?
yyyy
What was/is your dose of oral mebendazole (Vermox)?
When did you start taking fendbendazole (Panacur C)?
yyyy
What was/is your dose of fendbendazole (Panacur C)?
Which of the following statements do you most agree with:
Mebendazole/fenbendazole therapy has stopped the tumor from growing and/or caused a cancer antigen blood marker to remain stable.
Mebendazole/fenbendazole therapy has shrunken the tumor and/or caused reduction in a cancer antigen blood marker
Mebendazole/fenbendazole therapy has had no effect on the cancer
In an average month, approximately how much money did (or do) you spend on mebendazole/fenbendazole therapy?
Less than $50 US Dollars
$50-$99 US Dollars
$100-$199 US Dollars
$200-$299 US Dollars
$300-$399 US Dollars
$400 US Dollars or more
When did you start using other complementary or alternative therapies (e.g., herbal supplements, acupuncture, specific "anti-cancer" diet)?
yyyy
Have you ever used cannabis to treat your cancer?
Yes
No
Do you currently use cannabis to treat your cancer?
Yes
No