Q1.1 Have you heard about late effects of childhood cancer?

Q1.2 Introduction and Examples of Late Effects of Childhood Cancer
Health problems that develop years later because of a cancer treatment are known as late effects. Depending on what treatment/drug you had received, some common examples of late effects arisen from cancer treatment are listed below for reference:

Chemotherapy Heart problems Hearing loss Osteoporosis Infertility Early menopause Etc.

Radiotherapy Memory problems Increased risk of stroke Lymphedema Etc.

Hormone Therapy Body pain Frequent urination Nightmares Stomache ache Etc.

After reading the above information, please answer the following question:

Do you think you have been told about late effects of childhood cancer before filling out this questionnaire?

Q2.1 Who told you that you have late effects? (You may choose more than one option.)

Q2.2 Did your care givers / doctors tell you about late effects and follow-ups before you completed your treatment?

Q2.3 Is any part of your daily life affected by late effects of childhood cancer? If Yes then please write how have late effects affected/impacted your life.

Q2.4 Do you attend any follow-up consultations / treatments for your late effects?

Q2.4.1 Where do you go for consultations/treatments of your late effects?
In others always add Please specify (You may choose more than one option.)

Q2.4.2 Why don’t you attend follow-up consultations / treatments for your late effects? (You may choose more than one option.)

Q2.5 What kind(s) of document about late effects of childhood cancer have you ever received? (You may choose more than one option.)

Q3 Would you like to know (more) about late effects?

Q4.1 Why do you want to know (more) about late effects?

Q4.2 Why don’t you want to know (more) about late effects? (You may choose more than one option.)

Q5 Whom do you prefer to ask/consult about late effects? (You may choose up to three options.)

Q6 In which formats/channels would you like to get the information about late effects and health tips? (You may choose up to three options.)

Q7 While under treatment, did you ever have to stop going to school?

Q8 Highest Educational Attainment

Q9 At what age did you have to stop going to school?
(If you had to stop multiple times, please indicate age at which you first had to stop schooling and other ages as well.)

Q10 In total, how long did you stop schooling, because of your cancer treatment or other cancer related factors
(e.g. family no longer had money for my schooling due to expenses of treatment, etc)

Q11 Do you think that cancer survivors are discriminated against?

Q12 Have you ever been rejected for a job due to your cancer history?

Q13 Have you ever lost any relationship with your friends / partners because you told them you had cancer?

Q14 Have you ever felt hopeless about your future because you had cancer?

Q15 Have you ever felt ashamed that you had cancer?

Q16 Do you sometimes feel guilty that you are a survivor while others were not as lucky?

Q17 Did you find yourself losing interest in activities you previously found enjoyable or liked doing?

Q18 Are there occasions you experience fear or anger, with no real reasons for it?

Q19 Which of the following actions should a survivor take to stay healthy? (You may choose more than one option.)

Q20 Please rate the following about your recent physical conditions after surviving childhood cancer.

Q21 Email Address (Optional)
(If you would like to be connected to the Childhood Cancer International Asian Survivors Network, please leave your email here.)