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Make Sense: Head and neck cancer survivor survey

3. Have you finished treatment for your initial diagnosis? *This question is required.
4. Which one of the following statements most closely reflects the impact of your diagnosis of head and neck cancer on your emotional wellbeing post-treatment?
Please select one. Please feel free to expand in the comments.
  *This question is required.
5. How much have the following feelings impacted your emotional wellbeing since your treatment for head and neck cancer ended?
Please rank from 1 to 5 with 1 being not impacted at all and 5 being heavily impacted.
  *This question is required.
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Loneliness
Fear of the future, recurrence
Anxiety, worry
Depression, depressive symptoms
Anger
Guilt
6. How would you rate the support you have received for your emotional wellbeing since your treatment of head and neck cancer ended? *This question is required.
ExcellentGoodAveragePoorTerrible
For questions 7 - 10

How much have you been impacted in the following areas since your treatment for head and neck cancer ended?


Please rate from 1 to 5 with 1 being very positively impacted, 3 being not impacted and 5 being very negatively impacted. Please feel free to expand in the comments.
 
7. Physical impact overall
  *This question is required.
 12345 
Very positively impactedVery negatively impacted
Physical symptoms - please rate the impact on each of the following. *This question is required.
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Energy levels
Speaking
Appetite
Eating/ drinking
Sense of taste/ smell
Breathing
Sleeping
Physical appearance
To what extent do the physical effects (as listed above) of head and neck cancer currently affect your emotional wellbeing? *This question is required.
 12345 
Very positively impactedVery negatively impacted
8. Social impact overall
  *This question is required.
 12345 
Very positively impactedVery negatively impacted
Social activities - please rate the impact on each of the following. *This question is required.
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Family relationships/ spending time with family
Friendship relationships/ spending time with friends
Spending time doing things you enjoy/ hobbies
To what extent do the social effects (as listed above) of head and neck cancer currently affect your emotional wellbeing?

  *This question is required.
 12345 
Very positively impactedVery negatively impacted
9. Professional/ financial impact overall
  *This question is required.
 12345 
Very positively impactedVery negatively impacted
Professional/ financial activities - please rate the impact on each of the following. *This question is required.
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Ability to work
Ability to financially support yourself/ family
Career progression/ ability to find employment
Career satisfaction
To what extent do the professional/ financial effects (as listed above) of head and neck cancer currently affect your emotional wellbeing?

  *This question is required.
 12345 
Very positively impactedVery negatively impacted
10. How comfortable do you feel in discussing the emotional impact of head and neck cancer with your healthcare provider?
Please select the statement that most closely reflects your feelings.
  *This question is required.
11. How would you rate the following resources in supporting your emotional well-being post-treatment for head and neck cancer?
Please tick the statement that most closely fits your experience for each resource and feel free to expand in the comments.
  *This question is required.
Space Cell I have easy access to this, and I find it helpfulI have easy access to this, but do not find it helpfulI do not have easy access to this, and I would find it helpfulI do not have easy access to this, but I would not find it helpful
Reading materials on the long-term effects of head and neck cancer following treatment (e.g. pamphlets, websites)
Reading materials on long-term emotional impact of head and neck cancer (e.g. pamphlets, websites)
Family, friends
Mental health specialist
Peer to peer support groups
Digital tools for managing your own well-being (e.g. health apps)
Newspaper or magazine articles
Resources for carers or family/ friends in how to support you following treatment
Specialized nurses and social workers
12. Which one of the following statements most closely reflects the impact of the COVID-19 pandemic on your ability to access emotional support services post-treatment?
  *This question is required.