Cancer Crusaders Club
Questionnaire for Cancer Patients
Name _____________________________________________________________Age ___ Sex ___
Pls.check under which classification you like to be in and specify the type of cancer you had before.
Type of Cancer
|___ Cancer patient|
|___ Ex-cancer patient|
|___ Others ___________________________|
1. How many times have you attended the Annual Get-Together of the Cancer Crusaders Club? _____ (1x to 9x)
2. The following activities are usually done during the Annual Get-Together of the Cancer Crusaders Club. Pls. select two activities which you LIKE most and which you DISLIKE most and pls. give your reasons.
|Sharing of experience with other patients in public (on the stage)|
|Sharing of experience with other patients in private (on the seat)|
|Entertainment (songs and dances)|
|Raffle and gift-giving|
|Most durable award|
3. Pls. consider each statement below that describes the effect of the Annual Get-Together of the Cancer Crusaders Club and check if it is APPLICABLE to you and to your relative. For the checked statements, determine whether they have positive (BENEFICIAL) or negative (HARMFUL) effect on you.
|1a. It makes me feel stronger in living through life with a cancer.|
|1b. It makes me feel weak in coping with my cancer.|
|2a. It boosts my morale.|
|2b. It lowers my morale.|
|3a. It boosts my hope for living.|
|3b. It depresses my hope for living.|
|4a. It changes my outlook in life for the better.|
|4b. It changes my outlook in life for the worst.|
|5a. It makes me feel like an ex-cancer patient already.|
|5b. It reminds me that I am a cancer patient.|
|6. It helps me ACCEPTS my cancer|
|7. It makes me realize that I am NOT the only person on earth with a cancer.|
|8a. It gives me an opportunity to share experience with other cancer patients in public (on stage).|
|8b. It gives me an opportunity to share experience with other caner patients in private (on the seat).|
|8c. It gives me an opportunity to listen to the experiences of other cancer patients.|
|9a. It makes me learn more about cancer in general.|
|9b. It makes me learn more about the cancer that I have.|
|9c. It makes me learn more about patients with cancer.|
|10a. I feel the get-together is a reunion for cancer patients.|
|10b. I look forward to attending the get-together each year.|
|10c. I look forward to getting the most durable award.|
|11. It is a form of therapy for me.|
|12. It provides psychosocial support to me and my relative.|
4. For those who had attended the Annual Get-Together more than once – What made you attend AGAIN? You may have more than one answer.
___ The Annual Get-Together is BENEFICIAL to me.
___ My relative forces me to attend.
___ Others: ____________________________________________________
5. For those who had attended the Annual Get-Together only once – Why did you not ATTEND AGAIN? You may have more than one answer.
___ No invitation/no reminder
___ Problems in travel (distance and expense)
___ Conflict in schedule
___ No companion
___ I am afraid to be called to the stage to share experiences.
___ The Annual Get-Together has a harmful effect on me.
___ I don’t like to be reminded of my cancer.
___ Others: _____________________________________________________
6. Comments and suggestions for improvement of the Annual Get-Together of the Cancer Crusaders Club: