CCA Annual Conference - CCA and Nutrition

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. What is the patient's gender?

Male

Female

Non binary

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* 5. What is the patient's race? [Select all that apply]

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Hispanic or Latino

Other (please specify)

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* 6. What was the year of cholangiocarcinoma diagnosis? (YYYY)

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* 7. What was the patient's age at the time of cholangiocarcinoma diagnosis?

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* 8. What is/was the type of cholangiocarcinoma that the patient had?

Intrahepatic cholangiocarcinoma
Cancer develops in the hepatic bile ducts or the smaller intrahepatic biliary ducts inside the liver

Perihilar extrahepatic cholangiocarcinoma
Cancer develops where the right and left hepatic ducts have joined and are leaving the liver

Distal extrahepatic cholangiocarcinoma
Cancer outside the liver after the right and left hepatic bile ducts have joined to form the common bile duct

Unsure

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* 9. Has the patient ever had a consultation with a nutritionist before or after the cholangiocarcinoma diagnosis?

Yes, only before the cholangiocarcinoma diagnosis

Yes, only after the cholangiocarcinoma diagnosis

Yes, before and after the cholangiocarcinoma diagnosis

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* 10. Before the cholangiocarcinoma diagnosis, the patient (Select all that apply)

Ate fruits

Ate vegetables

Ate meat (all types)

Ate red meat (beef and pork)

Ate poultry (chicken and turkey)

Ate cooked fish (all types)

Ate uncooked fish (sushi and sashimi)

Ate dairy products

Ate processed foods (prepackaged or prepared such as boxed mac and cheese, frozen meals)

Ate snack foods, sweets, and/or desserts (such as chips, snack cakes, and cookies high in salt, sugar, and/or fat)

Ate fast food (such as hamburgers, french fries, chicken nuggets, etc.)

Ate whole grains and legumes (high fiber bread and beans)

Ate organic items (fruits, vegetables, grains, legumes)

Drank diet soda or diet sports drinks

Drank regular (non-diet) soda or sports drinks

Drank sports/energy drinks

Used sugar substitute or ate “sugar-free” foods containing the sugar substitute

Other (please specify)

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* 11. Please select who is filling out the survey

Patient

Caregiver

Former caregiver for a patient who passed away