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Medical Providers of Pediatric, Adolescent, Young Adult, and Adult

  • The Survivorship Working Group of the Georgia Comprehensive Cancer Control Program (GC3) would appreciate your input regarding your availability to provide medical follow-up for cancer survivors. We define this group as individuals of any age diagnosed with cancer between ages of birth and 17 (pediatric and adolescent); 18-39 (young adult); and 40 and over (adult) who have completed treatment without evidence of relapse or recurrence at the time of the survey. Those who have had recurrent disease or subsequent cancers in the past may be included if they are not receiving therapy and are tumor-free.
  • The questionnaire will be used to expand care for cancer survivors and identify resources needed by providers who treat them. We understand that venues for long-term follow-up vary by specialty and locale. Our goal is to maximize appropriate, culturally sensitive follow-up of survivors as close to home as possible. Support of providers is equally important as the number and complexity of survivors grows.
  • Thank you very much for taking the time to make a difference in the lives of cancer survivors in GA. We will contact you if you indicate your willingness to work with the Survivorship Working Group after all results are tabulated.

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* 1. What is your specialty?

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* 2. Do you currently see cancer survivors in your practice?

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* 3. How many survivors do you see each year? Please select all that apply.

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* 4. What diagnoses do you see? (Malignancies diagnosed in survivors at age 18 and older) Please select all that apply.

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* 5. What diagnoses do you see? (Malignancies diagnosed in survivors aged birth to 17 years)

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* 6. How often do you see survivors? Please select all that apply.

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* 7. What are the ages at diagnosis of the survivors you see each year? Please select all that apply.

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* 8. What Guidelines, if any, do you use? Please select all that apply.

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* 9. What additional resources, if any, do you offer cancer survivors?

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* 10. What reasons, if any, do you not see cancer survivors? Please select all that apply.

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* 11. Tell us about additional challenges you encounter with seeing cancer survivors. Please select all that apply.

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* 12. Tell us about any survivorship activities or support programs you have in place for survivors

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* 13. What do you think could be done to address challenges in seeing cancer survivors?

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* 14. Select if you are willing to be contacted regarding future training or educational opportunities related to cancer survivorship:

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* 15. Please provide the best way to contact you:

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* 16. Please share the name(s) and contact information of others in your practice who may be interested in follow up:

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