COVID_19 and IBC
IBC-IC Questionnaire for Inflammatory Breast Cancer Patients Receiving Treatment or Follow-up Care
What is your age? *
What is your sex? *
Which of the following best describes the area you live in? Choose only one *
What is your Race/Ethnicity? *
Are you presently in active treatment for IBC? *
Are you newly or recently diagnosed? *
Are you metastatic? *
Are you participating in a Clinical Trial? *
If you are in a clinical trial, are you concerned about COVID_19 causing changes in your trial that could impact your treatment? *
Have you completed treatment and now on follow-up care? *
Has COVID_19 restricted your ability to travel for treatment? *
Has your treatment been delayed or stopped due to restricted travel caused by COVID_19? *
If you are treated locally, have you experienced challenges accessing treatment at your medical center, outpatient center, or doctor’s office related to COVID_19? *
Where are you being treated? *
Are you concerned about navigating to and from treatment and exposure to other people/patients who may be infected with COVID_19? *
Have you personally cancelled/postponed going to appointments due to concern of COVID_19 exposure? Check all that apply. *
Required
Has your medical team cancelled or postponed any follow up visit(s) or imaging due to COVID_19? *
Has your oncologist, radiation oncologist or surgeon conducted virtual visits with you during the COVID_19 pandemic? *
Do you have anxiety about possible changes in your treatment protocol or treatment delays as a result of COVID_19? *
Have you experienced financial or medical insurance concerns due to lost income or employment, or medical insurance concerns due to other issues, because of COVID_19? Check all that apply. *
Required
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