Men & Cancer Questionnaire

Ty SnowdonNews

The majority of people using our service are female, but this doesn’t tie in with local cancer statistics which show that more men are diagnosed with cancer than women. We’re conducting a survey to find out how we can make sure we provide the services men affected by cancer need and want.

We’re interested in collecting info from men who:

  • have cancer now
  • are recovering from cancer or had cancer more than 5 years ago
  • are caring for someone with cancer
  • have lost a loved one to cancer

Why would I?

Your responses to the questionnaire can help us help more local men affected by cancer. And if that’s not enough, completed questionnaires returned to us by Friday 30 September 2016 will be entered into our free prize draw. Two lucky winners will receive a football (or rugby) shirt of their choice. What are you waiting for?

shirts

 

 

 

 

Click the link below to download the questionnaire. Then either fill it in and email karens@liverpoolsunflowers.com, or print it off, fill it in, and hand it in to us in the Sunflowers building on Aigburth Road

You click the link below to download the questionnaire, fill it in and hand back to us

Men’s Questionnaire

 

Alternatively, fill in the form below:

 

1. Below are some of the difficulties people encounter when affected by cancer.
Please indicate which of these you have experienced and rate between 1-5 in terms of how much of a problem it has been for you.
1=low 5 = high

Pain:

Fatigue:

Weight Loss:

Weight Gain:

Loss of fitness:

Loss of mobility:

Neuropathy:

Sleep Problems:

Low Mood:

Stress/Anxiety:

Lymphoedema:

Anger:

Feeling Isolated:

Feeling Hopeless:

Sexual Problems:

Financial Difficulties:

Relationship Problems:

2. Do you feel that you have (or had) enough contact with other people affected by cancer?

YesNo

3. In the last 12 months, in relation to cancer, roughly how many times have you visited:

GP:

Walk-in Centre:

A+E:

4. When you were diagnosed (or in the case of carers when your friend or relative was diagnosed) please indicate which of the following support services you:
a) were offered or signposted to
b) used
c) weren’t offered but would have liked:

Post Treatment advice:

Counselling:

Group Support:

Peer Support/Befriending:

Telephone Support:

Online info services:

Complimentary Therapies:

Fitness & Exercise Classes:

Art & Craft Therapies:

Nutrition Advice:

Practical Support (i.e transport):

Benefits/Work/Financial Advice:

Relationship Advice:

5. Please tell us anything else you think might help us plan future cancer support services for men in Liverpool.

Please also include your preferred rugby/football team, and shirt size:
Team:
Size: