• Complementary Alternative Therapy (CAM) Use Survey

    Definition: A broad set of healthcare practices, therapies, and modalities used in combination with conventional Western medical, surgical, and prescription therapies. (Please do not include any identifiable information)
  • Date
     - -
  • Are you or someone you know a current or past recipient of cancer treatments (chemo &/or radiation)?
  • How long were the treatments for?
  • What side effects of conventional cancer treatments were experienced?
  • Was some form of CAM (Complementary Alternative Medicine or Treatment) used to help relieve treatment side effects (past or present)? Check all that apply:
  • If "Yes" to CAM use, what side effects did it help relieve?
  • Why was the decision made to used these complementary therapies? (Check all that apply)
  • Type of cancer?
  • At any time during cancer treatments), was time spent in the hospital?*
  • Do you believe that you are directly responsible for your health?
  • *(Survivors Only) Do you continue to use some form of CAM during remission OR, have begun using it post treatment as a form of self-care?

  • Thank you for your participation in this survey!  Your responses will be used to shed light on the value added to the cancer patient's quality of life, help to encourage open communication between patients and providers regarding CAM use thus making it easier for patients to make health choices without feeling dismissed or devalued.

    Peace & Health :-)

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