CAR-T Therapy Survey 2020

Exit Survey

Questions marked with a * are required

100%

1. Which best describes your role with CLL?

CLL patient 

Caregiver to a CLL patient

Loved one of CLL patient (but not the primary caregiver) 

Healthcare professional 

Prefer not to say

Other, please specify:

2. What is your age?

3. What is your gender?

Female

Male

Prefer not to say

Prefer to identify as:

4. Please specify your race and ethnicity; select all that apply:

White or Caucasian 

Hispanic or Latino 

 Black or African American 

Asian or Asian American 

Indigenous, First Nation, American Indian or Alaska Native 

Native Hawaiian or Pacific Islander 

Don’t know / Not sure 

Prefer not to say

Other, please specify:

5. What is your or the CLL patient’s status of treatment for CLL?

I have not had treatment (also referred to as treatment naïve or watch and wait) 

I am currently being treated for the first time or I have completed my first treatment 

I have had two or more treatments or am currently being treated for the second time 

Don’t know/not sure 

Prefer not to say

6. Regarding the prognostic and predictive factors, I or the patient have:

	Yes	No	Don't know / not sure	Prefer not to say
Deletion 17p	Yes	No	Don't know / not sure	Prefer not to say

TP 53 Aberration	Yes	No	Don't know / not sure	Prefer not to say

Deletion11q	Yes	No	Don't know / not sure	Prefer not to say

IgVH Unmutated (also known as unmutated status)	Yes	No	Don't know / not sure	Prefer not to say

Complex Karyotype	Yes	No	Don't know / not sure	Prefer not to say

NOTCH1	Yes	No	Don't know / not sure	Prefer not to say

Please take a moment to complete the questions below regarding current knowledge and thoughts about CAR-T Therapy, also known as Chimeric Antigen Receptor-T Cell Therapy.

7. I am confident in my understanding of how CAR-T Therapy works.

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

8. I am confident in the safety of CAR-T Therapy.

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

9. I am confident in the effectiveness of CAR-T Therapy.

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

10. I am confident in my understanding about when someone should consider finding a clinical trial for CAR-T Therapy as a CLL patient.

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

11. I have had CAR-T Therapy.

Yes

Unsure

12. I am currently considering CAR-T Therapy as my next line of treatment.

Yes

Unsure

Not applicable

13. What would you like to see CLL Society do to help further CAR-T Therapy knowledge or access for CLL patients?