Ancora.ai Gastric Cancer Patient Experience Study

Introduction

Hello and thank you for filling in this questionnaire, which Ancora.ai is using to identify patients and caregivers to participate in a paid virtual engagement.

The purpose of the study is to collect patient and caregiver input to guide future developments in treatment. Your experiences and recommendations will be used by research sponsors to inform the development of new treatments and to improve screening and diagnosis of gastric cancer.

It will only take a few minutes to fill in these questions and your contact information, and then we will be in touch by email as soon as possible with next steps to participate.

Your participation is completely voluntary.

The patient interview will take approximately 60 minutes, and will be led by a professional moderator. We are offering an honorarium of $150 for the interview.

Additionally, before the interview there is a 10 minute pre-task to complete with an honorarium of $25.

Furthermore, this study includes an optional follow up task with additional compensation.

This study is for research purposes only and is in no way connected with any promotional effort.

If you have any questions or concerns during or after completing this screening survey please contact khamai@ancora.ai.

If you agree to participate on this basis, please proceed:

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* How old are you?

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* What is your gender?

Female

Male

Non-Binary

Prefer not to answer

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* Which of the following best describes where you live?

Urban

Suburban

Rural

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* Are you or is anyone in your immediate family currently an employee or paid consultant for any: Pharmaceutical, biotech or medical manufacturers, medical advertising agencies, public relations agencies, health insurance companies or market research agencies?

Yes

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* How would you describe yourself?

I am a cancer patient or survivor

I am a caregiver for a cancer patient or survivor

Other (please specify)

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* What diagnosis have you received?

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* Approximately when is the last time you received treatment for Gastric Cancer?

I have not received any treatment

I am currently receiving treatment

Within the past 3 months

3 to 6 months ago

6 to 12 months ago

1 to 2 years ago

2 to 3 years ago

3 to 5 years ago

More than 5 years ago

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* What stage of gastric cancer has the doctor said you have?

Stage I- Cancer is present in the stomach tissue but has not spread to lymph nodes

Stage II- The cancer has spread to nearby lymph nodes

Stage III- Cancer is in the lymph nodes but has not spread beyond lymph nodes to other sites

Stage IV- Cancer has spread/metastasized to another site

Remission/NED

Other (please specify)

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* Currently, which type of physician is primarily responsible for managing the treatment of your Gastric Cancer?

Medical Oncologist

Radiologist

Primary Care Physician

Not currently being treated by a physician

Other (please specify)

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* How would you describe your surgical status?

Not a candidate for surgery

Have not received surgery, but it is part of the future plan

Have already received surgery

Other (please specify)

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* How would you describe your treatment status?

Radiation (before surgery)

Radiation (after surgery)

Drug treatment via intravenous or pill before surgery (neoadjuvant)

Drug treatment via intravenous or pill after surgery (adjuvant)

Other (please specify)

None of the above

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* How confident are you filling out medical forms by yourself?

Extremely

Quite a bit

Somewhat

A little bit

Not at all

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* What type of medical health insurance do you currently have? Please select all that apply.

Self-paid health insurance

Employer-paid health insurance

Medicare

Medicaid

Veterans Health Administration

Other (please specify)

None of the above / Pay cash only

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* What is the highest level of education you have completed?

Some high school or less

High school /GED

Some college/technical school

College degree

Post graduate study or degree

Prefer not to answer

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* Which of the following describes your race / ethnicity? Please select all that apply.

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Prefer not to answer

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* Recording and Sponsor Engagement

The interview will be audio recorded. The sponsor of the study may also listen to the interviews remotely or listen to the audio recordings later. They will never know the names of any of the people on the tapes.

Do you agree to this? Note that even if you agree now you may withdraw this consent at any time later on.

Yes

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* Adverse Event Reporting Disclosure:

Different patients sometimes respond in different ways to the same medicine, and some side effects may not be found until many people have used a medicine over a period of time. If you mention a side effect the interviewer may need to pass that information on to the sponsor of the study so that they can learn more about the safety of their own medicines. If this happens, at the end of the interview, the interviewer will ask for additional information for the report. This will be done confidentially and your identify will remain anonymous in the report.

Do you agree to this?

Yes

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* Do you give your consent for us to contact you with more details about participation in relevant studies?

Yes

Other (please specify)

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* How did you find us?

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* Please share your contact details so we can get in touch with you about next steps.

Name *

State/Province

ZIP/Postal Code

Country *

Email Address *

Phone Number *