PLEASE NOTE THAT ENTRIES FOR 'DANCING WITH FEAR' ARE NO LONGER BEING ACCEPTED. THIS QUESTIONNAIRE IS BEING PROVIDED FOR REFERENCE PURPOSES ONLY.

Questionnaire

While other books offer medical advice, recount personal stories or give statistics, Dancing with Fear: breast cancer wisdom from survivors will combine practical tips through brief personal comments from hundreds of survivors. The tips will be combined, edited for brevity, categorized for ease of use, or quoted as is. There are no right or wrong answers. Each experience and feeling is valid and valuable. In order to protect privacy and guarantee confidentiality, participants may choose to remain anonymous.

A portion of the proceeds from the sale of this book will be donated to breast cancer research and prevention.

You can also download a printer-friendly version of the questionnaire here.

Optional and confidential: please include your contact information for further contact, and to receive a 50% discount coupon on the price of the published book.

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Name and address, phone or fax number:

For a direct quote, mention my

full name
first name
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Please provide brief answers only to questions which are important to you
Share best personal tips to help others. Feel free to include additional information. If the space provided is insufficient, please use additional pages, numbering answers to match the categories.

1. BRIEF PROFILE OF YOURSELF
Background, diagnosis, reaction
EXAMPLES: - Work, lifestyle, diet before cancer - Age, the year of diagnosis - Warning signs - Type of cancer - Type of biopsy or biopsies - Size of tumor, stage, medical term - Were tests done immediately? Any unreasonable delay and why? - The way your cancer was discovered - Did mammogram find it or miss it? - Who told you of your diagnosis and how? - Did you get a second opinion? - First reaction

2. DEALING WITH THE MEDICAL SYSTEM
Doctors, appointments, hospital, surgery
EXAMPLES: - Standard treatment or clinical trial? How did you decide? - What makes a good doctor? - What makes a good patient? - Tips for appointments and hospital - Number of lymph nodes removed, and how many had cancer - Underarm numbness after syrgery - Exercises to regain arm movement - Dealing with problems (frozen shoulder) after lymph node removal - Clothing to wear home from the surgery

3. LUMPECTOMY
Your experience and tips to help others
EXAMPLES: - How much tissue was removed? - Was a partial prosthesis needed? - Dealing with pain or discomfort

4. MASTECTOMY, RECONSTRUCTION, PROSTHESIS
Losing the breast and recovery
EXAMPLES: - What helped in recovery? - Decision about reconstruction - Recovery tips - Reconstruction, simultaneous or later - Reconstruction after a lumpectomy or after radiation, results - Reasons for reconstruction or avoiding it - A prophylactic mastectomy (removal of a healthy breast in high-risk cases), reasons, experience, tips to others - Prosthesis (total or partial) - With no reconstruction nor prosthesis, what do you put into your bra? - Tips on clothing during and after treatments - Life without a breast, emotionally and physically

5. LYMPHEDEMA
Dealing with it, avoiding it
EXAMPLES: - Did it start immediately after surgery and how? - Did it start later, how, and was it from something that could have been avoided? - Ways to avoid it - Tips for dealing with it - Solutions to take blood pressure or draw blood safely if lymph nodes were removed from underarms on both sides

6. CHEMOTHERAPY
Type(s), duration, experience
EXAMPLES: - Dealing with complications and side effects - Creative solutions for hair loss - What helped you to get through emotionally and physically - Foods you liked or disliked - How were normal routines affected?

7. RADIATION
Type, duration, experience
EXAMPLES: - Major complications and dealing with them - Minor inconveniences or side effects and your solutions

8. TAMOXIFEN (OR OTHER HORMONAL THERAPY DRUGS)
EXAMPLES: - The drug you took, number of years - Major complications and dealing with them - Minor side effects and your solutions

9. COMPLEMENTARY THERAPIES AND ALTERNATIVE TREATMENTS
Do you feel they helped you or hurt you?

EXAMPLES: - Experience with hypnosis, meditation, Tai Chi, yoga, etc., during or after medical treatments - Where did you learn about alternative treatments? - Did your doctors recommend vitamins or supplements and what were they? - Did you take other vitamins or supplements without your doctor’s advice or knowledge, and if so, which ones? - Any concern about alternative treatments possibly interfering with the medical treatments?

10. RECURRENCE
Summoning the courage to face the challenge again
EXAMPLES: - How soon did it happen after your first breast cancer? - Details and possible reasons behind recurrence, and the prognosis - The way you found out - Any warning symptoms - Your tips to others who have been diagnosed with a recurrence

11. FEAR OF RECURRENCE
What triggers your fear? What helps you in those moments?
EXAMPLES: Battle plan to help prevent recurrence or ensure early diagnosis - Do you read all you can or avoid reading about breast cancer? - Do you feel discouraged to hear someone has died from breast cancer, or do you want to know all the details? - Do you feel that breast self-examination and mammograms are helpful for early detection, and why or why not?

12. OPTIMISM AND PESSIMISM
Did optimism or pessimism play any role in your case?
EXAMPLES: - What helped you to have a positive outlook? - Best tips for staying positive - Were you able to express negative feelings? - Dealing with anger, depression, stress, sleepless nights, emotional or physical fatigue, self-blame, self-pity, etc. - Did you need antidepressants or counseling? - Pains and problems that still worry you even if follow-up tests do not reveal any reason for concern - Unanswered questions or problems

13. AFTERMATH
When the treatments are over
EXAMPLES: - How did you feel and how do you feel now? - Dealing with financial burdens - Revealing the cancer to family, children, friends, coworkers, or keeping it from them - Handling job and housework during your illness - Handling medical checkups and anniversaries of diagnosis - Dealing with concontradictory information, misconceptions and urban legends - Why do you think you got cancer? - Excessive stress or anything else unusual prior to your cancer - If you feel that breast cancer in industrial countries is due to specific environmental issues, what are they? - If you think it’s the dietary habits, what should you include or exclude? - What do you wish you would have known about breast cancer and treatments? - What would you do differently with your treatments or with your life before cancer? - What things did you do right? - Advice to other women when they are diagnosed - Best gifts you received or bought, and why they were good

14. SUPPORT
What helped you emotionally, physically, and practically?
EXAMPLES: - Importance of help from friends and family - If alone, what helped you? - Was your partner supportive or in denial? - Experience with support groups, chat rooms, listserves, etc. - Reasons and experience with volunteering - Best things others said and how it helped you - Worst things others said and how you dealt with it - Did you lose any friends or gain new ones during the cancer and why?

15. RECLAIMING LIFE
Do you feel your life now is better, worse, or the same as before cancer, and why?
EXAMPLES: - Ways this crisis affected you and your family - Effect on intimacy - Tips on returning to normalcy (work, exercise, sexuality, etc.) - Things you miss from pre-cancer days - Ways your diet and/or lifestyle have changed due to cancer - Future plans and priorities - Joys of ordinary life today

16. SPIRITUALITY
Did you discover or rediscover faith to help you on your journey?
EXAMPLES: - Ways spiritual faith brought you comfort - Did you lose or gain any faith as a result of your cancer? - Reasons for gratitude

17. FACING DEATH
Did you think you might die, and how did it change you?
EXAMPLES: - Handling occasional feelings that, even if the prognosis is good, you still might die from this disease - Regardless of cancer or prognosis, if you knew you had six months to live, what would you do with your remaining time?

18. HUMOR
Ways humor helped you in difficult times
EXAMPLES: - Humorous moments during your cancer journey - Did you lose your sense of humor during treatments?


19. BEST BOOKS, VIDEOS, AND WEB SITES YOU WOULD RECOMMEND TO OTHERS


20. ANYTHING ELSE YOU WISH TO ADD


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Surviving together and helping others,
gratefully yours,
Leila Peltosaari