Survey for Patients Who Have Taken a Bruton’s Tyrosine Kinase Inhibitor (BTKi, such as ibrutinib, acalabrutinib, or zanubrutinib) for CLL/SLL and Have Discontinued for Reasons Other than Progression (Relapse) of CLL/SLL
 

Questions marked with a * are required
What BTKi have you taken for CLL/SLL that was discontinued specifically for reasons other than progression (for example stopped for side effects, physician or patient preference with either the intent to never take it again or discontinuing for 3+ months)? (if you have taken multiple BTKi that were discontinued for reasons other than progression, check only the first one that you received for treatment of CLL/SLL)
If you have taken more than one BTKi for CLL/SLL that were discontinued specifically for reasons other than progression, please answer the following questions based on the first of these BTKi that you took for CLL/SLL. You will have the opportunity to answer additional questions for a second BTKi you have discontinued at the end of this survey.
 
What number of other CLL/SLL treatments did you take before starting the BTKi?
If you took any CLL treatments before the BTKi, what treatments did you receive?  (check all that apply)
What risk factors does your CLL/SLL have before starting the BTKi? (check all that apply)
How long did you take the BTKi before you stopped?
What was the reason you discontinued the BTKi? (check all that apply)
If you discontinued BTKi due to side effects, what side effect caused you to discontinue? (check all that apply)
When you knew that you would be stopping the BTKi, how did you feel? (check all that apply)
When you knew that you would be stopping the BTKi, how much anxiety did you feel? (scale from 1 to 5)
Prior to discontinuation of the BTKi, how would you rate your quality of life?  (scale from 1 to 5)
Prior to discontinuation of the BTKi, did your health care provider check if you had measurable residual disease (MRD) and your disease status? (check all that apply)
Prior to discontinuation of the BTKi, if your health care provider checked if you had measurable residual disease (MRD) and disease status, what were the results? (check all that apply)
If you discontinued BTKi because of side effects, what happened to the side effects?
After discontinuation of the BTKi, how would you rate your quality of life?  (scale from 1 to 5)
If you discontinued BTKi and your CLL/SLL has not came back, how long have you been off of the BTKi?
If you discontinued BTKi and your CLL/SLL came back, how did it come back? (check all that apply)
If you discontinued BTKi and your CLL/SLL came back, how long between when you stopped BTKi and you or your health care provider noticed your white blood cells rising or lymph node size increasing?  
If you discontinued BTKi and your CLL/SLL came back, how long between when you stopped BTKi and you started treatment for CLL/SLL?  
If your CLL came back after discontinuing the BTKi and you started another CLL/SLL treatment, what is the next treatment that you received? (if it was a combination, check both)
If your CLL/SLL came back after discontinuing the BTKi and you started another CLL/SLL treatment, how long have you been receiving or did you receive the NEXT treatment?
If your CLL came back after discontinuing the BTKi and you started another CLL/SLL treatment and have stopped that NEXT CLL/SLL treatment, why did you stop the next CLL/SLL treatment? (check all that apply)
If your CLL/SLL came back after discontinuing the BTKi, did your health care provider check for resistance mutations?
If your CLL/SLL came back after discontinuing the BTKi and your health care provider checked for resistance mutations and your CLL/SLL had resistance mutations, what mutations were present?
Have you taken more than one BTKi for CLL/SLL that was discontinued specifically for reasons other than progression? 
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