On what date was the patient first diagnosed with mesothelioma?If you don't know the exact date, please take your best guess. What type of mesothelioma does the patient have?*Pleural (Malignant Pleural Mesothelioma)PeritonealPericardialTesticularI don't knowDo you know the cell-type or histology?*EpithelialSarcomatoidBiphasic (mixed epithelial and sarcomatoid)I don't knowIs the patient CURRENTLY a candidate for mesothelioma surgery?*YesNoI don't know Is the patient planning to have mesothelioma surgery?*Planned types of surgery may include: 1. Extrapleural Pneumonectomy 2. Pneumonectomy 3. PleurectomyYesNoI don't knowAs a surgical candidate, has the patient received any kind of prior treatment for mesothelioma?*YesNoI don't know As a surgical candidate, has the patient had chemotherapy for mesothelioma?*YesNoI don't know Has the patient received any kind of treatment for mesothelioma?*YesNoI don't know Was standard or standard-of-care chemotherapy refused?*YesNoI don't know How many different types of chemotherapy has the patient had?*Another way this question may be worded would be to ask: "How many different lines of chemotherapy has the patient had?"One (1)Two (2)Three (3)Four or more (4+)I don't know Is the patient still receiving chemotherapy for mesothelioma?*Yes, they still have at least one chemotherapy appointment remainingNo, they have completed or stopped receiving chemotherapyI don't knowWhat was the approximate date of the patients last chemotherapy treatment?* What was the 1st or 1st-line of chemotherapy used?*The two most common would be: Pemetrexed (Alimta) and Cisplatin or Pemetrexed (Alimta) and Carboplatinpemetrexed/cisplatin (combination)pemetrexed/carboplatin (combination)pemetrxed/cisplatin/bevacizumab (combination)gemcitabine/cisplatin (combination)carboplatin (alone)cisplatin (alone)gemcitabine (alone)pemetrexed (alone)vinorelbine (alone)I don't know What was the 2nd or 2nd-line of chemotherapy used?*pemetrexed/cisplatin (combination)pemetrexed/carboplatin (combination)pemetrxed/cisplatin/bevacizumab (combination)gemcitabine/cisplatin (combination)carboplatin (alone)cisplatin (alone)gemcitabine (alone)pemetrexed (alone)vinorelbine (alone)I don't know What was the 3rd or 3rd-line of chemotherapy used?*pemetrexed/cisplatin (combination)pemetrexed/carboplatin (combination)pemetrxed/cisplatin/bevacizumab (combination)gemcitabine/cisplatin (combination)carboplatin (alone)cisplatin (alone)gemcitabine (alone)pemetrexed (alone)vinorelbine (alone)I don't know What was the 4th or 4th-line of chemotherapy used?*pemetrexed/cisplatin (combination)pemetrexed/carboplatin (combination)pemetrxed/cisplatin/bevacizumab (combination)gemcitabine/cisplatin (combination)carboplatin (alone)cisplatin (alone)gemcitabine (alone)pemetrexed (alone)vinorelbine (alone)I don't know What were the results of the patients last Scan or PET Scan?*Please answer this question based on the results of the last scan done. We recognize that the patient may have another scan scheduled or may be awaiting the results of a recent scan.There was less mesothelioma than the prior scanThere was no progression since the prior scan (stable)The mesothelioma had progressedI don't know Which of the following would best describe the patient TODAY?*They are:Fully active, able to carry on all pre-disease performance without restrictionRestricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office workAmbulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hoursCapable of only limited selfcare, confined to bed or chair more than 50% of waking hoursCompletely disabled. Cannot carry on any selfcare. Totally confined to bed or chairI don't know
