Is XELODA Right for Me? Questionnaire

1. Is your breast cancer classified as "metastatic" or Stage IV? In other words, has your doctor told you that your breast cancer has spread beyond the original tumor to other parts of your body?
  Yes
  No
  Not sure

2. After you were told that you had cancer of the breast, did you have surgery to remove the tumor?
  Yes
  No
  Not sure

3. If you had surgery to remove the tumor, did you receive neoadjuvant or adjuvant chemotherapy (medications that you took shortly before surgery or soon after surgery)?
  Yes
  No
  Not sure

4. Have you been treated with an anthracycline medication? Examples of anthracycline medications include Adriamycin®¹ (doxorubicin) and epirubicin. Your doctor may have also prescribed a drug combination that included an anthracycline. These combinations are often referred to by an abbreviation containing the letter "A" or "E," such as AC,FAC,TAC, or FEC.
  Yes
  No
  Not sure

  
 
Note: We value your privacy. The information you submit here will not be stored and will not be shared with any other companies.
 
FOOTNOTE
1. Adriamycin® is a registered trademark of Pharmacia.