OVATION-2 Study
Eligibility Questionnaire
3. Are you seeking treatment for one of the following types of ovarian cancer? (please select one)
Epithelial ovarian cancer
Fallopian tube cancer
Primary peritoneal cancer
Another type of cancer
Unsure
Why are we asking this?
You need to have been newly diagnosed with certain forms of ovarian cancer in order to participate in the OVATION-2 Study.
4. Have you begun active treatment (e.g., chemotherapy, surgery) for your cancer?
Yes
No
Unsure
Why are we asking this?
Information about where you are in your treatment will help us understand if you may be eligible for the OVATION-2 Study.
5. Have you ever received treatment for cancer in your abdomen or pelvic region before?
Yes
No
Unsure
Why are we asking this?
Information about any cancer history you have will help us understand if you may be eligible for the OVATION-2 Study.
6. Have you had evidence of any other cancer within the past three years?
Yes
No
Unsure
Why are we asking this?
Information about any cancer history you have will help us understand if you may be eligible for the OVATION-2 Study.
7. What stage is your cancer?
Stage 1
Stage 2
Stage 3
Stage 4
Unsure
Why are we asking this?
We are only enrolling participants with specific stages of cancer into the OVATION-2 Study. Learn more about cancer types and stages here.
8. How would you describe your current activity level?
Fully active; able to carry on all activities without restriction
Restricted in physically strenuous activities but ambulatory and able to carry out light or sedentary work (e.g., light housework, office work)
Ambulatory and capable of self-care but unable to carry out work activities; up and about more than 50% of waking hours
Limited in self-care; confined to a bed or chair for more than 50% of waking hours
Not capable of self-care; completely confined to a bed or chair
Why are we asking this?
Information about your current health and activity level will help us understand if you may be eligible for the OVATION-2 Study.
9. Are you currently receiving treatment for an autoimmune disease (e.g., systemic lupus erythematosus, multiple sclerosis, inflammatory bowel disease, rheumatoid arthritis)?
Yes
No
Unsure
Why are we asking this?
People receiving treatment for certain diseases may not be eligible to participate in the OVATION-2 Study.
10. Are you currently pregnant?
Yes
No
Why are we asking this?
You cannot participate in the OVATION-2 Study if you are pregnant.
11. Are you currently taking corticosteroids?
Yes
No
Why are we asking this?
It’s important we know about certain medications you may be taking when we evaluate your potential eligibility for the OVATION-2 Study.
12. Is the steroid use related to ongoing immunosuppressive therapy?
Yes
No
Unsure
Why are we asking this?
Information about other therapies you may be receiving will help us understand if you may be eligible for the OVATION-2 Study.