What is Your Child's Name?*
Show your child's name?*
If you select no, we will list any details below anonymously. If you select yes, your child's name may be released along with the information below. Even if you opt to allow us to release your child's name, we would only do so if we believe there would be a benefit to the researcher to have it.
Does your child have a CarePage or CaringBridge site, blog, or other website?
Please share the URL if you wish so we can learn more about your child!
How old was your child at diagnosis?*
Which hospitals care/cared for your child?
Feel free to list multiple.
Who is/was (are/were) your child's primary clinical doctor(s)?
Feel free to list multiple.
What type of PRIMARY tumor does/did your child have?*
AT/RT = Atypical Teratoid Rhabdoid Tumor (Brain/Spine)
If AT/RT, where is/was the PRIMARY (first) tumor located?*
If MRT/RTK, where was the PRIMARY (first) tumor located?*
If you chose Other in questions #4 or #5 above, please provide additional details:
Did your child have surgery to remove the PRIMARY tumor?*
If so, please provide the approximate result.
Which chemotherapy protocol did your child follow?*
If you remember the name of the protocol, please select one below. If not, please check Other. If your child did not have any chemotherapy, please select None.
Which chemotherapy drugs did your child receive?*
Please be as thorough as possible, though I know it can be difficult to remember them all!
In your opinion, was chemotherapy effective for your child?
This is an opinion question only, there is no right or wrong answer.
Did your child receive radiation therapy?*
You may select multiple answers
In your opinion, was radiation effective for your child?
This is an opinion question, there is no right or wrong answer
Did your child have high-dose chemotherapy requiring stem-cell rescue?*
If so, how many rounds?
Have you had genetic DNA testing performed?*
Was your child conceived via in vitro fertilization?*
Some studies show a higher chance of AT/RT occuring with in vitro fertilization. We would like to collect this data to verify if there may be a true correlation.
What is your child's current status?*
Would you like to share any additional details regarding your child's diagnosis, treatment, or outcome?
We appreciate all of the information you can provide!
May we contact you if we have any additional questions?*
We will never call you for any type of solicitation, only if additional information regarding your child's treatment is needed, and possibly for udates on your child's progress at predefined time intervals.
If yes, please provide your email address and/or phone number:
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Please Note: Questions followed by an asterisk (*) require an answer to be provided.
