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Table 1 Structure of original questionnaire for nation-wide survey

From: A survey on pulmonary screening practices among otolaryngology-head & neck surgeons across Canada in the post treatment surveillance of head and neck squamous cell carcinoma

Questions

Possible responses

1. How do you perform routine lung screening during the post treatment follow-up of head and neck cancer

Lung radiography

All patients

Low-dose CT

Only symptomatic patients

PET/CT

Only high risk patients (smokers, radiation exposure, family history and advanced HNSCC)

Sputum cytology

Physical exam

No routine screen

2. What is the frequency and duration of lung screening in head and neck cancer during follow up in your practice

5 years

Biennially

10 years

Annually

Lifelong

Half-yearly

3. How effective do you believe the screening procedures listed in question 1 are in reducing lung cancer mortality during the follow-up of head and neck cancer

Very effective

Somewhat effective

No effective

Don’t know

4. Have any of your patients during the past 12 months inquired about lung screening

Yes

No

5. Number of years of your clinical head and neck practice and years since graduation from medical school

0-5 years

6-10 years

11-20 years

More than 20 years

6. What is your practicing census region and the patient volume during a typical week of your head & neck practice

Alberta

<75 patients/week

Manitoba

Saskatchewan

British Columbia

New Brunswick

75-125 patients/week

Nova Scotia

Prince Edward Island

Newfoundland and Labrador

Northwest Territories

>125 patients/week

Nunavut

Ontario

Quebec

Yukon