Proxy questionnaire, patient alive

A_I. What is your relationship with [PT NAME]? 1 Spouse 2 Child 3 Other relative 4 Friend

A_II. How long have you known [PT NAME]? [text answer] units=Weeks

A_III. Do you or did you ever live in the same house? 1 Yes 2 No

A_IV. How long did you live/have you lived in the same house? [text answer] units=Weeks

A1. What is [PT NAME]’s date of birth? [text answer]

A2. Is [PT NAME]…? 1 Female 2 Male

A3. Is he/she of Hispanic or Latino origin? 1 Yes 2 No

A4. What racial or ethnic group best describes him/her? 1 African-American/Black 2 Asian 3 Caucasian/White 4 American Indian or Alaskan native 5 Native Hawaiian or other Pacific Islander 6 Unknown 7 Other:

A5. Was [PT NAME] born in the United States? 1 Yes 2 No

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A6. In what part of the world was [PT NAME] born? 1 North America (outside the US) 2 Middle East 3 South America 4 Asia/India/Pacific Island 5 Caribbean 6 Europe 7 Africa 8 Australia/New Zealand

A7. Is he/she presently: 1 Married 2 Separated 3 Divorced 4 Widowed 5 Single or never married 6 Living as married

A8. Which best describes [PT NAME]’s current living situation? 1 Living alone in a house or apartment 2 Living with others in a house or apartment 3 Living in a group or assisted living facility or nursing home 4 Homeless or homeless shelter 5 Other:

A9. What is the highest grade or year of school [PT NAME] completed? 1 Never attended school or only kindergarten 2 Grades 1 through 8 (elementary) 3 Grades 9 through 11 (some high school) 4 Grade 12 or GED (high school graduate) 5 College 1 year to 3 years (some college or technical school) 6 College graduate or graduate school (4 or more years)

A10. To the best of your knowledge, what was [PT NAME]’s approximate total household income for the last year?

1 Less than $10.000 2 $10,001 - $20,000 3 $20,001 - $30,000 4 $30,001 - $40,000 5 $40,001 - $50,000 6 $50,001 - $60,000 7 $60,001 - $70,000 8 $70,001 - $90,000 9 More than $90,000 10 Currently no income

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B1. Which of the following categories best describes the usual type of paid work [PT NAME] has done?

1 Farmer, farm worker 2 Service worker or laborer 3 Craftsworker, factory worker, mechanic 4 Clerical worker, salesperson, technician 5 Professional, administrator, executive 6 Other 7 Never worked [Did not work for at least 6 months]

B2. For the job that [PT NAME] held longest, did he/she regularly work in dusty conditions? 1 Yes 2 No

B3. Was the dust from? 1 Sand or rock 2 Concrete, brick or mortar 3 Soil 4 Grains, animal bedding or manure 5 Flour 6 Clay, ceramics or enamel 7 Wood dust 8 Rubber or plastic 9 Metals 10 Other materials

B4. For the job that [PT NAME] held longest, did he/she regularly breathe in chemical vapors or fumes?

1 Yes 2 No

B5. Did [PT NAME] regularly get chemicals or oils on their skin or clothing? 1 Yes 2 No

B6. Did [PT NAME] regularly come in contact with solvents or degreasers? 1 Yes 2 No

B7. Did [PT NAME] regularly come in contact with metal chips, metal dust or metal fumes? 1 Yes 2 No

B8. Has [PT NAME] served in the military? 1 Yes 2 No

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B9. Where was [PT NAME] stationed when he/she served? 1 USA/Canada 2 Africa 3 Asia/South Pacific 4 Caribbean 5 Mexico 6 Middle East 7 Northern/Central Europe/Mediterranean 8 Other 9 Don't know

B10. What was [PT NAME]’s primary or longest military occupational specialty (MOS)? [text answer]

B11. In what branches of the military did [PT NAME] serve? 1 Army 2 Navy 3 Air Force 4 Marine Corps 5 Coast Guard

B12. Did [PT NAME] ever serve a tour of duty that included combat operations? 1 Yes 2 No

C1. Did a doctor ever tell [PT NAME] that he/she had: 1 Arthritis (including rheumatoid arthritis) 2 Hypertension (high blood pressure) 3 Depression 4 Heart attack, heart problems, or stroke 5 Asthma, chronic bronchitis, emphysema 6 High cholesterol 7 High triglycerides 8 Neurological problems like seizures, epilepsy, or migraines 9 None of the above

C2. Did a doctor ever tell [PT NAME] that he/she had diabetes (high blood sugar)? 1 Yes 2 No

C3. When did [PT NAME]’s doctor first tell him/her that he/she had diabetes? [text answer] units=Age

C4. Did [PT NAME] ever take pills for his/her diabetes? 1 Yes 2 No

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C5. When did [PT NAME] start taking pills for his/her diabetes? [text answer] units=Age

C6. How long did [PT NAME] take pills for his/her diabetes? [text answer] units=Months

C7. Did [PT NAME] ever take Avandia or Actos for his/her diabetes? 1 Yes 2 No

C8. When did [PT NAME] start taking Avandia or Actos for his/her diabetes? [text answer] units=Age

C9. Did [PT NAME] ever take glipizide (GLUCOTROL) for their diabetes? 1 Yes 2 No

C10. When did [PT NAME] start taking glipizide (GLUCOTROL) for their diabetes? [text answer] units=Age

C11. Did [PT NAME] ever take glyburide (DIABETA, GLYCRON, GLYNASE, MICRONASE) for their diabetes?

1 Yes 2 No

C12. When did [PT NAME] start taking glyburide (DIABETA, GLYCRON, GLYNASE, MICRONASE) for their diabetes?

[text answer] units=Age

C13. Did [PT NAME] ever take metformin (Fortamet, Glucophage, Gulmetza, Riomet) for their diabetes?

1 Yes 2 No

C14. When did [PT NAME] start taking metformin (Fortamet, Glucophage, Gulmetza, Riomet) for their diabetes?

[text answer] units=Age

C15. Did [PT NAME] ever take insulin for their diabetes? 1 Yes 2 No

C16. When did [PT NAME] start taking insulin for their diabetes? [text answer] units=Age

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C17. Did [PT NAME] ever take any other medications for their diabetes? 1 Yes 2 No

C18A. What is the name of another medication [PT NAME] took for their diabetes? [text answer]

C18B. When did [PT NAME] start taking this for their diabetes? [text answer] units=Age

C18C. Did [PT NAME] take any other medications for their diabetes? 1 Yes 2 No

C18D. What is the name of another medication [PT NAME] took for their diabetes? [text answer]

C18E. When did [PT NAME] start taking this for their diabetes? [text answer] units=Age

C18F. Did [PT NAME] take any other medications for their diabetes? 1 Yes 2 No

C18G. What is the name of another medication [PT NAME] took for their diabetes? [text answer]

C18H. When did [PT NAME] start taking this for their diabetes? [text answer] units=Age

C19. Was [PT NAME] ever told he/she had hepatitis? 1 Yes 2 No

C20. Was [PT NAME] ever told he/she had hepatitis C? 1 Yes 2 No

C21. Did [PT NAME] ever receive treatment for hepatitis C? 1 Yes 2 No

C22. Was [PT NAME] treated with interferon (the shot)? 1 Yes 2 No

C23. How many times per week did [PT NAME] receive interferon (the shot)? [text answer]

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C24. Was [PT NAME] treated with ribavirin (the pills)? 1 Yes 2 No

C25. How many times per day did [PT NAME] take ribavirin (the pills)? [text answer]

C26. Was [PT NAME] treated with sylimarin (milk thistle)? 1 Yes 2 No

C27. How many times per day did [PT NAME] take sylimarin (milk thistle)? [text answer]

C28. Was [PT NAME] treated with any other medications for Hepatitis C? 1 Yes 2 No

C29A. What was the name of one of the other medications [PT NAME] took for Hepatitis C? [text answer]

C29B. How many time per day did [PT NAME] take it? [text answer]

C29C. Was [PT NAME] treated with any other medications for Hepatitis C? 1 Yes 2 No

C29D. What was one of the other medications [PT NAME] took for Hepatitis C? [text answer]

C29E. How many time per day did [PT NAME] take it? [text answer]

C29F. Was [PT NAME] treated with any other medications for Hepatitis C? 1 Yes 2 No

C29G. What was one of the other medications [PT NAME] took for Hepatitis C? [text answer]

C29H. How many times per day did [PT NAME] take it? [text answer]

C30. In total, how many weeks/months/years did [PT NAME] take hepatitis C treatment? [text answer] units=Weeks

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C31. Does [PT NAME] know if the hepatitis C treatment was successful or not? 1 Yes 2 No

C32. Has [PT NAME] ever been told he/she had Hepatitis B? 1 Yes 2 No

C33. Did [PT NAME] receive treatment for hepatitis B? 1 Yes 2 No

C34. Was [PT NAME] treated with Lamivudine? 1 Yes 2 No

C35. Was [PT NAME] treated with Adefovir? 1 Yes 2 No

C36. Was [PT NAME] treated with Entecavir? 1 Yes 2 No

C37. Was [PT NAME] treated with tenofovir? 1 Yes 2 No

C38. Were you treated with any other medications for Hepatitis B? 1 Yes 2 No

C39. What other medications did [PT NAME] take? [text answer]

C40. In total, how many weeks/months/years did [PT NAME] take hepatitis B treatment? [text answer] units=Weeks

C41A. Did [PT NAME] ever take atorvastatin (Lipitor, Caduet)? 1 Yes 2 No

C41B. Did [PT NAME] ever take fluvastatin (Lescol)? 1 Yes 2 No

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C41C. Did [PT NAME] ever take lovastatin (Mevacor, Advicor, and Altoprev)? 1 Yes 2 No

C41D. Did [PT NAME] ever take pravastatin (Pravachol, Pravigard PAC)? 1 Yes 2 No

C41E. Did [PT NAME] ever take rosuvastatin (Crestor)? 1 Yes 2 No

C41F. Did [PT NAME] ever take simvastatin (Zocor, Vytorin)? 1 Yes 2 No

C41G. Did [PT NAME] ever take Baychol? 1 Yes 2 No

C42. In total, how many weeks/months/years did [PT NAME] take these medications? [text answer] units=Weeks

C43A. Did he/she take any colesevelam (WelChol) to lower cholesterol? 1 Yes 2 No

C43B. Did he/she take any colestipol (Colestid)? 1 Yes 2 No

C43C. Did he/she take any cholestyramine (Locholest, Questran)? 1 Yes 2 No

C43D. Did he/she take any niacin obtained over the counter or by prescription (Nicotinic acid, Advicor)?

1 Yes 2 No

C43E. Did [PT NAME] take any gemfibrozel (Lopid)? 1 Yes 2 No

C43F. Did [PT NAME] take any fenofibrate (TriCor, Antara, Lofibra, Triglide)? 1 Yes 2 No

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C43G. Did [PT NAME] take any ezetimibe (Zetia, Vytorin)? 1 Yes 2 No

C44. In total, how many weeks/months/years did [PT NAME] take these medications? [text answer] units=Weeks

D1. Has [PT NAME] ever drunk coffee on a regular basis? 1 Yes 2 No

D1A. For how many years have you been aware of how much coffee he/she drinks? [text answer]

D1C. During the years that you have been aware of his/her coffee intake, about how often did he/she drink an 8 oz. cup of coffee? Do not include the 12 months before he/she was diagnosed with cancer.

[text answer] units=Per day

D2. How often was the coffee that [PT NAME] drank during that time regular coffee; that is, it contained caffeine?

1 Almost always 2 Often 3 Sometimes 4 Seldom 5 Never

D3. Did [DECEDENT] drink coffee during the year before he/she was diagnosed with liver cancer? 1 Yes 2 No

E1. During the year before [PT NAME] was diagnosed with liver cancer, did he/she ever drink an 8 oz cup of coffee with caffeine?

1 Yes 2 No

E1A. How often did he/she drink caffeinated coffee during the year before he/she was diagnosed? [text answer] units=Per day

E2. During the year before he/she was diagnosed with liver cancer, did he/she ever drink an 8 oz cup of decaffeinated coffee ?

1 Yes 2 No

E2A. How often did he/she drink an 8 oz cup of decaffeinated coffee during the year before he/she was diagnosed?

[text answer] units=Per day

E3. During the year before [PT NAME]’s diagnosis, did he/she drink any other type of coffee?

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1 Yes 2 No 3 DK/REF

E4. How often did he/she drink an 8 oz. cup of [OTHER TYPE OF] coffee during the year before their diagnosis?

[text answer] units=Per day

E5. Which of the following did he/she usually add to coffee? 1 Creamer, half & half 2 Nondairy creamer 3 Milk 4 None of these 5 Did not drink coffee

E6. Did he/she usually add sugar (or honey) to coffee? 1 Yes 2 No

E7. How many teaspoons per cup? [text answer]

E8. Did he/she usually add artificial sweetener to coffee? 1 Yes 2 No

E9. How many teaspoons or packets per cup? [text answer] units=teaspoons per cup

E10. What type of artificial sweetener did he/she usually use? 1 Pink pack/Sweet and Low 2 Blue pack/Nutra Sweet 3 Yellow pack/Splenda 4 Other

E11. During the year before [PT NAME] was diagnosed with liver cancer, did he/she drink iced or hot tea with caffeine (NOT including herbal tea or green tea)?

1 Yes 2 No

E11A. How often did he/she drink an 8 oz. cup of iced or hot tea with caffeine (NOT including herbal tea or green tea)?

[text answer] units=Per day

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E12. During the year before he/she was diagnosed with liver cancer, did he/she drink decaffeinated iced or hot tea (NOT including herbal tea or green tea)?

1 Yes 2 No

E12A. How often did he/she drink an 8 oz. cup of decaffeinated iced or hot tea (NOT including herbal tea or green tea)?

[text answer] units=Per day

E13. During the year before he/she was diagnosed with liver cancer, did he/she drink green tea? 1 Yes 2 No

E13A. How often did he/she drink an 8 oz. cup of green tea? [text answer] units=Per day

E14. During the year before he/she was diagnosed with liver cancer, did he/she drink herbal tea? 1 Yes 2 No

E14A. About how often did he/she drink an 8 oz. cup of herbal tea? [text answer] units=Per day

E15. During the year before their diagnosis, did he/she drink any other type of tea? 1 Yes 2 No

E16. How often did he/she drink an 8 oz. cup of tea during the year before your diagnosis? [text answer] units=Per day

E17. Which of the following did he/she usually add to tea? 1 Creamer, half & half 2 Nondairy creamer 3 Milk 4 None of these

E18. Did he/she usually add sugar (or honey) to tea? 1 Yes 2 No

E19. How many teaspoons per each cup? [text answer]

E20. Did he/she usually add artificial sweetener to tea? 1 Yes 2 No

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E21. How many teaspoons or packets per cup? [text answer] units=teaspoons per cup

E22. What type of artificial sweetener Does he/she usually use? 1 Pink pack/Sweet and Low 2 Blue pack/NutraSweet 3 Yellow pack/Splenda 4 Other

F1. During the year before [PT NAME]’s diagnosis, did he/she drink regular or diet soft drinks with caffeine (Coke, Pepsi, Mountain Dew, Mello Yello, SunDrop, Dr. Pepper, Red Bull)?

1 Yes 2 No

F1A. How often did he/she drink regular or diet soft drinks with caffeine (Coke, Pepsi, Mountain Dew, Mello Yello, SunDrop, Dr. Pepper, Red Bull)?

[text answer] units=Per day

F2. During the year before [PT NAME]’s diagnosis, did he/she drink regular or diet soft drinks that were caffeine-free? (Caffeine-free Coke, Pepsi or Diet Coke, Sprite, Fresca, 7-Up, Ginger Ale)?

1 Yes 2 No

F2A. How often did he/she drink regular or diet soft drinks that were caffeine-free? (Caffeine-free Coke, Pepsi or Diet Coke, Sprite, Fresca, 7-Up, Ginger Ale)

[text answer] units=Per day

G1. Before [PT NAME]’s liver cancer diagnosis, did a doctor ever tell him/her that he/she had a cancer other than liver cancer?

1 Yes 2 No

G1A. What other type of cancer was that? [text answer]

G1B. How old was he/she when he/she was diagnosed with this cancer? [text answer]

G2. Did a doctor ever tell him/her that he/she had an other cancer type besides liver cancer and the one you mentioned?

1 Yes 2 No

G2A. What other type of cancer was that? [text answer]

G2B. How old was he/she when he/she was diagnosed with this other cancer? [text answer]

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G3. Did a doctor ever tell him/her that he/she had an other cancer type besides liver cancer and the other two you mentioned?

1 Yes 2 No

G3A. What other type of cancer was that? [text answer]

G3B. How old was he/she when he/she was diagnosed with this other cancer? [text answer]

G3C. Did a doctor ever tell him/her that he/she had an other cancer type besides liver cancer and the other three you mentioned?

1 Yes 2 No

G3D. What other type of cancer was that? [text answer]

G3E. How old was he/she when he/she was diagnosed with this other cancer? [text answer]

G4. [ONLY ASK IF PROSTATE CANCER WAS REPORTED] What kind of treatment did he receive for prostate cancer?

1 Radical surgery (prostatectomy) 2 Minimally invasive surgery (laparoscopic or robotic) 3 Radiation therapy 4 Hormone therapy 5 Other 6 Did not receive any treatment

H1. Before we begin asking about family history, was [PT NAME] adopted? 1 Yes 2 No

H2. Do you have medical information about any of your biological family members (parents or full siblings)?

1 Yes 2 No

II2. Was she ever pregnant? Pease include miscarriages, stillbirths, tubal pregnancies, and abortions. 1 Yes 2 No

I3. How many times was she been pregnant? [text answer]

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I4. How many of [PT NAME]’s pregnancies lasted 6 months or longer? [text answer]

I5. How many of [PT NAME]’s pregnancies resulted in live births? [text answer]

I6. How old was she at the first live birth? [text answer]

I7. How old was she at the last live birth? [text answer]

J1. What was [PT NAME]’s approximate weight one year before he/she was diagnosed with cancer? [text answer]

J4. What is the most he/she ever weighed since age 18? [text answer]

J5. How old were they when they first weighed this amount? [text answer]

J6. What's your best estimate for his/her current weight? [text answer]

J7. How tall is he/she? [text answer]

KK1. Has he/she ever consumed alcohol on a regular basis? By regular, I mean at least once a week for 6 months or longer?

1 Yes 2 No

K2. How many of the years that [PT NAME] drank alcohol on a regular basis were you aware of how much alcohol he/she consumed?

[text answer]

K3. Would you say that during those years he/she was a… 1 Heavy drinker 2 Moderate drinker 3 Light drinker

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K4. During the time that you were aware of his/her alcohol consumption, what type of alcohol did he/she consume most of the time?

1 Beer 2 Hard cider 3 Wine 4 Sake 5 Liquor 6 Spirits 7 Mixed drinks 8 Cocktails

L1. Has [PT NAME] ever smoked cigarettes on a regular basis? By 'regular', I mean at least one cigarette a day for 3 months or longer.

1 Yes 2 No

L2. In total, how long [did/have] he/she smoked cigarettes regularly? [text answer] units=Weeks

L3. During the periods when he/she smoked regularly, how many cigarettes did they typically smoked in a day?

[text answer]

L4. At what age did he/she FIRST start smoking cigarettes regularly? [text answer]

L5. Does he/she currently smoke cigarettes regularly? 1 Yes 2 No

L6. At what age did he/she permanently stop smoking cigarettes regularly? [text answer]

L7. Have he/she used any of the following other tobacco products on a regular basis for six months or longer?

1 pipe 2 cigars 3 cigarillos 4 chewing tobacco 5 snuff 6 None of the above

L8. Have he/she ever smoked marijuana on a regular basis? By 'regular', I mean 2 or more days per week.

1 Yes 2 No

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L9. In total, how long did they smoke marijuana regularly? [text answer] units=Weeks

L10. During the periods when he/she smoked marijuana regularly, how many times has he/she typically smoked in a day?

[text answer]

L11. At what age did he/she FIRST start smoking marijuana regularly? [text answer]

L12. Does he/she currently smoke marijuana regularly? 1 Yes 2 No

L13. At what age did he/she permanently stop smoking marijuana regularly? [text answer]

M1. Did he/she ever have surgery (before he/she was diagnosed with liver cancer)? 1 Yes 2 No

M2. What kind of surgery did he/she have? [text answer]

M3. Did he/she ever have a blood transfusion? 1 Yes 2 No

M4. During which time period(s) did he/she have a blood transfusion? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M5. Did he/she ever use intravenous recreational drugs (injected drugs with a needle into their vein)? 1 Yes 2 No

M6. Which intravenous recreational drugs did he/she use? [text answer]

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M7. During which time period(s) did he/she use intravenous recreational drugs? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M8. Did he/she ever snort cocaine? 1 Yes 2 No

M9. During which time period(s) did he/she snort cocaine? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M10. Did he/she ever skin-pop (use a needle to inject drugs beneath the skin, such as steroids, vitamins)?

1 Yes 2 No

M11. Which medications did he/she skin-pop? [text answer]

M12. During which time period(s) did he/she skin-pop medications? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M13. Was he/she ever stuck or cut with a needle or sharp object after it was in contact with another individual while at work?

1 Yes 2 No

M14. During which time period(s) was he/she stuck or cut with a needle or sharp object? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M15. Did he/she ever have a tattoo? 1 Yes 2 No

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M16. During which time period(s) did he/she have your tattoo(s) placed? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M17. Did he/she ever have any part of your body (including ears) pierced? 1 Yes 2 No

M18. During which time period(s) did he/she have piercing done? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

MM19. Has he/she ever been incarcerated (in prison or jail) or in a detention facility for more than 48 hours?

1 Yes 2 No

M20. During which time period(s) were he/she incarcerated? 1 Prior to 1970 2 1970 to 1980 3 1981 to 1990 4 1991 to 2000 5 2001 to present

M21A. Was he/she ever tested for HIV? 1 Yes 2 No

M22. What was the result of [PT NAME]’s HIV test? 1 Positive 2 Negative

O2. From time to time other research studies become available. Should such a study become available, may we contact you?

1 Yes 2 No

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