1. Information on your person

1.1 Age:……years

1.2 Sex:  female  male

1.3 Education

 no high school graduation

 junior high school

 high school diploma

 college degree

1.4 Marital status single  married divorced widowed  domestic partnership

 number of children below the age of 15 ….

1.5 Religion Christian  Muslim other none

2. Lifestyle

2.1 Do you keep a healthy diet? Regularly  Once and again  Not at all

2.2 Do you smoke? yes no

2.3 Do you drink alcohol on a regular basis? yes no

2.4 How many hours of sport do you do every week?

 0–1 hours 2–4 hours  more than 4 hours

2.5 Do you use psychological support? yes no

2.6 Do you attend a self-help group? yes no

3. To your opinion, what is the reason of your cancer disease? (several answers possible)

 genetic disposition Toxins in the environment  psychological stress smoking/alcohol

 unhealthy nutrition

 others (please specify): ……………………………………………………………………..

Please score which methods/substances you use and how satisfied you are using them / I am interested in this method / I currently take/use / I have taken/used before my cancer was diagnosed / Satisfaction
(Please score accordingly)
  1. Vitamins (including vitamin C infusions)
/  yes no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Selenium and other trace elements
/  yes  no  I don’t know / ¨ yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Supplements (including combinations from vitamins, trace elements and plant extracts)
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Mistletoe
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Enzymes
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Acupuncture
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Anthroposophical medicine
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Herbs
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Homeopathy
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Medical mushrooms
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Meditation
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Prayer
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Relaxation techniques
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Yoga / Tai Chi / Qi Gong
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Bioresonance therapy
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Hyperthermia
/  yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
  1. Anthroposophical medicine
/  yes  no  I don’t know /  yes no /  yes no
  1. Others: please list:

 yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
 yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
 yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much
 yes  no  I don’t know /  yes no /  yes no / Not at all [4] [3] [2] [1] very much

4. If you marked “yes” at least once in the list, please continue here. If you marked no all over the list please turn to question 4.5.

4.1. Since that complementary therapy, I feel:  better  worse  the same as before

4.2. Did you inform your physician on using complementary therapies? yes no

4.3. Why are you interested in complementary therapy?

(several answers possible)

 to strengthen the immune system to increase my strength and well-being

 to detoxify as a cure against cancer

 in order to be able to do something for myself

 others (please specify): ………………………………………

4.4. From where do you get information on complementary therapies? (several answers possible)

 physician  pharmacist  non-medical practitioner family/friends

 internet journals/books tv/radio others: …………………………………

4.5 Please only answer in case you do not use complementary therapies: if you donot use complementary therapies, would you be interested in them?  yes  no

5. How do you rate the following phrases regarding the above mentioned therapies?

I prefer complementary therapy as I am afraid of the side effects of conventional methods

 I fully agree I don’t agree  I don’t know

I only trust in those treatments which have a scientific reasoning

 I fully agree I don’t agree  I don’t know

It is impressive to see that my physician or non-medical practitioner has success with treatments I do not understand.

 I fully agree I don’t agree  I don’t know

I have experienced the effectiveness of these therapies myself

 I fully agree I don’t agree  I don’t know

If I have undiagnosed health problems I prefer being treated by naturopaths as well as conventional physicians

 I fully agree I don’t agree  I don’t know

I prefer naturopaths or non-medical practitioners as

... I am disappointed by conventional medicine.

 I fully agree I don’t agree  I don’t know

… they get closer to my underlying problem as a conventional physician

 I fully agree I don’t agree  I don’t know

... they make time for me

 I fully agree I don’t agree  I don’t know