PIVOT Membership

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Welcome to Patient and Investigator Voices Organizing Together (PIVOT)!

PIVOT is an innovative approach to bridge the gap between the researcher and people impacted by cancer - the cancer survivors, co-survivors, and someone at high risk for cancer. PIVOT is one of a few comprehensive cancer center patient research advocacy programs in the country allowing enhanced opportunities for people with a lived cancer experience to work with cancer researchers. With PIVOT, you have the opportunity to share your ideas and cancer-related experiences to help scientists design research studies that take patient and family preferences into account, and move research forward!

You are welcome to watch a few videos about the program and see how our research advocates are making a difference in cancer research.

- PIVOT Intro: https://youtu.be/gLPmFI8qHXY

- PIVOT Overview: https://youtu.be/l51A7VG64Rc

- What is PIVOT?: https://youtu.be/kMvy7PrtNqM

First name:

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Last name:

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Email:

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Preferred telephone number:

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What is the best way to contact you?

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Call

Street address:

City:

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City:

State:

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Kansas

Missouri

Other

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Other state:

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Zip code:

Kansas county:

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Missouri county:

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Date of birth:

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M-D-Y

Please select all that apply in regards to your lived cancer experience.

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I am a Survivor (someone who has received a cancer diagnosis)

I am a Co-survivor (family or friend caregiver of a cancer patient)

I am a Pre-vivor (an individual who has not received a cancer diagnosis, but is at high risk and may have undergone related decision-making, testing or procedures)

Age:

View equation

Survivor cancer type:

Anal

Brain & Central Nervous System

Breast

Cervix

Colon & Rectum

Esophagus

Head & Neck

HPV-related

Kidney & Renal Pelvis

Leukemia

Liver & Bile duct

Lung & Bronchus

Lymphoma

Melanoma of skin

Multiple Myeloma

Ovary

Pancreas

Prostate

Sarcoma

Stomach

Thyroid

Uterus

Other

Other Survivor Cancer Type:

Co-survivor cancer type:

Anal

Brain & Central Nervous System

Breast

Cervix

Colon & Rectum

Esophagus

Head & Neck

HPV-related

Kidney & Renal Pelvis

Leukemia

Liver & Bile duct

Lung & Bronchus

Lymphoma

Melanoma of skin

Multiple Myeloma

Ovary

Pancreas

Prostate

Sarcoma

Stomach

Thyroid

Uterus

Other

Other Co-Survivor cancer type:

Pre-Vivor/High risk cancer type:

Anal

Brain & Central Nervous System

Breast

Cervix

Colon & Rectum

Esophagus

Head & Neck

HPV-related

Kidney & Renal Pelvis

Leukemia

Liver & Bile duct

Lung & Bronchus

Lymphoma

Melanoma of skin

Multiple Myeloma

Ovary

Pancreas

Prostate

Sarcoma

Stomach

Thyroid

Uterus

Other

Other Pre-Vivor/High risk cancer type:

We would like to use the information you provided today to create a roster of our current members. Please select the information you are comfortable sharing with PIVOT members and researchers.

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Name

Location

Telephone

Cancer background

I give permission for PIVOT to share my name and email with KU Cancer Center researchers.

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Yes

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I give permission for PIVOT to share my name and email with other PIVOT members.

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Yes

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How did you hear about PIVOT?

Direct invitation

PIVOT Member

PIVOT Researcher

KU Cancer Center employee

KU Cancer Center website

PIVOT website

Facebook

News article

Community organization/Representative

Other

Other (please list)

Name of PIVOT member

Name of PIVOT Researcher:

You will receive an email shortly with next steps. Please indicate below if you would also like an introductory call from our PIVOT program manager?

Yes

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What time of day would you like to be called?

Morning

Afternoon

Evening

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.