Annelotte van Bommel

142 49. What is currently your marital status? Married/relationship – divorced/separated – widow/widower/partner diseased – single 50. Which description is most applicable to you at this moment? Attendingschool/education–paidemployment–unemployed/seekingwork– incapacitated–housewife – retired 51. What is your nationality? Dutch –Moroccan – Surinamese – Turkish – German – Belgian – Other 52. At time of your breast cancer surgery, how tall were you and howmuch did you weigh? [height in cm] [weight in kg] 53. At time of your breast cancer diagnosis, did you smoke? Yes – no 54. At time of your treatment for breast cancer, did you suffer from one or more of undermentioned diseases? Any other type of cancer – lung disease – cardiovascular disease – gastrointestinal disease – illness of urinaryorreproductivesystem–musculoskeletaldisease–centralnervesystem– illnessofmetabolism or coagulopathy – infectious disease – none – other 55. What was your breast size at the time of your breast cancer diagnosis? AA – A – B – C – D – E – F – G – other 56. Were youmenopausal at time of your treatment with chemotherapy? Premenopausal – perimenopausal – postmenopausal – I don’t know – not applicable 57. Are you an activemember of a patient association for breast cancer or breast disease? No – yes, but not very active – yes, activemember Do you have any questions/remarks?