ID

10293

Beschrijving

FACT-B (Version 4), E2100 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AC2FF0E4-063C-2184-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AC2FF0E4-063C-2184-E034-0003BA12F5E7

Trefwoorden

D016430

D011788

Mammatumoren, Mensch

27-08-12 27-08-12 -
23-05-15 23-05-15 -

Geüploaded op

23 mei 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

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FACT-B (Version 4), E2100

model
Details

Form No. 1576

1 Formulieren

StudyEvent: FACT-B (Version 4), E2100
1. Form No. 1576

Name

Type

Description | Question | Decode (Coded Value)

Datatype

Alias

ECOG clinical trial administrative data

Item Group

ECOG clinical trial administrative data

ECOGProtocolNo.

Item

ECOG Protocol No.

text

ECOGPatientID

Item

ECOG Patient ID (B1)

text

RegistrationStep

Item

Registration Step

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)

Dateofassessment

Item

Date of assessment

text

Patient'sName

Item

Patient's Name

text

ParticipatingGroupProtocolNo.

Item

Participating Group Protocol No.

text

ParticipatingGroupPatientID

Item

Participating Group Patient ID

text

MainMemberInstitution/Affiliate

Item

Institution/Affiliate (GP1)

text

PHYSICAL WELL-BEING

Item Group

Physical Well-being

PatientEnergyAssessmentQualityofLifeScale

Item

I have a lack of energy (GP2)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C48058 (NCI Thesaurus Property-2)
C0542479 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.1

Code List

I have a lack of energy (GP2)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientNauseaAssessmentQualityofLifeScale

Item

I have nausea (GP3)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3258 (NCI Thesaurus Property-2)
C0027497 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.2

Code List

I have nausea (GP3)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientGeneralPhysicalConditionAssessmentQualityofLifeScale

Item

Because of my physical condition, I have trouble meeting the needs of my family (GP4)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL104641 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.3

Code List

Because of my physical condition, I have trouble meeting the needs of my family (GP4)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientPainAssessmentQualityofLifeScale

Item

I have pain (GP5)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.4

Code List

I have pain (GP5)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientAdverseEventAssessmentQualityofLifeScale

Item

I am bothered by side effects of treatment (GP6)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41331 (NCI Thesaurus Property-2)
C0877248 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.5

Code List

I am bothered by side effects of treatment (GP6)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientMalaiseAssessmentQualityofLifeScale

Item

I feel ill (GP7)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3832 (NCI Thesaurus Property-2)
C0231218 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.6

Code List

I feel ill (GP7)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientBedRestAssessmentQualityofLifeScale

Item

I am forced to spend time in bed (GS1)

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)

CL.7

Code List

I am forced to spend time in bed (GS1)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

SOCIAL/FAMILY WELL-BEING

Item Group

Social/family Well-being

Ifeelclosetomyfriends

Item

I feel close to my friends (GS2)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.8

Code List

I feel close to my friends (GS2)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Igetemotionalsupportfrommyfamily

Item

I get emotional support from my family (GS3)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.9

Code List

I get emotional support from my family (GS3)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Igetsupportfrommyfriends

Item

I get support from my friends (GS4)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.10

Code List

I get support from my friends (GS4)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Myfamilyhasacceptedmyillness

Item

My family has accepted my illness (GS5)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.11

Code List

My family has accepted my illness (GS5)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iamsatisfiedwithfamilycommunicationaboutmyillness

Item

I am satisfied with communication about my illness (GS6)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.12

Code List

I am satisfied with communication about my illness (GS6)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Ifeelclosetomypartner(orthepersonwhoismymainsupport)

Item

I feel close to my partner (or the person who is my main support)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.13

Code List

I feel close to my partner (or the person who is my main support)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

(Prefernottoanswernextquestion)

Item

(Prefer not to answer next question) (Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please check this box and go to the next section.)

text

Iamsatisfiedwithmysexlife

Item

I am satisfied with my sex life.

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.14

Code List

I am satisfied with my sex life.

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

EMOTIONAL WELL-BEING

Item Group

Emotional Well-being

Ifeelsad

Item

I feel sad (GE2)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.15

Code List

I feel sad (GE2)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

IamsatisfiedwithhowIamcopingwithmyillness

Item

I am satisfied with how I am coping with my illness (GE3)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.16

Code List

I am satisfied with how I am coping with my illness (GE3)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iamlosinghopeinthefightagainstmyillness

Item

I am losing hope in the fight against my illness (GE4)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.17

Code List

I am losing hope in the fight against my illness (GE4)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Ifeelnervous

Item

I feel nervous (GE5)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.18

Code List

I feel nervous (GE5)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iworryaboutdying

Item

I worry about dying (GE6)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.19

Code List

I worry about dying (GE6)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iworrythatmyconditionwillgetworse

Item

I worry that my condition will get worse (GF1)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.20

Code List

I worry that my condition will get worse (GF1)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

FUNCTIONAL WELL-BEING

Item Group

Functional Well-being

AbilityPatientWorkAssessmentQualityofLifeScale

Item

I am able to work (include work at home) (GF2)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0085732 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.21

Code List

I am able to work (include work at home) (GF2)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

SatisfactionPatientWorkAssessmentQualityofLifeScale

Item

My work (include work at home) is fulfilling (GF3)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0242428 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.22

Code List

My work (include work at home) is fulfilling (GF3)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientEnjoymentofLifeAssessmentQualityofLifeAssessment

Item

I am able to enjoy life (GF4)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL196329 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.23

Code List

I am able to enjoy life (GF4)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

Ihaveacceptedmyillness

Item

I have accepted my illness (GF5)

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.24

Code List

I have accepted my illness (GF5)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

Iamsleepingwell

Item

I am sleeping well (GF6)

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.25

Code List

I am sleeping well (GF6)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PleasurePatientRecreationAssessmentQualityofLifeScale

Item

I am enjoying things I usually do for fun (GF7)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0679105 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0034872 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.26

Code List

I am enjoying things I usually do for fun (GF7)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientQualityofLifeAssessmentQualityofLifeScale

Item

I am content with the quality of my life right now

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C20989 (NCI Thesaurus Property-2)
C0031809 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.27

Code List

I am content with the quality of my life right now

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

ADDITIONAL CONCERNS

Item Group

Additional Concerns

QualityofLifeDyspneaEvaluationScale

Item

I have been short of breath (B2)

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C2998 (NCI Thesaurus Property-2)
C0013404 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.28

Code List

I have been short of breath (B2)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

A Little Bit (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

Iamself-conciousaboutthewayIdress

Item

I am self-concious about the way I dress (B3)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.29

Code List

I am self-concious about the way I dress (B3)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Oneorbothofmyarmsareswollenandtender

Item

One or both of my arms are swollen and tender (B4)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.30

Code List

One or both of my arms are swollen and tender (B4)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Ifeelsexuallyattractive

Item

I feel sexually attractive (B5)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.31

Code List

I feel sexually attractive (B5)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iambotheredbymyhairloss

Item

I am bothered by my hair loss (B6)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.32

Code List

I am bothered by my hair loss (B6)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

IworrythatothermembersofmyfamilymightsomedaygetthesameillnessIhave

Item

I worry that other members of my family might someday get the same illness I have (B7)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.33

Code List

I worry that other members of my family might someday get the same illness I have (B7)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iworryabouttheeffectsofstressonmyillness

Item

I worry about the effects of stress on my illness (B8)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.34

Code List

I worry about the effects of stress on my illness (B8)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iambotheredbyachangeinweight

Item

I am bothered by a change in weight (B9)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.35

Code List

I am bothered by a change in weight (B9)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

Iamabletofeellikeawoman

Item

I am able to feel like a woman

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.36

Code List

I am able to feel like a woman

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)

CL Item

A Little (A little bit)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)

CCRR MODULE

Item Group

Ccrr Module For Fact-b (version 4), E2100

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Model Commentaren :

Itemgroep Commentaren voor :

Item Commentaren voor :

FACT-B (Version 4), E2100

Form No. 1576

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