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10775

Beschrijving

E3A06 Quality of Life Assessment Form NCT01169337 Lenalidomide or Observation in Treating Patients With Asymptomatic High-Risk Smoldering Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=86D10DC2-628F-A706-E040-BB89AD434839

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=86D10DC2-628F-A706-E040-BB89AD434839

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
  3. 08-06-15 08-06-15 -
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8 juni 2015

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Creative Commons BY-NC 3.0 Legacy
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    E3A06 Quality of Life Assessment Form NCT01169337

    Engels

    INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).

    1 Formulieren  
    Header
    Beschrijving

    Header

    ECOG Protocol Number
    Beschrijving

    Protocol Number ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    ECOG Patient ID
    Beschrijving

    Patient ID ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    DCI Name
    Beschrijving

    Generic drug form

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C3242750
    NCI Thesaurus Property
    C19464
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus ObjectClass-2
    C25452
    Registration Step
    Beschrijving

    Registration Number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Patient demographics
    Beschrijving

    Patient demographics

    ECOG Protocol Number
    Beschrijving

    Protocol Number ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    Patient Initials (Last, First)
    Beschrijving

    Patient Initials

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    ECOG Patient ID
    Beschrijving

    Patient ID ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    Participating Group Protocol Number
    Beschrijving

    Study Number Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Institution/Affiliate
    Beschrijving

    Institution Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group Patient ID
    Beschrijving

    Trial subject ID Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Reporting period
    Beschrijving

    Reporting period

    On Treatment or Observation Report Period (Note: Choose "End of Treatment/Observation" when patient discontinues treatment at any point.)
    Beschrijving

    Cycle number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25214
    NCI Thesaurus Property-2
    C25616
    NCI Thesaurus ObjectClass
    C15368
    Off Treatment or Off Observation Report Period
    Beschrijving

    PersonOff-TreatmentTimePeriodType

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25601
    UMLS 2011AA Property-2
    C1518544
    NCI Thesaurus Property-3
    C25207
    UMLS 2011AA Property-3
    C0040223
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Date of Assessment
    Beschrijving

    Assessment Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985720
    NCI Thesaurus ObjectClass
    C25367
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C38000
    Physical Well-being
    Beschrijving

    Physical Well-being

    I have a lack of energy (GP1)
    Beschrijving

    PatientEnergyAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C48058
    UMLS 2011AA Property-2
    C0542479
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have nausea (GP2)
    Beschrijving

    PatientNauseaAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3258
    UMLS 2011AA Property-2
    C0027497
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Because of my physical condition, I have trouble meeting the needs of my family (GP3)
    Beschrijving

    PatientGeneralPhysicalConditionAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL104641
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have pain (GP4)
    Beschrijving

    PatientPainAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am bothered by side effects of treatment (GP5)
    Beschrijving

    PatientAdverseEventAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C41331
    UMLS 2011AA Property-2
    C0877248
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel ill (GP6)
    Beschrijving

    PatientMalaiseAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3832
    UMLS 2011AA Property-2
    C0231218
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am forced to spend time in bed (GP7)
    Beschrijving

    PatientBedRestAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    Functional Well-being
    Beschrijving

    Functional Well-being

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

    AbilityPatientWorkAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus ObjectClass
    C0085732
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0043227
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    My work (include work at home) is fulfilling
    Beschrijving

    SatisfactionPatientWorkAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C62185
    UMLS 2011AA Property
    C0242428
    NCI Metathesaurus Property
    C0043227
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am able to enjoy life
    Beschrijving

    PatientEnjoymentofLifeAssessmentQualityofLifeAssessment

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL196329
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have accepted my illness
    Beschrijving

    Ihaveacceptedmyillness

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am sleeping well
    Beschrijving

    Iamsleepingwell

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am enjoying the things I usually do for fun
    Beschrijving

    IamenjoyingthethingsIusuallydoforfun

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am content with the quality of my life right now
    Beschrijving

    PatientQualityofLifeAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17047
    UMLS 2011AA Property
    C0518214
    NCI Thesaurus Property-2
    C20989
    UMLS 2011AA Property-2
    C0031809
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Additional Concerns - Mms
    Beschrijving

    Additional Concerns - Mms

    I have certain parts of my body where I experience pain
    Beschrijving

    SignificantPatientLocalizedPainAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C41130
    UMLS 2011AA ObjectClass-2
    C0750502
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL232212
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel weak all over
    Beschrijving

    NeurotoxicityPatientMuscleWeaknessAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C27961
    UMLS 2011AA ObjectClass-2
    C0235032
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0151786
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel fatigued
    Beschrijving

    Quality-of-LifeAssessmentPatientFatigueScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel fatigued
    Beschrijving

    Quality-of-LifeAssessmentPatientFatigueScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have trouble concentrating
    Beschrijving

    Quality-of-LifeAssessmentPatientDifficultyAttentionConcentrationScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C62189
    UMLS 2011AA Property-2
    C1299586
    NCI Thesaurus Property-3
    C41209
    UMLS 2011AA Property-3
    C0004268
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I worry about getting infections
    Beschrijving

    Quality-of-LifeAssessmentPatientInfectiousDisorderAnxietyScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C26696
    UMLS 2011AA Property-2
    C0003467
    NCI Thesaurus Property-3
    C26726
    UMLS 2011AA Property-3
    C0009450
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel discouraged about my illness
    Beschrijving

    PatientDespondencyAssessmentQualityofLifeScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0392375
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Because of my illness, I have difficulty planning for the future
    Beschrijving

    Quality-of-LifeAssessmentPatientDifficultyPlanFutureScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C67527
    UMLS 2011AA Property-2
    C0016884
    NCI Thesaurus Property-3
    C25619
    UMLS 2011AA Property-3
    C1301732
    NCI Thesaurus Property-4
    C62189
    UMLS 2011AA Property-4
    C1299586
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I worry that I might get new symptoms of my illness
    Beschrijving

    Quality-of-LifeAssessmentPatientNewSymptomAnxietyScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C25586
    UMLS 2011AA Property-2
    C0205314
    NCI Thesaurus Property-3
    C26696
    UMLS 2011AA Property-3
    C0003467
    NCI Thesaurus Property-4
    C4876
    UMLS 2011AA Property-4
    C1457887
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have emotional ups and downs
    Beschrijving

    Quality-of-LifeAssessmentPatientFluctuateEmotionScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C54266
    UMLS 2011AA Property-2
    C0013987
    NCI Thesaurus Property-3
    C67528
    UMLS 2011AA Property-3
    C0231241
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have bone pain
    Beschrijving

    Quality-of-LifeAssessmentPatientBonePainScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus Property-3
    C12366
    UMLS 2011AA Property-3
    C0262950
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I need help doing my usual activities
    Beschrijving

    Quality-of-LifeAssessmentPatientSupportActivityScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C43431
    UMLS 2011AA Property-2
    C0441655
    NCI Thesaurus Property-3
    C37902
    UMLS 2011AA Property-3
    C1521721
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have trouble walking because of pain
    Beschrijving

    Quality-of-LifeAssessmentPatientDifficultyMobilePainScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus Property-3
    C25295
    UMLS 2011AA Property-3
    C0231435
    NCI Thesaurus Property-4
    C62189
    UMLS 2011AA Property-4
    C1299586
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have gained weight
    Beschrijving

    Quality-of-LifeAssessmentPatientWeightGainScale

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C62754
    UMLS 2011AA Property-2
    C0043094
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
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    Similar models

    INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).

    1 Formulieren
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    Header
    Protocol Number ECOG
    Item
    ECOG Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Patient ID ECOG
    Item
    ECOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Generic drug form
    Item
    DCI Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C3242750 (UMLS CUI-1)
    C19464 (NCI Thesaurus Property)
    C25474 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus ObjectClass-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Item Group
    Patient demographics
    Protocol Number ECOG
    Item
    ECOG Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    Patient Initials (Last, First)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient ID ECOG
    Item
    ECOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Study Number Participating Group
    Item
    Participating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Reporting period
    Item
    On Treatment or Observation Report Period (Note: Choose "End of Treatment/Observation" when patient discontinues treatment at any point.)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25616 (NCI Thesaurus Property-2)
    C15368 (NCI Thesaurus ObjectClass)
    CL.1
    Code List
    On Treatment or Observation Report Period (Note: Choose "End of Treatment/Observation" when patient discontinues treatment at any point.)
    CL Item
    Baseline (baseline)
    C25213 (NCI Thesaurus)
    C1442488 (UMLS 2011AA)
    C25213 (NCI Thesaurus-3)
    C1442488 (UMLS 2011AA-4)
    CL Item
    Cycle 6 (Cycle 6)
    CL Item
    Cycle 12 (Cycle 12)
    CL Item
    Cycle 18 (Cycle 18)
    CL Item
    Cycle 24 (Cycle 24)
    CL Item
    Cycle 30 (Cycle 30)
    CL Item
    Cycle 36 (Cycle 36)
    CL Item
    Cycle 42 (Cycle 42)
    CL Item
    Cycle 48 (Cycle 48)
    CL Item
    End Of Treatment Or Observation (End of Treatment or Observation)
    Item
    Off Treatment or Off Observation Report Period
    text
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25601 (NCI Thesaurus Property-2)
    C1518544 (UMLS 2011AA Property-2)
    C25207 (NCI Thesaurus Property-3)
    C0040223 (UMLS 2011AA Property-3)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Off Treatment or Off Observation Report Period
    CL Item
    3 Months (3 months post registration)
    CL Item
    6 Months (6 months post registration)
    CL Item
    9 Months (9 months post registration)
    CL Item
    12 Months (12 months post registration)
    CL Item
    15 Months (15 months post registration)
    CL Item
    18 Months (18 months post registration)
    CL Item
    21 Months Post Registration (21 months post registration)
    CL Item
    24 Months (24 months post registration)
    CL Item
    30 Months (30 months post registration)
    CL Item
    36 Months (36 months post registration)
    CL Item
    42 Months Post Registration (42 Months Post Registration)
    CL Item
    4 Years (48 months post registration)
    Assessment Date
    Item
    Date of Assessment
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985720 (UMLS CUI-1)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C38000 (NCI Thesaurus Property)
    Item Group
    Physical Well-being
    Item
    I have a lack of energy (GP1)
    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.3
    Code List
    I have a lack of energy (GP1)
    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)
    Item
    I have nausea (GP2)
    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.4
    Code List
    I have nausea (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)
    Item
    Because of my physical condition, I have trouble meeting the needs of my family (GP3)
    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.5
    Code List
    Because of my physical condition, I have trouble meeting the needs of my family (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 (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)
    Item
    I have pain (GP4)
    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.6
    Code List
    I have pain (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 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)
    Item
    I am bothered by side effects of treatment (GP5)
    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.7
    Code List
    I am bothered by side effects of treatment (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)
    Item
    I feel ill (GP6)
    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.8
    Code List
    I feel ill (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)
    Item
    I am forced to spend time in bed (GP7)
    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.9
    Code List
    I am forced to spend time in bed (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)
    Item Group
    Functional Well-being
    Item
    I am able to work (include work at home)
    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.10
    Code List
    I am able to work (include work at home)
    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)
    Item
    My work (include work at home) is fulfilling
    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.11
    Code List
    My work (include work at home) is fulfilling
    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)
    Item
    I am able to enjoy life
    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.12
    Code List
    I am able to enjoy life
    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)
    Item
    I have accepted my illness
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.13
    Code List
    I have accepted my illness
    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)
    Item
    I am sleeping well
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.14
    Code List
    I am sleeping well
    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)
    Item
    I am enjoying the things I usually do for fun
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.15
    Code List
    I am enjoying the things I usually do for fun
    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)
    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.16
    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)
    Item Group
    Additional Concerns - Mms
    Item
    I have certain parts of my body where I experience pain
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C41130 (NCI Thesaurus ObjectClass-2)
    C0750502 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    CL232212 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.17
    Code List
    I have certain parts of my body where I experience pain
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel weak all over
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C27961 (NCI Thesaurus ObjectClass-2)
    C0235032 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0151786 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.18
    Code List
    I feel weak all over
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel fatigued
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C3036 (NCI Thesaurus Property-2)
    C0015672 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.29
    Code List
    I feel fatigued
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel fatigued
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C3036 (NCI Thesaurus Property-2)
    C0015672 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.29
    Code List
    I feel fatigued
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have trouble concentrating
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C62189 (NCI Thesaurus Property-2)
    C1299586 (UMLS 2011AA Property-2)
    C41209 (NCI Thesaurus Property-3)
    C0004268 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.20
    Code List
    I have trouble concentrating
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I worry about getting infections
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus Property-2)
    C0003467 (UMLS 2011AA Property-2)
    C26726 (NCI Thesaurus Property-3)
    C0009450 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.21
    Code List
    I worry about getting infections
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel discouraged about my illness
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0392375 (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
    I feel discouraged about my illness
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    Because of my illness, I have difficulty planning for the future
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C67527 (NCI Thesaurus Property-2)
    C0016884 (UMLS 2011AA Property-2)
    C25619 (NCI Thesaurus Property-3)
    C1301732 (UMLS 2011AA Property-3)
    C62189 (NCI Thesaurus Property-4)
    C1299586 (UMLS 2011AA Property-4)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.23
    Code List
    Because of my illness, I have difficulty planning for the future
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I worry that I might get new symptoms of my illness
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C25586 (NCI Thesaurus Property-2)
    C0205314 (UMLS 2011AA Property-2)
    C26696 (NCI Thesaurus Property-3)
    C0003467 (UMLS 2011AA Property-3)
    C4876 (NCI Thesaurus Property-4)
    C1457887 (UMLS 2011AA Property-4)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.24
    Code List
    I worry that I might get new symptoms of my illness
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have emotional ups and downs
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C54266 (NCI Thesaurus Property-2)
    C0013987 (UMLS 2011AA Property-2)
    C67528 (NCI Thesaurus Property-3)
    C0231241 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.25
    Code List
    I have emotional ups and downs
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have bone pain
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C12366 (NCI Thesaurus Property-3)
    C0262950 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.26
    Code List
    I have bone pain
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I need help doing my usual activities
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C43431 (NCI Thesaurus Property-2)
    C0441655 (UMLS 2011AA Property-2)
    C37902 (NCI Thesaurus Property-3)
    C1521721 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.27
    Code List
    I need help doing my usual activities
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have trouble walking because of pain
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C25295 (NCI Thesaurus Property-3)
    C0231435 (UMLS 2011AA Property-3)
    C62189 (NCI Thesaurus Property-4)
    C1299586 (UMLS 2011AA Property-4)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.28
    Code List
    I have trouble walking because of pain
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have gained weight
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C62754 (NCI Thesaurus Property-2)
    C0043094 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.30
    Code List
    I have gained weight
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
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