Description:

RTOG-0522 FA: FACT (Function Assessment Cancer Therapy) NCT00265941 Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F60B771F-164B-2C87-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F60B771F-164B-2C87-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 6/21/15
Uploaded on:

June 21, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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RTOG-0522 FA: FACT (Function Assessment Cancer Therapy) NCT00265941

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  1. StudyEvent: RTOG-0522 FA: FACT (Function Assessment Cancer Therapy)
    1. No Instruction available.
RTOG clinical trial administrative data
AMENDED DATA
Physical Well-being
I have a lack of energy
I have nausea
Because of my physical condition, I have trouble meeting the needs of my family
I have pain
I am bothered by side effects of treatment
I feel ill
I am forced to spend time in bed
Social/family Well-being
I feel close to my friends
I get emotional support from my family
I get support from my friends
My family has accepted my illness
I am satisfied with family communication about my illness
I feel close to my partner (or the person who is my main support)
I am satisfied with my sex life
Emotional Well-being
I feel sad
I am satisfied with how I am coping with my illness
I am losing hope in the fight against my illness
I feel nervous
I worry about dying
I worry that my condition will get worse
Functional Well-being
I am able to work (include work at home)
My work is fulfilling (include work at home)
I am able to enjoy life
I have accepted my illness
I am sleeping well
I am enjoying the things I usually do for fun
I am content with the quality of my life right now
Additional Concerns
I am able to eat the foods that I like
My mouth is dry
I have trouble breathing
My voice has its usual quality and strength
I am able to eat as much food as I want
I am unhappy with how my face and neck look
I can swallow naturally and easily
I smoke cigarettes or other tobacco products
I drink alcohol (e.g. beer, wine, etc.)
I am able to communicate with others
I can eat solid foods
I have pain in my mouth, throat or neck

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