Description:

RTOG-0421 SS: Radiation Therapy Oncology Group Head & Neck Symptom Index-10 (FHNSI-10) Miscellaneous Patient Assessment Form NCT00113399 Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer That Cannot Be Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB3734B1-A6F3-725D-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB3734B1-A6F3-725D-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-0421 SS: Radiation Therapy Oncology Group Head & Neck Symptom Index-10 (FHNSI-10) Miscellaneous Patient Assessment Form NCT00113399

No Instruction available.

  1. StudyEvent: RTOG-0421 SS: Radiation Therapy Oncology Group Head & Neck Symptom Index-10 (FHNSI-10) Miscellaneous Patient Assessment Form
    1. No Instruction available.
RTOG clinical trial administrative data
Miscellaneous Patient Assessment
I have pain
I have a lack of energy
I can swallow naturally and easily
I have pain in my mouth, throat, or neck
I have trouble breathing
I am able to communicate with others
I have nausea
I can eat solid foods
I worry that my condition will get worse
I am content with the quality of my life right now
I am unhappy with how my face and neck look
My appearance keeps me from participating in activities
I am bothered by an unpleasant odor at the site of my disease
I am bothered by the built-up of secretions in my mouth or neck
I have tingling or numbness in my hands or feet
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