ID

1191

Description

Quality of Life Supplement (Form 24-QLS) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA67FC-7593-635E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA67FC-7593-635E-E034-0003BA12F5E7

Keywords

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

August 27, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00659373 Quality of Life - Quality of Life Supplement (Form 24-QLS) - 2073782v3.0

QUALITY OF LIFE SUPPLEMENT (Form 24-QLS) Patient Instructions: The following questions ask your feelings during the past week. For each of the following statements, mark an ?X? in the box that best describes the way you felt.

Ccrr Module For Quality Of Life Supplement (form 24-qls)
Description

Ccrr Module For Quality Of Life Supplement (form 24-qls)

Patient ID Number (Study No.)
Description

PatientStudyID,CoordinatingGroup

Data type

text

Patient Initials (f m fl sl)
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Patient's Date of Birth (day)
Description

PatientBirthDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Participating Center/Affiliate
Description

MainMemberInstitution/Affiliate

Data type

text

Center Code (During the past week:)
Description

ParticipatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
I was bothered by things that usually don?t bother me
Description

Iwasbotheredbythingsthatusuallydon?tbothermeQualityofLifeDayFrequency

Data type

text

Alias
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I did not feel like eating; my appetite was poor
Description

QualityofLifePoorAppetiteAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77959
UMLS 2011AA Property
C2700379
NCI Thesaurus Property
C25152
UMLS 2011AA Property
C0003618
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt that I could not shake off the blues even with the help of my family and friends
Description

QualityofLifeMildPersistentDepressionAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C70666
UMLS 2011AA Property
C2945599
NCI Thesaurus Property
C2982
UMLS 2011AA Property
C0011570
NCI Thesaurus Property
C43623
UMLS 2011AA Property
C0205322
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt that I was just as good as other people
Description

QualityofLifeEqualityAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C61582
UMLS 2011AA Property
C0205163
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I had trouble keeping my mind on what I was doing
Description

QualityofLifeDifficultyAttentionConcentrationAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C62189
UMLS 2011AA Property
C1299586
NCI Thesaurus Property
C41209
UMLS 2011AA Property
C0004268
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt depressed
Description

QualityofLifeDepressionAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C2982
UMLS 2011AA Property
C0011570
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt that everything I did was an effort
Description

QualityofLifeEffortHouseholdActivityAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C53291
UMLS 2011AA Property
C1708387
NCI Thesaurus Property
C74530
UMLS 2011AA Property
C0015264
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt hopeful about the future
Description

QualityofLifeHopeFutureOutlookAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C72885
UMLS 2011AA Property
C0004271
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77962
UMLS 2011AA Property
C0392347
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I thought my life had been a failure
Description

QualityofLIfeLifeFailuareThinkingAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C37987
UMLS 2011AA Property
C0376558
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C25745
UMLS 2011AA Property
C0231174
NCI Thesaurus Property
C54226
UMLS 2011AA Property
C0039869
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt fearful
Description

QualityofLifeFearAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77960
UMLS 2011AA Property
C0015726
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
My sleep was restless
Description

QualityofLifeRestlessnessSleepAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property
C74533
UMLS 2011AA Property
C0085631
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I was happy
Description

QualityofLifeHappinessAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C72670
UMLS 2011AA Property
C0018592
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I talked less than usual
Description

QualityofLifeSpeechReducedAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25640
UMLS 2011AA Property
C0392756
NCI Thesaurus Property
C38025
UMLS 2011AA Property
C0037817
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt lonely
Description

QualityofLifeLonelinessAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C34785
UMLS 2011AA Property
C0023974
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
People were unfriendly
Description

QualityofLifeNegationFriendlyPersonAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77968
UMLS 2011AA Property
C2700214
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I enjoyed life
Description

QualityofLifeJoyAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77961
UMLS 2011AA Property
C0018592
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I had crying spells
Description

QualityofLifeCryingEpisodeAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C77963
UMLS 2011AA Property
C0010399
NCI Thesaurus Property
C75539
UMLS 2011AA Property
C0332189
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt sad
Description

QualityofLifeSadnessAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C74534
UMLS 2011AA Property
C0344315
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I felt that people disliked me
Description

QualityofLifeSocialDiscomfortAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C62650
UMLS 2011AA Property
C0728831
NCI Thesaurus Property
C50535
UMLS 2011AA Property
C0234215
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
I could not get ?going?
Description

QualityofLifeBeginDailyActivityDifficultyAssessmentDayFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C43431
UMLS 2011AA Property
C0441655
NCI Thesaurus Property
C25473
UMLS 2011AA Property
C0332173
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C25431
UMLS 2011AA Property
C0439659
NCI Thesaurus Property
C62189
UMLS 2011AA Property
C1299586
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
How much of a problem was each of the following during the past four (4) weeks?
Description

Howmuchofaproblemwaseachofthefollowingduringthepastfour(4)weeks?

Data type

text

Lack of sexual interest
Description

Lackofsexualinterest

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Unable to relax and enjoy sex
Description

Unabletorelaxandenjoysex

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Difficulty in becoming aroused
Description

Difficultyinbecomingaroused

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Difficulty in having an orgasm
Description

Difficultyinhavinganorgasm

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Pain or discomfort with intercourse
Description

Painordiscomfortwithintercourse

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307

Similar models

QUALITY OF LIFE SUPPLEMENT (Form 24-QLS) Patient Instructions: The following questions ask your feelings during the past week. For each of the following statements, mark an ?X? in the box that best describes the way you felt.

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Quality Of Life Supplement (form 24-qls)
PatientStudyID,CoordinatingGroup
Item
Patient ID Number (Study No.)
text
PatientInitialsName
Item
Patient Initials (f m fl sl)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientBirthDate
Item
Patient's Date of Birth (day)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
MainMemberInstitution/Affiliate
Item
Participating Center/Affiliate
text
ParticipatingGroupCode
Item
Center Code (During the past week:)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Item
I was bothered by things that usually don?t bother me
text
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I was bothered by things that usually don?t bother me
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I did not feel like eating; my appetite was poor
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77959 (NCI Thesaurus Property)
C2700379 (UMLS 2011AA Property)
C25152 (NCI Thesaurus Property)
C0003618 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I did not feel like eating; my appetite was poor
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that I could not shake off the blues even with the help of my family and friends
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C70666 (NCI Thesaurus Property)
C2945599 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property)
C0011570 (UMLS 2011AA Property)
C43623 (NCI Thesaurus Property)
C0205322 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt that I could not shake off the blues even with the help of my family and friends
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that I was just as good as other people
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C61582 (NCI Thesaurus Property)
C0205163 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt that I was just as good as other people
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I had trouble keeping my mind on what I was doing
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property)
C1299586 (UMLS 2011AA Property)
C41209 (NCI Thesaurus Property)
C0004268 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I had trouble keeping my mind on what I was doing
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt depressed
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property)
C0011570 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt depressed
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that everything I did was an effort
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C53291 (NCI Thesaurus Property)
C1708387 (UMLS 2011AA Property)
C74530 (NCI Thesaurus Property)
C0015264 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt that everything I did was an effort
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt hopeful about the future
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72885 (NCI Thesaurus Property)
C0004271 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77962 (NCI Thesaurus Property)
C0392347 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt hopeful about the future
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I thought my life had been a failure
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C37987 (NCI Thesaurus Property)
C0376558 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25745 (NCI Thesaurus Property)
C0231174 (UMLS 2011AA Property)
C54226 (NCI Thesaurus Property)
C0039869 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I thought my life had been a failure
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt fearful
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77960 (NCI Thesaurus Property)
C0015726 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt fearful
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
My sleep was restless
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property)
C0037313 (UMLS 2011AA Property)
C74533 (NCI Thesaurus Property)
C0085631 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
My sleep was restless
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I was happy
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72670 (NCI Thesaurus Property)
C0018592 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I was happy
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I talked less than usual
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25640 (NCI Thesaurus Property)
C0392756 (UMLS 2011AA Property)
C38025 (NCI Thesaurus Property)
C0037817 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I talked less than usual
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt lonely
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C34785 (NCI Thesaurus Property)
C0023974 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt lonely
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
People were unfriendly
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77968 (NCI Thesaurus Property)
C2700214 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
People were unfriendly
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I enjoyed life
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77961 (NCI Thesaurus Property)
C0018592 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I enjoyed life
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I had crying spells
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77963 (NCI Thesaurus Property)
C0010399 (UMLS 2011AA Property)
C75539 (NCI Thesaurus Property)
C0332189 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I had crying spells
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt sad
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C74534 (NCI Thesaurus Property)
C0344315 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt sad
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that people disliked me
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C62650 (NCI Thesaurus Property)
C0728831 (UMLS 2011AA Property)
C50535 (NCI Thesaurus Property)
C0234215 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I felt that people disliked me
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I could not get ?going?
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property)
C1299586 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
I could not get ?going?
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Howmuchofaproblemwaseachofthefollowingduringthepastfour(4)weeks?
Item
How much of a problem was each of the following during the past four (4) weeks?
text
Item
Lack of sexual interest
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Lack of sexual interest
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Unable to relax and enjoy sex
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Unable to relax and enjoy sex
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Difficulty in becoming aroused
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Difficulty in becoming aroused
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Difficulty in having an orgasm
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Difficulty in having an orgasm
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Pain or discomfort with intercourse
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Pain or discomfort with intercourse
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)

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