ID

33132

Description

ADVANCED PROSTATE CANCER DATA COLLECTION Version 2.3.1 Revised: April 10th, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Conditions: All patients with advanced prostate cancer, either having metastatic disease or biochemical recurrence progressing after salvage treatment or ineligible for salvage treatment. Patients with biochemical recurrence treated with salvage therapy are referred to the localized prostate cancer set. Treatment Approaches: Hormonal Therapy | Chemotherapy | Immunotherapy | Radiopharmaceuticals | Radiation | Interventions for Complications of Local Progression This form contains patient-reported variables, to be assessed at baseline. Questionnaires used in this form: Expanded Prostate Cancer Index Composite (EPIC-26): The EPIC-26 is free for all health care organizations, and a license is not needed. The scoring guide may be found at http://www.med.umich.edu/urology/research/EPIC/EPIC-26-Scoring-1.2007.pdf ; Wei J, Dunn R, Litwin M, Sandler H, and Sanda M. "Development and Validation of the Expanded Prostate Cancer Index Composite (EPIC) for Comprehensive Assessment of Health-Related Quality of Life in Men with Prostate Cancer", Urology. 56: 899-905, 2000. For registries choosing to implement the EPIC‐CP rather than the EPIC‐26, we recommend using the same variable IDs as the corresponding EPIC‐26 questions. This means that only questions 2, 3, 4a, 4b, 4d, 4e, 5, 6e, 6b, 7, 8b, 9, 12, 13a, 13c, and 13d of the EPIC-26 are administered. Utilization of Sexual Medications/Devices: The Utilization of Sexual Medications/Devices is free for all health care organizations, and a license is not needed (according to ICHOM). Refer to http://dx.doi.org/10.1016/j.urology.2006.01.077 for more information European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): For use of the EORTC QLQ-C30 a license is needed, therefore the questions will not be part of this version of the standard set. (eortc.be) The following paper has been published about development of this standard set: Morgans AK, van Bommel ACM, Stowell C, Abrahm JL, Basch E, Bekelman JE, et al. Development of a Standardized Set of Patient-centered Outcomes for Advanced Prostate Cancer: An International Effort for a Unified Approach. Eur Urol. 2015 Nov;68(5):891–8. For the standard set ICHOM has been supported by the Movember Foundation.

Link

http://www.ichom.org/

Keywords

Versions (4)
  1. 12/7/17 12/7/17 -
  2. 11/29/18 11/29/18 - Sarah Riepenhausen
  3. 11/29/18 11/29/18 - Sarah Riepenhausen
  4. 4/30/20 4/30/20 - Sarah Riepenhausen
Copyright Holder

ICHOM

Uploaded on

November 29, 2018

DOI

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License

Creative Commons BY-NC 3.0
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ICHOM Advanced Prostate Cancer

English

Baseline Patient-reported Form

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Description

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Data type

integer

Alias
UMLS CUI [1]
C1269815
Demographic factors
Description

Demographic factors

Alias
UMLS CUI-1
C1704791
What is your date of birth?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical or patient-reported TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0421451
DD/MM/YYYY
What is your height in centimeters or inches?
Description

Height and weight are used to calculate BMI INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Numerical value RESPONSE OPTIONS: Numerical value of height in cm or in

Data type

float

Alias
UMLS CUI [1]
C0005890
Indicate units of height
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C1519795
What is your weight in kilograms or pounds?
Description

Height and weight are used to calculate BMI INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Numerical value RESPONSE OPTIONS: Numerical value of weight in kg or lbs

Data type

float

Alias
UMLS CUI [1]
C0005910
Indicate units of weight
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C1519795
What is your ethnicity (Select all that apply) American Indian or Alaska Native
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C1515945
What is your ethnicity (Select all that apply) Asian
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C0078988
What is your ethnicity (Select all that apply) Black or African American
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C0005680
UMLS CUI [2,1]
C0015031
UMLS CUI [2,2]
C0085756
What is your ethnicity (Select all that apply) Hispanic or Latino
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C0086409
UMLS CUI [2,1]
C0015031
UMLS CUI [2,2]
C0086528
What is your ethnicity (Select all that apply) Native Hawaiian or Other Pacific Islander
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C1513907
What is your ethnicity (Select all that apply) White
Description

Varies by country and should be determined by country (not for cross country comparison). This is based upon the U.S. Standards for the Classification of Federal Data on Race and Ethnicity, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer (https://ichom.co1.qualtrics.com/jfe/form/SV_8AhYQGQKZE2tRwV?Q_JFE=qdg linked in Reference Guide it is multiple answer)

Data type

boolean

Alias
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C0007457
Please indicate highest level of schooling completed
Description

The level of schooling is defined in each country as per ISCED [International Standard Classification] INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0013658
What is your relationship status?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0024819
Which statement best describes your living arrangements?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C2184149
Baseline Clinical Factors
Description

Baseline Clinical Factors

Alias
UMLS CUI-1
C0449440
UMLS CUI-2
C1442488
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0549184
Have you been told by a doctor that you have any of the following? 1 = Heart disease (For example, angina, heart attack, or heart failure)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0018799
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0020538
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0085096
UMLS CUI [1,2]
C0009488
Have you been told by a doctor that you have any of the following? 4 = Lung disease (For example, asthma, chronic bronchitis, or emphysema)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0024115
Have you been told by a doctor that you have any of the following? 5 = Diabetes
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011849
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0022658
Have you been told by a doctor that you have any of the following? 7 = Liver disease
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0023895
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0038454
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (For example, Parkinson’s disease or multiple sclerosis)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0027765
Have you been told by a doctor that you have any of the following? 10 = Other cancer (within the last 5 years)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C1707251
Have you been told by a doctor that you have any of the following? 11 = Depression
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011581
Have you been told by a doctor that you have any of the following? 12 = Arthritis
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer (Separate multiple entries with "";"")

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0003864
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average pain over the last 7 days?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Numerical value RESPONSE OPTIONS: Ordinal values from 0 to 10, with 'No pain' marked at '0' and 'Worst pain imaginable' marked at '10'

Data type

integer

Alias
UMLS CUI [1]
C0582148
Do you have a first degree relative (father, brother, son) with a prostate cancer diagnosis?
Description

A first degree relative is a father, brother, or son INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1532320
Degree of health
Description

Degree of health

Alias
UMLS CUI-1
C0018759
Do you take pain medication? 0 = No
Description

Over the counter pain medicine is for example paracetamol, NSAIDS INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0002771
UMLS CUI [1,2]
C1298908
Do you take pain medication? 1 = Yes, over the counter or non-prescription pain medication
Description

Over the counter pain medicine is for example paracetamol, NSAIDS INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0002771
UMLS CUI [1,2]
C0013231
UMLS CUI [2,1]
C0002771
UMLS CUI [2,2]
C2709201
Do you take pain medication? 2 = Yes, prescription pain medications (opioid or narcotic medications)
Description

Over the counter pain medicine is for example paracetamol, NSAIDS INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0002771
UMLS CUI [1,2]
C0304227
UMLS CUI [2]
C0027409
UMLS CUI [3]
C0002772
EORTC QLQ-C30 Total Score
Description

As a license is needed for use of this questionnaire, the 30 actual questions are not included in this version of the standard set. ICHOM IDs are EORTCQLQC30_Q01 up to EORTCQLQC30_Q30. INCLUSION CRITERIA: All patients TIMING: Baseline, 30 days + annually up to 5 years after index event REPORTING SOURCE: Patient-reported TYPE: Numerical (each question is single answer in original set)

Data type

integer

Alias
UMLS CUI [1,1]
C4055104
UMLS CUI [1,2]
C2964552
This questionnaire is designed to measure Quality of Life issues in patients with Prostate cancer. To help us get the most accurate measurement, it is important that you answer all questions honestly and completely. Remember, as with all medical records, information contained within this survey will remain strictly confidential. 1: Over the past 4 weeks, how often have you leaked urine?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289637
2: Which of the following best describes your urinary control during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289645
3: How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289630
4a: How big a problem, if any, has the following been for you during the last 4 weeks? Dripping or leaking urine
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289641
4b: Pain or burning on urination
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289629
4c: Bleeding with urination
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289644
4d: Weak urine stream or incomplete emptying
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289625
4e: Need to urinate frequently during the day
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289626
5: Overall, how big a problem has your urinary function been for you during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289631
6a: How big a problem, if any, has the following been for you? Urgency to have a bowel movement
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289627
6b: Increased frequency of bowel movements
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289636
6c: Losing control of your stools
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289634
6d: Bloody stools
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4287870
6e: Abdominal/Pelvic/Rectal pain
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289649
7: Overall, how big a problem have your bowel habits been for you during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289633
8a: How would you rate the following during the last 4 weeks? Your ability to have an erection?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289647
8b: Your ability to reach orgasm (climax)?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289646
9: How would you describe the usual QUALITY of your erections during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289628
10: How would you describe the FREQUENCY of your erections during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289639
11: Overall, how would you rate your ability to function sexually during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289648
12: Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289632
13a: How big a problem during the last 4 weeks, if any, has the following been for you? Hot flashes
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289638
13b: Breast tenderness/enlargement
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289643
13c: Feeling depressed
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289640
13d: Lack of energy
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289635
13e: Change in body weight
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C4289642
During the last 4 weeks, to what extent were you interested in sex?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C3899191
Have you used any medications or devices to aid or improve erections?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C3827672
For each of the following medicines or devices, please indicate whether or not you have tried or currently use it to improve your erections: Viagra or another pill
Description

INCLUSION CRITERIA: All patients, If answered 'yes' to using medications or devices to aid or improve erections (LIBID_Q02) TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0663448
Muse (intra-urethral alprostadil suppository)
Description

INCLUSION CRITERIA: All patients, If answered 'yes' to using medications or devices to aid or improve erections (LIBID_Q02) TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C2366566
Penile injection therapy (such as caverject)
Description

INCLUSION CRITERIA: All patients, If answered 'yes' to using medications or devices to aid or improve erections (LIBID_Q02) TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C3828613
Vacuum erection device (such as erect-aid)
Description

INCLUSION CRITERIA: All patients, If answered 'yes' to using medications or devices to aid or improve erections (LIBID_Q02) TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C3827672
Other medication/device
Description

INCLUSION CRITERIA: All patients, If answered 'yes' to using medications or devices to aid or improve erections (LIBID_Q02) TIMING: Baseline, 3 months post initiation of treatment, 6 months post initiation of treatment, 1 year post initiation of treatment, Tracked ongoing annually for life REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1115771
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Similar models

Baseline Patient-reported Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Item Group
Demographic factors
C1704791 (UMLS CUI-1)
Date of birth
Item
What is your date of birth?
date
C0421451 (UMLS CUI [1])
Height
Item
What is your height in centimeters or inches?
float
C0005890 (UMLS CUI [1])
Item
Indicate units of height
integer
C0005890 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Height units
Code List
Indicate units of height
CL Item
centimeters (1)
C0475210 (UMLS CUI-1)
(Comment:en)
CL Item
inches (2)
C0439204 (UMLS CUI-1)
(Comment:en)
Weight
Item
What is your weight in kilograms or pounds?
float
C0005910 (UMLS CUI [1])
Item
Indicate units of weight
integer
C0005910 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Pathological tumor stage
Code List
Indicate units of weight
CL Item
kilograms (1)
C0439209 (UMLS CUI-1)
(Comment:en)
CL Item
pounds (2)
C0439219 (UMLS CUI-1)
(Comment:en)
Ethnicity: American Indian of Alaska Native
Item
What is your ethnicity (Select all that apply) American Indian or Alaska Native
boolean
C0015031 (UMLS CUI [1,1])
C1515945 (UMLS CUI [1,2])
Ethnicity: Asian
Item
What is your ethnicity (Select all that apply) Asian
boolean
C0015031 (UMLS CUI [1,1])
C0078988 (UMLS CUI [1,2])
Ethnicity: Black or African American
Item
What is your ethnicity (Select all that apply) Black or African American
boolean
C0015031 (UMLS CUI [1,1])
C0005680 (UMLS CUI [1,2])
C0015031 (UMLS CUI [2,1])
C0085756 (UMLS CUI [2,2])
Ethnicity: Hispanic or Latino
Item
What is your ethnicity (Select all that apply) Hispanic or Latino
boolean
C0015031 (UMLS CUI [1,1])
C0086409 (UMLS CUI [1,2])
C0015031 (UMLS CUI [2,1])
C0086528 (UMLS CUI [2,2])
Ethnicity: Native Hawaiian or Other Pacific Islander
Item
What is your ethnicity (Select all that apply) Native Hawaiian or Other Pacific Islander
boolean
C0015031 (UMLS CUI [1,1])
C1513907 (UMLS CUI [1,2])
Ethnicity: White
Item
What is your ethnicity (Select all that apply) White
boolean
C0015031 (UMLS CUI [1,1])
C0007457 (UMLS CUI [1,2])
Item
Please indicate highest level of schooling completed
integer
C0013658 (UMLS CUI [1])
Site of metastatic disease
Code List
Please indicate highest level of schooling completed
CL Item
None (0)
C0557286 (UMLS CUI-1)
(Comment:en)
CL Item
Primary (1)
C0013658 (UMLS CUI-1)
C0033145 (UMLS CUI-2)
(Comment:en)
CL Item
Secondary (2)
C0557289 (UMLS CUI-1)
(Comment:en)
CL Item
Tertiary  (3)
C0557291 (UMLS CUI-1)
(Comment:en)
Item
What is your relationship status?
integer
C0024819 (UMLS CUI [1])
Extent of metastatic disease
Code List
What is your relationship status?
CL Item
Never married/ partnered (0)
C0027952 (UMLS CUI-1)
C1546497 (UMLS CUI-2)
C2003901 (UMLS CUI-3)
(Comment:en)
CL Item
Married/partnered (1)
C0555047 (UMLS CUI-1)
C0682323 (UMLS CUI-2)
(Comment:en)
CL Item
Divorced/separated (2)
C0682073 (UMLS CUI-1)
(Comment:en)
CL Item
Widowed (3)
C0206275 (UMLS CUI-1)
(Comment:en)
Item
Which statement best describes your living arrangements?
integer
C2184149 (UMLS CUI [1])
Prior radiation therapy: Primary treatment
Code List
Which statement best describes your living arrangements?
CL Item
I live with partner/spouse/family/friends (1)
C1443355 (UMLS CUI-1)
C2184147 (UMLS CUI-2)
C0557130 (UMLS CUI-3)
C0557128 (UMLS CUI-4)
(Comment:en)
CL Item
I live alone (2)
C0439044 (UMLS CUI-1)
(Comment:en)
CL Item
I live in a nursing home, hospital or other long term care home (3)
C0425205 (UMLS CUI-1)
C0557218 (UMLS CUI-2)
C3640869 (UMLS CUI-3)
(Comment:en)
CL Item
Other (888)
C0205394 (UMLS CUI-1)
C0237096 (UMLS CUI-2)
(Comment:en)
Item Group
Baseline Clinical Factors
C0449440 (UMLS CUI-1)
C1442488 (UMLS CUI-2)
Comorbidities: None
Item
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
boolean
C0009488 (UMLS CUI [1,1])
C0549184 (UMLS CUI [1,2])
Comorbidities: Heart Disease
Item
Have you been told by a doctor that you have any of the following? 1 = Heart disease (For example, angina, heart attack, or heart failure)
boolean
C0009488 (UMLS CUI [1,1])
C0018799 (UMLS CUI [1,2])
Comorbidities: Hypertension
Item
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
boolean
C0009488 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Comorbidities: Peripheral vascular disease
Item
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
boolean
C0085096 (UMLS CUI [1,1])
C0009488 (UMLS CUI [1,2])
Comorbidities: Lung Disease
Item
Have you been told by a doctor that you have any of the following? 4 = Lung disease (For example, asthma, chronic bronchitis, or emphysema)
boolean
C0009488 (UMLS CUI [1,1])
C0024115 (UMLS CUI [1,2])
Comorbidities: Diabetes
Item
Have you been told by a doctor that you have any of the following? 5 = Diabetes
boolean
C0009488 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
Comorbidities: Kidney Disease
Item
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
boolean
C0009488 (UMLS CUI [1,1])
C0022658 (UMLS CUI [1,2])
Comorbidities: Liver Diseases
Item
Have you been told by a doctor that you have any of the following? 7 = Liver disease
boolean
C0009488 (UMLS CUI [1,1])
C0023895 (UMLS CUI [1,2])
Comorbidities: Stroke
Item
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
boolean
C0009488 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
Comorbidities: Nervous System Disorder
Item
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (For example, Parkinson’s disease or multiple sclerosis)
boolean
C0009488 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
Comorbidities: Other Cancer
Item
Have you been told by a doctor that you have any of the following? 10 = Other cancer (within the last 5 years)
boolean
C0009488 (UMLS CUI [1,1])
C1707251 (UMLS CUI [1,2])
Comorbidities: Depression
Item
Have you been told by a doctor that you have any of the following? 11 = Depression
boolean
C0009488 (UMLS CUI [1,1])
C0011581 (UMLS CUI [1,2])
Comorbidities: Arthritis
Item
Have you been told by a doctor that you have any of the following? 12 = Arthritis
boolean
C0009488 (UMLS CUI [1,1])
C0003864 (UMLS CUI [1,2])
Pain score
Item
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average pain over the last 7 days?
integer
C0582148 (UMLS CUI [1])
Item
Do you have a first degree relative (father, brother, son) with a prostate cancer diagnosis?
integer
C1532320 (UMLS CUI [1])
Pathological nodal stage
Code List
Do you have a first degree relative (father, brother, son) with a prostate cancer diagnosis?
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item Group
Degree of health
C0018759 (UMLS CUI-1)
Pain medication use: No
Item
Do you take pain medication? 0 = No
boolean
C0002771 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
Pain medication use: Over the counter or non-prescription
Item
Do you take pain medication? 1 = Yes, over the counter or non-prescription pain medication
boolean
C0002771 (UMLS CUI [1,1])
C0013231 (UMLS CUI [1,2])
C0002771 (UMLS CUI [2,1])
C2709201 (UMLS CUI [2,2])
Pain medication use: Prescription, Opioid or narcotic
Item
Do you take pain medication? 2 = Yes, prescription pain medications (opioid or narcotic medications)
boolean
C0002771 (UMLS CUI [1,1])
C0304227 (UMLS CUI [1,2])
C0027409 (UMLS CUI [2])
C0002772 (UMLS CUI [3])
EORTC QLQ-C30 Total Score
Item
EORTC QLQ-C30 Total Score
integer
C4055104 (UMLS CUI [1,1])
C2964552 (UMLS CUI [1,2])
Item
This questionnaire is designed to measure Quality of Life issues in patients with Prostate cancer. To help us get the most accurate measurement, it is important that you answer all questions honestly and completely. Remember, as with all medical records, information contained within this survey will remain strictly confidential. 1: Over the past 4 weeks, how often have you leaked urine?
integer
C4289637 (UMLS CUI [1])
Question 1 of EORTC-QLQ-C30
Code List
This questionnaire is designed to measure Quality of Life issues in patients with Prostate cancer. To help us get the most accurate measurement, it is important that you answer all questions honestly and completely. Remember, as with all medical records, information contained within this survey will remain strictly confidential. 1: Over the past 4 weeks, how often have you leaked urine?
CL Item
More than once a day (1)
C3853132 (UMLS CUI-1)
(Comment:en)
CL Item
About once a day (2)
C3843680 (UMLS CUI-1)
(Comment:en)
CL Item
More than once a week (3)
C0439093 (UMLS CUI-1)
C0558293 (UMLS CUI-2)
(Comment:en)
CL Item
About once a week (4)
C3900130 (UMLS CUI-1)
(Comment:en)
CL Item
Rarely or never (5)
C3843074 (UMLS CUI-1)
C2003901 (UMLS CUI-2)
(Comment:en)
Item
2: Which of the following best describes your urinary control during the last 4 weeks?
integer
C4289645 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
2: Which of the following best describes your urinary control during the last 4 weeks?
CL Item
No urinary control whatsoever (1)
C4528708 (UMLS CUI-1)
(Comment:en)
CL Item
Frequent dribbling (2)
C4527381 (UMLS CUI-1)
(Comment:en)
CL Item
Occasional dribbling (3)
C4527382 (UMLS CUI-1)
(Comment:en)
CL Item
Total control (4)
C4527383 (UMLS CUI-1)
(Comment:en)
Item
3: How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks?
integer
C4289630 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
3: How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks?
CL Item
1 pad per day (1)
C4527378 (UMLS CUI-1)
(Comment:en)
CL Item
2 pads per day (2)
C4527379 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more pads per day (3)
C4527380 (UMLS CUI-1)
(Comment:en)
CL Item
None (0)
C0549184 (UMLS CUI-1)
(Comment:en)
Item
4a: How big a problem, if any, has the following been for you during the last 4 weeks? Dripping or leaking urine
integer
C4289641 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
4a: How big a problem, if any, has the following been for you during the last 4 weeks? Dripping or leaking urine
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
4b: Pain or burning on urination
integer
C4289629 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
4b: Pain or burning on urination
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
4c: Bleeding with urination
integer
C4289644 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
4c: Bleeding with urination
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
4d: Weak urine stream or incomplete emptying
integer
C4289625 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
4d: Weak urine stream or incomplete emptying
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
4e: Need to urinate frequently during the day
integer
C4289626 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
4e: Need to urinate frequently during the day
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
5: Overall, how big a problem has your urinary function been for you during the last 4 weeks?
integer
C4289631 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
5: Overall, how big a problem has your urinary function been for you during the last 4 weeks?
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
6a: How big a problem, if any, has the following been for you? Urgency to have a bowel movement
integer
C4289627 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
6a: How big a problem, if any, has the following been for you? Urgency to have a bowel movement
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
6b: Increased frequency of bowel movements
integer
C4289636 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
6b: Increased frequency of bowel movements
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
6c: Losing control of your stools
integer
C4289634 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
6c: Losing control of your stools
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
6d: Bloody stools
integer
C4287870 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
6d: Bloody stools
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
6e: Abdominal/Pelvic/Rectal pain
integer
C4289649 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
6e: Abdominal/Pelvic/Rectal pain
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
7: Overall, how big a problem have your bowel habits been for you during the last 4 weeks?
integer
C4289633 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
7: Overall, how big a problem have your bowel habits been for you during the last 4 weeks?
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
8a: How would you rate the following during the last 4 weeks? Your ability to have an erection?
integer
C4289647 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
8a: How would you rate the following during the last 4 weeks? Your ability to have an erection?
CL Item
Very poor to none (1)
C3641766 (UMLS CUI-1)
C0549184 (UMLS CUI-2)
(Comment:en)
CL Item
Poor (2)
C2700379 (UMLS CUI-1)
(Comment:en)
CL Item
Fair (3)
C2911689 (UMLS CUI-1)
(Comment:en)
CL Item
Good (4)
C0205170 (UMLS CUI-1)
(Comment:en)
CL Item
Very good (5)
C3641222 (UMLS CUI-1)
(Comment:en)
Item
8b: Your ability to reach orgasm (climax)?
integer
C4289646 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
8b: Your ability to reach orgasm (climax)?
CL Item
Very poor to none (1)
C3641766 (UMLS CUI-1)
C0549184 (UMLS CUI-2)
(Comment:en)
CL Item
Poor (2)
C2700379 (UMLS CUI-1)
(Comment:en)
CL Item
Fair (3)
C2911689 (UMLS CUI-1)
(Comment:en)
CL Item
Good (4)
C0205170 (UMLS CUI-1)
(Comment:en)
CL Item
Very good (5)
C3641222 (UMLS CUI-1)
(Comment:en)
Item
9: How would you describe the usual QUALITY of your erections during the last 4 weeks?
integer
C4289628 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
9: How would you describe the usual QUALITY of your erections during the last 4 weeks?
CL Item
None at all (1)
C0549184 (UMLS CUI-1)
(Comment:en)
CL Item
Not firm enough for any sexual activity (2)
C3828773 (UMLS CUI-1)
(Comment:en)
CL Item
Firm enough for masturbation and foreplay only (3)
C3830112 (UMLS CUI-1)
(Comment:en)
CL Item
Firm enough for intercourse (4)
C3830113 (UMLS CUI-1)
(Comment:en)
Item
10: How would you describe the FREQUENCY of your erections during the last 4 weeks?
integer
C4289639 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
10: How would you describe the FREQUENCY of your erections during the last 4 weeks?
CL Item
I NEVER had an erection when I wanted one (1)
C4527372 (UMLS CUI-1)
(Comment:en)
CL Item
I had an erection LESS THAN HALF the time I wanted one (2)
C4527373 (UMLS CUI-1)
(Comment:en)
CL Item
I had an erection ABOUT HALF the time I wanted one (3)
C4527374 (UMLS CUI-1)
(Comment:en)
CL Item
I had an erection MORE THAN HALF the time I wanted one (4)
C4527375 (UMLS CUI-1)
(Comment:en)
CL Item
I had an erection WHENEVER I wanted one (5)
C4527376 (UMLS CUI-1)
(Comment:en)
Item
11: Overall, how would you rate your ability to function sexually during the last 4 weeks?
integer
C4289648 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
11: Overall, how would you rate your ability to function sexually during the last 4 weeks?
CL Item
Very poor (1)
C3641766 (UMLS CUI-1)
(Comment:en)
CL Item
Poor (2)
C2700379 (UMLS CUI-1)
(Comment:en)
CL Item
Fair (3)
C2911689 (UMLS CUI-1)
(Comment:en)
CL Item
Good (4)
C0205170 (UMLS CUI-1)
(Comment:en)
CL Item
Very good (5)
C3641222 (UMLS CUI-1)
(Comment:en)
Item
12: Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks?
integer
C4289632 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
12: Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks?
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
13a: How big a problem during the last 4 weeks, if any, has the following been for you? Hot flashes
integer
C4289638 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
13a: How big a problem during the last 4 weeks, if any, has the following been for you? Hot flashes
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
13b: Breast tenderness/enlargement
integer
C4289643 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
13b: Breast tenderness/enlargement
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
13c: Feeling depressed
integer
C4289640 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
13c: Feeling depressed
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
13d: Lack of energy
integer
C4289635 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
13d: Lack of energy
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
13e: Change in body weight
integer
C4289642 (UMLS CUI [1])
Question 2 of EPIC-26
Code List
13e: Change in body weight
CL Item
Very small problem (1)
C0033213 (UMLS CUI-1)
C0442811 (UMLS CUI-2)
(Comment:en)
CL Item
Small problem (2)
C0033213 (UMLS CUI-1)
C0700321 (UMLS CUI-2)
(Comment:en)
CL Item
Moderate problem (3)
C0033213 (UMLS CUI-1)
C0205081 (UMLS CUI-2)
(Comment:en)
CL Item
No problem (0)
C0033213 (UMLS CUI-1)
C1298908 (UMLS CUI-2)
(Comment:en)
CL Item
Big problem (4)
C0033213 (UMLS CUI-1)
C0549177 (UMLS CUI-2)
(Comment:en)
Item
During the last 4 weeks, to what extent were you interested in sex?
integer
C3899191 (UMLS CUI [1])
Question 1 of additional libido and use of sexual aids questions
Code List
During the last 4 weeks, to what extent were you interested in sex?
CL Item
Not at all (0)
C2984077 (UMLS CUI-1)
(Comment:en)
CL Item
A little (1)
C2984078 (UMLS CUI-1)
(Comment:en)
CL Item
Quite a bit (2)
C2984080 (UMLS CUI-1)
(Comment:en)
CL Item
Very much (3)
C2984081 (UMLS CUI-1)
(Comment:en)
Item
Have you used any medications or devices to aid or improve erections?
integer
C3827672 (UMLS CUI [1])
Question 2 of additional libido and use of sexual aids questions
Code List
Have you used any medications or devices to aid or improve erections?
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
For each of the following medicines or devices, please indicate whether or not you have tried or currently use it to improve your erections: Viagra or another pill
integer
C0663448 (UMLS CUI [1])
Question 3a of additional libido and use of sexual aids questions
Code List
For each of the following medicines or devices, please indicate whether or not you have tried or currently use it to improve your erections: Viagra or another pill
CL Item
Have not tried it (0)
C3844323 (UMLS CUI-1)
(Comment:en)
CL Item
Tried it but was not helpful (1)
C3827771 (UMLS CUI-1)
(Comment:en)
CL Item
It helped but I am not using it now (2)
C3829718 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it sometimes (3)
C3829719 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it always (4)
C3829720 (UMLS CUI-1)
(Comment:en)
Item
Muse (intra-urethral alprostadil suppository)
integer
C2366566 (UMLS CUI [1])
Question 3a of additional libido and use of sexual aids questions
Code List
Muse (intra-urethral alprostadil suppository)
CL Item
Have not tried it (0)
C3844323 (UMLS CUI-1)
(Comment:en)
CL Item
Tried it but was not helpful (1)
C3827771 (UMLS CUI-1)
(Comment:en)
CL Item
It helped but I am not using it now (2)
C3829718 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it sometimes (3)
C3829719 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it always (4)
C3829720 (UMLS CUI-1)
(Comment:en)
Item
Penile injection therapy (such as caverject)
integer
C3828613 (UMLS CUI [1])
Question 3a of additional libido and use of sexual aids questions
Code List
Penile injection therapy (such as caverject)
CL Item
Have not tried it (0)
C3844323 (UMLS CUI-1)
(Comment:en)
CL Item
Tried it but was not helpful (1)
C3827771 (UMLS CUI-1)
(Comment:en)
CL Item
It helped but I am not using it now (2)
C3829718 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it sometimes (3)
C3829719 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it always (4)
C3829720 (UMLS CUI-1)
(Comment:en)
Item
Vacuum erection device (such as erect-aid)
integer
C3827672 (UMLS CUI [1])
Question 3a of additional libido and use of sexual aids questions
Code List
Vacuum erection device (such as erect-aid)
CL Item
Have not tried it (0)
C3844323 (UMLS CUI-1)
(Comment:en)
CL Item
Tried it but was not helpful (1)
C3827771 (UMLS CUI-1)
(Comment:en)
CL Item
It helped but I am not using it now (2)
C3829718 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it sometimes (3)
C3829719 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it always (4)
C3829720 (UMLS CUI-1)
(Comment:en)
Item
Other medication/device
integer
C1115771 (UMLS CUI [1])
Question 3a of additional libido and use of sexual aids questions
Code List
Other medication/device
CL Item
Have not tried it (0)
C3844323 (UMLS CUI-1)
(Comment:en)
CL Item
Tried it but was not helpful (1)
C3827771 (UMLS CUI-1)
(Comment:en)
CL Item
It helped but I am not using it now (2)
C3829718 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it sometimes (3)
C3829719 (UMLS CUI-1)
(Comment:en)
CL Item
It helped and I use it always (4)
C3829720 (UMLS CUI-1)
(Comment:en)
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