ID

3439

Beskrivning

RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire Higher-Dose Radiation Therapy or Standard Radiation Therapy in Treating Patients With Early-Stage Breast Cancer That Was Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9D7B30AD-FE61-0FB3-E040-BB89AD435271

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9D7B30AD-FE61-0FB3-E040-BB89AD435271

Nyckelord

2012-09-20 2012-09-20 -
2015-01-09 2015-01-09 - Martin Dugas

Uppladdad den

20 september 2012

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy

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NCT01349322 Quality of Life - RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire - 3194282v1.0

model
Detaljer

INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

1 Formulär

StudyEvent: RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire
1. INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

Header Module

Item Group

Unnamed Module 1

ProtocolRTOGIdentifierNumber

Item

RTOG Study No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Item

Case #

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass)
C1514695 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property)
C1706256 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)

InstitutionName

Item

Institution Name

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

InstitutionIdentifierNumber

Item

Institution No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientInitialsName

Item

Patient Initials

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)

PatientRadiationTherapyOncologyGroupIdentifierNumber

Item

RTOG Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

DataAmendedInd-3

Item

Are data amended

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)

CL.1

Code List

Are data amended

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

Unnamed1

Item Group

Unamed Module 2

AssessmentPeriodType

Item

Time point

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)

CL.2

Code List

Time point

CL Item

Pretreatment (Pretreatment)

CL Item

At End Of Rt (At end of RT)

CL Item

1 Month Post Rt Completion (1 month post RT Completion)

CL Item

6 Months Post Rt Completion (6 months post RT Completion)

CL Item

1 Year Post Rt Completion (1 year post RT Completion)

CL Item

2 Years Post Rt Completion (2 years post RT Completion)

CL Item

3 Years Post Rt Completion (3 years post RT Completion)

TreatmentBeginDate

Item

Treatment Start Date

date

C15368 (NCI Thesaurus ObjectClass)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)

PatientQuestionnaireCompleteInd-2

Item

Was patient questionnaire completed

text

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)

CL.3

Code List

Was patient questionnaire completed

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

QualityofLifeCompleteAssessmentDate

Item

Date patient questionnaire completed

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)

PatientIncompleteQuestionnaireReason

Item

Reason Questionnaire was not Completed (PATIENT)

text

C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)

CL.4

Code List

Reason Questionnaire was not Completed (PATIENT)

CL Item

Not Applicable, Questionnaire Was Completed (Not applicable, questionnaire was completed)

CL Item

Patient Refused Due To Illness (Patient refused due to illness)

CL Item

Patient Refused For Other Reason (Patient refused for other reason)

CL Item

Patient Unable To Be Contacted (Patient unable to be contacted)

CL Item

Institution Error (Institutional error)

CL Item

Tool Not Availalble In Patient's Language (Tool not available in patient's language)

CL Item

Other Reason (Other reason)

CL Item

Patient Withdrew Consent Prior/after (Patient withdrew consent prior/after)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PatientRefuseIncompleteQuestionnaireSpecify

Item

Patient refused for other reason, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

PatientIncompleteQuestionnaireOtherSpecify

Item

Other reason, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)

PatientQuestionnaireCompleteMethodofCollectionType

Item

Specify method of completion

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)

CL.5

Code List

Specify method of completion

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

At Appointment (At appointment)

CL Item

By Mail (By mail)

CL Item

By Telephone (By telephone)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PatientQuestionnaireAssistanceInd

Item

Did the patient require any assistance in completing the questionnaire?

text

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)

CL.6

Code List

Did the patient require any assistance in completing the questionnaire?

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

Unknown If Assistance Given (Unknown if assistance given)

PatientQuestionnaireAssistancePersonCategory

Item

Specify the person who assisted the patient

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)

CL.7

Code List

Specify the person who assisted the patient

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

Staff Member (Staff member)

CL Item

Family (Family)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CL Item

Unknown (Unknown)

PatientQuestionnaireAssistancePersonSpecify

Item

Other, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)

PatientQuestionnaireAssistanceType

Item

Extent of the assistance

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)

CL.8

Code List

Extent of the assistance

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

Read Items To Patient (Read items to patient)

CL Item

Interpreted Items For Patient (Interpreted items for patient)

CL Item

Marked Items Per Patient's Response (Marked items per patient's response)

CL Item

Combination Of Above (Combination of above)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PatientQuestionnaireAssistanceCombinedSpecify

Item

Combination of above, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25454 (NCI Thesaurus ValueDomain)
C0205195 (UMLS 2011AA ValueDomain)

PatientQuestionnaireAssistanceOtherSpecify

Item

Other, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)

ResponsiblePersonSignatureText

Item

Signature of Person Completing This Form

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)

FormCompleteDate

Item

Date Form Completed (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)

Difference between treated and untreated breast and area

Item Group

Difference Between Treated And Untreated Breast And Area

BreastReconstructionComparisonSizeAssessmentStatus

Item

Breast size

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.9

Code List

Breast size

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonTextureAssessmentStatus

Item

Breast texture

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C41144 (NCI Thesaurus Property)
C0449582 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.10

Code List

Breast texture

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonArmHeavyAssessmentStatus

Item

Arm heaviness

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C68807 (NCI Thesaurus Property)
C0439539 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.11

Code List

Arm heaviness

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonNippleAssessmentStatus

Item

Nipple appearance

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C12299 (NCI Thesaurus Property)
C0028109 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.12

Code List

Nipple appearance

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonShoulderAssessmentStatus

Item

Should movement

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.13

Code List

Should movement

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonArmAssessmentStatus

Item

Arm movement

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.14

Code List

Arm movement

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonPainAssessmentStatus

Item

Breast pain

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
E11167 (CTCAE Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.15

Code List

Breast pain

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonLiftingAssessmentStatus

Item

Ability to lift objects

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C86567 (NCI Thesaurus Property)
C0206244 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.16

Code List

Ability to lift objects

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonFitShoulderClothingAssessmentStatus

Item

Fit of shirt sleeve

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C70826 (NCI Thesaurus Property)
C2349186 (UMLS 2011AA Property)
C86930 (NCI Thesaurus Property)
C0009072 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.17

Code List

Fit of shirt sleeve

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonTendernessAssessmentStatus

Item

Breast tenderness

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C75540 (NCI Thesaurus Property)
C0234233 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.18

Code List

Breast tenderness

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonShoulderJointStiffnessAssessmentStatus

Item

Shoulder stiffness

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C79603 (NCI Thesaurus Property)
C0162298 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.19

Code List

Shoulder stiffness

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonShapeAssessmentStatus

Item

Breast shape

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25677 (NCI Thesaurus Property)
C0332479 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.20

Code List

Breast shape

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonElevationAssessmentStatus

Item

Breast elevation

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25494 (NCI Thesaurus Property)
C0702240 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.21

Code List

Breast elevation

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonScarAssessmentStatus

Item

Scar tissue

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C34483 (NCI Thesaurus Property)
C2004491 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.22

Code List

Scar tissue

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonShoulderPainAssessmentStatus

Item

Shoulder pain

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.23

Code List

Shoulder pain

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonArmPainAssessmentStatus

Item

Arm pain

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.24

Code List

Arm pain

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonArmSwellingAssessmentStatus

Item

Arm swelling

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.25

Code List

Arm swelling

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonSwellingAssessmentStatus

Item

Breast swelling

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.26

Code List

Breast swelling

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonArmJointStiffnessAssessmentStatus

Item

Arm stiffness

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C79603 (NCI Thesaurus Property)
C0162298 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.27

Code List

Arm stiffness

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonUndergarmentAssessmentStatus

Item

Fit of bra

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C86932 (NCI Thesaurus Property)
C0453880 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.28

Code List

Fit of bra

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonSensitivityAssessmentStatus

Item

Breast sensitivity

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C68816 (NCI Thesaurus Property)
C2349185 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.29

Code List

Breast sensitivity

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

BreastReconstructionComparisonFitClothingAssessmentStatus

Item

Fit of clothing

text

C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C70826 (NCI Thesaurus Property)
C2349186 (UMLS 2011AA Property)
C86930 (NCI Thesaurus Property)
C0009072 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.30

Code List

Fit of clothing

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Slight (Slight)

CL Item

Moderate (Moderate)

C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)

CL Item

Large (Large)

C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)

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NCT01349322 Quality of Life - RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire - 3194282v1.0

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