0 Evaluaciones
ID

40544

Descripción

LOCALIZED PROSTATE CANCER DATA COLLECTION Version 2.0.5 Revised: April 7th , 2017 www.ichom.org Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. Conditions: Localized prostate cancer Treatment Approaches: Active Surveillance | Watchful Waiting | Radical Prostatectomy* | External Beam Radiation Therapy* | Androgen Deprivation Therapy (ADT)* | Focal Therapy* | Other* * These should also be collected as salvage treatments where necessary This ODM-file contains Patient-reported Health Status. To be used before treatment, 6 months after treatment and annually up to ten years after treatment. Surveys used: 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). This standard set uses questions 2 and 3 a-e. 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- PR25): The EORTC QLQ-PR25 is free for all health care organizations, but a license is needed for use. Therefore it will not be integrated verbatim in this Version of the questionnaire. This standard set uses only question 50. For more information, please visit http://groups.eortc.be/qol/eortc-qlq-c30 . ICHOM was supported for the Localized Prostate Cancer Standard Set by the Movember Foundation. Publication: Martin NE, Massey L, Stowell C, et al. Defining a standard set of patient-centered outcomes for men with localized prostate cancer. Eur Urol. 2015;67(3):460‐467. doi:10.1016/j.eururo.2014.08.075 For this version of the standard set, semantic annotation with UMLS CUIs has been added.

Link

www.ichom.org

Palabras clave

Versiones (2)
  1. 22/8/18 22/8/18 - Sarah Riepenhausen
  2. 30/4/20 30/4/20 - Sarah Riepenhausen
Titular de derechos de autor

ICHOM

Subido en

30 de abril de 2020

DOI

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Licencia

Creative Commons BY-NC 4.0
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    ICHOM Localized Prostate Cancer

    Inglés

    Patient-Reported Form (Questionnaires)

    1 formularios  
    Patient ID
    Descripción

    Patient ID

    Alias
    UMLS CUI-1
    C1269815
    Indicate the patient's medical record number
    Descripción

    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 TYPE: Numerical RESPONSE OPTIONS: According to institution

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C1269815
    Time Relative to Baseline (e.g. before treatment, 6 months after treatment, 1 year follow-up, ...) for up to 10 years after treatment
    Descripción

    This Item does not exist in the original standard set, instead it is asked to do the following: Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. For example, VARIABLEID_BASE (baseline); VARIABLEID_6MO (6 month follow-up); VARIABLEID_1YR (1 year follow-up), etc.

    Tipo de datos

    text

    Alias
    UMLS CUI [1,1]
    C0439564
    UMLS CUI [1,2]
    C1442488
    EPIC-26
    Descripción

    EPIC-26

    Alias
    UMLS CUI-1
    C4288133
    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?
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    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?
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    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
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    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
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    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?
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    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
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    text

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C4289620
    13d: Lack of energy
    Descripción

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    * 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. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C4289642
    Libido Questions
    Descripción

    Libido Questions

    Alias
    UMLS CUI-1
    C0023618
    UMLS CUI-2
    C0034394
    Question 50 of EORTC-QLQ-PR25
    Descripción

    As a license is required for use of EORTC-QLQ-PR25 neither the acutal question nor the acutal answers will appear in this version of the ICHOM standard set. INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1,1]
    C0451149
    UMLS CUI [1,2]
    C0600139
    UMLS CUI [1,3]
    C3816723
    Have you used any medications or devices to aid or improve erections?
    Descripción

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1,1]
    C0030847
    UMLS CUI [1,2]
    C0013227
    UMLS CUI [2]
    C3880111
    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
    Descripción

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C0663448
    UMLS CUI [2,1]
    C0030847
    UMLS CUI [2,2]
    C0994475
    UMLS CUI [2,3]
    C0205394
    Muse (intra-urethral alprostadil suppository)
    Descripción

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C3237711
    Penile injection therapy (such as caverject)
    Descripción

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1]
    C0403343
    Vacuum erection device (such as erect-aid)
    Descripción

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

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

    INCLUSION CRITERIA: All patients TIMING: Before treatment, 6 months after treatment, Annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

    Tipo de datos

    integer

    Alias
    UMLS CUI [1,1]
    C0030847
    UMLS CUI [1,2]
    C0013227
    UMLS CUI [1,3]
    C0205394
    UMLS CUI [2,1]
    C3880111
    UMLS CUI [2,2]
    C0205394
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    Similar models

    Patient-Reported Form (Questionnaires)

    1 formularios
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Patient ID
    C1269815 (UMLS CUI-1)
    Patient ID
    Item
    Indicate the patient's medical record number
    integer
    C1269815 (UMLS CUI [1])
    Time Relative to Baseline
    Item
    Time Relative to Baseline (e.g. before treatment, 6 months after treatment, 1 year follow-up, ...) for up to 10 years after treatment
    text
    C0439564 (UMLS CUI [1,1])
    C1442488 (UMLS CUI [1,2])
    Item Group
    EPIC-26
    C4288133 (UMLS CUI-1)
    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 EPIC-26*
    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)
    CL Item
    About once a day (2)
    CL Item
    More than once a week (3)
    CL Item
    About once a week (4)
    CL Item
    Rarely or never (5)
    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)
    CL Item
    Frequent dribbling (2)
    CL Item
    Occasional dribbling (3)
    CL Item
    Total control (4)
    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 3 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
    None (0)
    CL Item
    1 pad per day (1)
    CL Item
    2 pads per day (2)
    CL Item
    3 or more pads per day (3)
    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 4a 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
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    4b: Pain or burning on urination
    integer
    C4289629 (UMLS CUI [1])
    Question 4b of EPIC-26*
    Code List
    4b: Pain or burning on urination
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    4c: Bleeding with urination
    integer
    C4289644 (UMLS CUI [1])
    Question 4c of EPIC-26*
    Code List
    4c: Bleeding with urination
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    4d: Weak urine stream or incomplete emptying
    integer
    C4289625 (UMLS CUI [1])
    Question 4d of EPIC-26*
    Code List
    4d: Weak urine stream or incomplete emptying
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    4e: Need to urinate frequently during the day
    integer
    C4289626 (UMLS CUI [1])
    Question 4e of EPIC-26*
    Code List
    4e: Need to urinate frequently during the day
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    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 5 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
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    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 6a 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
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    6b: Increased frequency of bowel movements
    integer
    C4289636 (UMLS CUI [1])
    Question 6b of EPIC-26*
    Code List
    6b: Increased frequency of bowel movements
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    6c: Losing control of your stools
    integer
    C4289634 (UMLS CUI [1])
    Question 6c of EPIC-26*
    Code List
    6c: Losing control of your stools
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    6d: Bloody stools
    integer
    C4287870 (UMLS CUI [1])
    Question 6d of EPIC-26*
    Code List
    6d: Bloody stools
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    Item
    6e: Abdominal/Pelvic/Rectal pain
    integer
    C4289649 (UMLS CUI [1])
    Question 6e of EPIC-26*
    Code List
    6e: Abdominal/Pelvic/Rectal pain
    CL Item
    No problem (0)
    CL Item
    Very small problem (1)
    CL Item
    Small problem (2)
    CL Item
    Moderate problem (3)
    CL Item
    Big problem (4)
    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 7 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
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    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 8a 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)
    CL Item
    Poor (2)
    CL Item
    Fair (3)
    CL Item
    Good (4)
    CL Item
    Very good (5)
    Item
    8b: Your ability to reach orgasm (climax)?
    integer
    C4289646 (UMLS CUI [1])
    Question 8b of EPIC-26*
    Code List
    8b: Your ability to reach orgasm (climax)?
    CL Item
    Very poor to none (1)
    CL Item
    Poor (2)
    CL Item
    Fair (3)
    CL Item
    Good (4)
    CL Item
    Very good (5)
    Item
    9: How would you describe the usual QUALITY of your erections during the last 4 weeks?
    integer
    C4289628 (UMLS CUI [1])
    Question 9 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)
    CL Item
    Not firm enough for any sexual activity (2)
    CL Item
    Firm enough for masturbation and foreplay only (3)
    CL Item
    Firm enough for intercourse (4)
    Item
    10: How would you describe the FREQUENCY of your erections during the last 4 weeks?
    integer
    C4289639 (UMLS CUI [1])
    Question 10 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)
    CL Item
    I had an erection LESS THAN HALF the time I wanted one (2)
    CL Item
    I had an erection ABOUT HALF the time I wanted one (3)
    CL Item
    I had an erection MORE THAN HALF the time I wanted one (4)
    CL Item
    I had an erection WHENEVER I wanted one (5)
    Item
    11: Overall, how would you rate your ability to function sexually during the last 4 weeks?
    integer
    C4289648 (UMLS CUI [1])
    Question 11 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)
    CL Item
    Poor (2)
    CL Item
    Fair (3)
    CL Item
    Good (4)
    CL Item
    Very good (5)
    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 12 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
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item
    13a: How big a problem during the last 4 weeks, if any, has the following been for you? Hot flashes
    text
    C4289638 (UMLS CUI [1])
    Question 13a 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
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item
    13b: Breast tenderness/enlargement
    integer
    C4289643 (UMLS CUI [1])
    Question 13b of EPIC-26*
    Code List
    13b: Breast tenderness/enlargement
    CL Item
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item
    13c: Feeling depressed
    integer
    C4289620 (UMLS CUI [1])
    Question 13c of EPIC-26*
    Code List
    13c: Feeling depressed
    CL Item
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item
    13d: Lack of energy
    integer
    C4289635 (UMLS CUI [1])
    Question 13d of EPIC-26*
    Code List
    13d: Lack of energy
    CL Item
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item
    13e: Change in body weight
    integer
    C4289642 (UMLS CUI [1])
    Question 13e of EPIC-26*
    Code List
    13e: Change in body weight
    CL Item
    No problem (1)
    CL Item
    Very small problem (2)
    CL Item
    Small problem (3)
    CL Item
    Moderate problem (4)
    CL Item
    Big problem (5)
    Item Group
    Libido Questions
    C0023618 (UMLS CUI-1)
    C0034394 (UMLS CUI-2)
    Item
    Question 50 of EORTC-QLQ-PR25
    integer
    C0451149 (UMLS CUI [1,1])
    C0600139 (UMLS CUI [1,2])
    C3816723 (UMLS CUI [1,3])
    Question 50 of EORTC-PR25
    Code List
    Question 50 of EORTC-QLQ-PR25
    CL Item
    Answer 1 of Question 50 of EORTC-QLQ-PR25 (0)
    (Comment:en)
    CL Item
    Answer 2 of Question 50 of EORTC-QLQ-PR25 (1)
    (Comment:en)
    CL Item
    Answer 3 of Question 50 of EORTC-QLQ-PR25 (2)
    (Comment:en)
    CL Item
    Answer 4 of Question 50 of EORTC-QLQ-PR25 (3)
    (Comment:en)
    Item
    Have you used any medications or devices to aid or improve erections?
    integer
    C0030847 (UMLS CUI [1,1])
    C0013227 (UMLS CUI [1,2])
    C3880111 (UMLS CUI [2])
    Question 2 of Utilization of Sexual Medications/Devices
    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])
    C0030847 (UMLS CUI [2,1])
    C0994475 (UMLS CUI [2,2])
    C0205394 (UMLS CUI [2,3])
    Question 3a of Utilization of Sexual Medications/Devices
    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
    C3237711 (UMLS CUI [1])
    Question 3a of Utilization of Sexual Medications/Devices
    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
    C0403343 (UMLS CUI [1])
    Question 3a of Utilization of Sexual Medications/Devices
    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 Utilization of Sexual Medications/Devices
    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
    C0030847 (UMLS CUI [1,1])
    C0013227 (UMLS CUI [1,2])
    C0205394 (UMLS CUI [1,3])
    C3880111 (UMLS CUI [2,1])
    C0205394 (UMLS CUI [2,2])
    Question 3a of Utilization of Sexual Medications/Devices
    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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