English

Patient-reported Form (Baseline, 6 months and annually post-treatment)

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
Patient's last name:
Description

The patients' name will not be shared with ICHOM.  INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical

Data type

text

Alias
UMLS CUI [1]
C1299487
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
Description

This Item does not exist in the original standard set. In other standard sets with multiple timepoints the following is requested to do: 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.

Data type

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Degree of health
Description

Degree of health

Over the last 4 weeks 1: Do certain solid foods increase the number of bowel movements in a day?
Description

INCLUSION CRITERIA: Patients with surgery/radiotherapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0453855
UMLS CUI [1,2]
C2128962
2: Do certain liquids that you drink increase the number of bowel movements in a day?
Description

INCLUSION CRITERIA: Patients with surgery/radiotherapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0452428
UMLS CUI [1,2]
C2128962
3: Have you limited the types of solid foods you eat to control your bowel movements?
Description

INCLUSION CRITERIA: Patients with surgery/radiotherapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0439801
UMLS CUI [1,2]
C0453855
UMLS CUI [1,3]
C1290944
4: Have you limited the types of liquids you drink to control your bowel movements?
Description

INCLUSION CRITERIA: Patients with surgery/radiotherapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0439801
UMLS CUI [1,2]
C0452428
UMLS CUI [1,3]
C1290944
EORTC QLQ-C30
Description

Due to need for a license the questions are not included in this version of the standard set. In the original standard set they have IDs from EORTCQLQ30_Q01 to EORTCQLQC30_Q30. INCLUSION CRITERIA: All patients TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported Type: originally: Single answer for the separate questions

Data type

float

Alias
UMLS CUI [1]
C4055104
EORTC QLQ-C29
Description

Due to need for a license the questions are not included in this version of the standard set. In the original standard set they have IDs from EORTCQLQ29_Q31 to EORTCQLQC29_Q59. INCLUSION CRITERIA: Patients with surgery/radiotherapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported Type: originally: Single answer for the separate questions

Data type

float

Alias
UMLS CUI [1]
C0451149
Please indicate the extent to which you have experienced the following symptom during the past week. During the past week: Have you had tingling hands or feet?
Description

INCLUSION CRITERIA: Patients with systemic therapy TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0451149
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Similar models

Patient-reported Form (Baseline, 6 months and annually post-treatment)

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])
Patient's last name
Item
Patient's last name:
text
C1299487 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Degree of health
Item
Over the last 4 weeks 1: Do certain solid foods increase the number of bowel movements in a day?
integer
C0453855 (UMLS CUI [1,1])
C2128962 (UMLS CUI [1,2])
Question 1 of MSKCC_Q01
Code List
Over the last 4 weeks 1: Do certain solid foods increase the number of bowel movements in a day?
CL Item
Most of the time  (1)
C3828954 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes  (2)
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Rarely  (3)
C3843074 (UMLS CUI-1)
(Comment:en)
CL Item
Never  (4)
C2003901 (UMLS CUI-1)
(Comment:en)
CL Item
Always  (0)
C2003902 (UMLS CUI-1)
(Comment:en)
Item
2: Do certain liquids that you drink increase the number of bowel movements in a day?
integer
C0452428 (UMLS CUI [1,1])
C2128962 (UMLS CUI [1,2])
Question 1 of MSKCC_Q01
Code List
2: Do certain liquids that you drink increase the number of bowel movements in a day?
CL Item
Most of the time  (1)
C3828954 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes  (2)
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Rarely  (3)
C3843074 (UMLS CUI-1)
(Comment:en)
CL Item
Never  (4)
C2003901 (UMLS CUI-1)
(Comment:en)
CL Item
Always  (0)
C2003902 (UMLS CUI-1)
(Comment:en)
Item
3: Have you limited the types of solid foods you eat to control your bowel movements?
integer
C0439801 (UMLS CUI [1,1])
C0453855 (UMLS CUI [1,2])
C1290944 (UMLS CUI [1,3])
Question 1 of MSKCC_Q01
Code List
3: Have you limited the types of solid foods you eat to control your bowel movements?
CL Item
Most of the time  (1)
C3828954 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes  (2)
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Rarely  (3)
C3843074 (UMLS CUI-1)
(Comment:en)
CL Item
Never  (4)
C2003901 (UMLS CUI-1)
(Comment:en)
CL Item
Always  (0)
C2003902 (UMLS CUI-1)
(Comment:en)
Item
4: Have you limited the types of liquids you drink to control your bowel movements?
integer
C0439801 (UMLS CUI [1,1])
C0452428 (UMLS CUI [1,2])
C1290944 (UMLS CUI [1,3])
Question 1 of MSKCC_Q01
Code List
4: Have you limited the types of liquids you drink to control your bowel movements?
CL Item
Most of the time  (1)
C3828954 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes  (2)
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Rarely  (3)
C3843074 (UMLS CUI-1)
(Comment:en)
CL Item
Never  (4)
C2003901 (UMLS CUI-1)
(Comment:en)
CL Item
Always  (0)
C2003902 (UMLS CUI-1)
(Comment:en)
EORTC QLQ-C30
Item
EORTC QLQ-C30
float
C4055104 (UMLS CUI [1])
EORTC QLQ-C29
Item
EORTC QLQ-C29
float
C0451149 (UMLS CUI [1])
Item
Please indicate the extent to which you have experienced the following symptom during the past week. During the past week: Have you had tingling hands or feet?
integer
C0451149 (UMLS CUI [1])
Question 1 of MSKCC_Q01
Code List
Please indicate the extent to which you have experienced the following symptom during the past week. During the past week: Have you had tingling hands or feet?
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
(Comment:en)
CL Item
A little (2)
C2984078 (UMLS CUI-1)
(Comment:en)
CL Item
Quite a bit (3)
C2984080 (UMLS CUI-1)
(Comment:en)
CL Item
Very much (4)
C2984081 (UMLS CUI-1)
(Comment:en)
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