ID

42648

Beskrivning

RTOG 1016 FQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Work Status Questionnaire Radiation Therapy With Cisplatin or Cetuximab in Treating Patients With Oropharyngeal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=953353B4-562C-83C2-E040-BB89AD433EAB

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=953353B4-562C-83C2-E040-BB89AD433EAB

Nyckelord

Head and Neck Neoplasms

D016430

Lebensqualität

Uppladdad den

17 september 2021

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy

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NCT01302834 Quality of Life - RTOG 1016 FQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Work Status Questionnaire - 3160066v1.0

model
Detaljer

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 Formulär

StudyEvent: RTOG 1016 FQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Work Status Questionnaire
1. INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

Header Module

Item Group

Unnamed Module 1

Protocol ID RTOG

Item

RTOG Study No.

text

C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Item

Case #

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)

Institution Name

Item

Institution Name

text

C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)

Institution Number

Item

Institution No.

text

C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)

Patient Initials

Item

Patient Initials

text

C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)

Trial subject ID RTOG

Item

RTOG Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Data amended

Item

Amended data

boolean

C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)

Work Status Questionnaire

Item Group

Eortc Qlq-h&n35

PersonGenderTextType

Item

Patient gender

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS 2011AA Property)

CL.2

Code List

Patient gender

CL Item

Male Gender (Male)

C46109 (NCI Thesaurus)
C1706180 (UMLS 2011AA)

CL Item

Female Gender (Female)

C46110 (NCI Thesaurus)
C0086287 (UMLS 2011AA)

PatientAgeValue

Item

Patient Age

float

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)

EthnicGroupCategoryText

Item

Patient Ethnicity

text

C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16564 (NCI Thesaurus ObjectClass)
C0015031 (UMLS 2011AA ObjectClass)

CL.3

Code List

Patient Ethnicity

CL Item

Hispanic Or Latino (Hispanic or Latino)

C17459 (NCI Thesaurus)
C0086409 (UMLS 2011AA)

CL Item

Not Hispanic Or Latino (Not Hispanic or Latino)

C41222 (NCI Thesaurus)
C1518424 (UMLS 2011AA)

RaceCategoryText

Item

Patient Race

text

C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS 2011AA ObjectClass)

CL.4

Code List

Patient Race

CL Item

American Indian Or Alaska Native (American Indian or Alaska Native)

C41259 (NCI Thesaurus)
C1515945 (UMLS 2011AA)

CL Item

Asian (Asian)

C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)

CL Item

Black Or African American (Black or African American)

C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)

CL Item

Native Hawaiian Or Other Pacific Islander (Native Hawaiian or other Pacific Islander)

C41219 (NCI Thesaurus)
C1513907 (UMLS 2011AA)

CL Item

Not Reported (Not Reported)

C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

CL Item

White (White)

C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)

PaternalRaceCategory

Item

Paternal Race

text

CL.5

Code List

Paternal Race

CL Item

American Indian Or Alaska Native (American Indian or Alaska Native)

C41259 (NCI Thesaurus)
C1515945 (UMLS 2011AA)

CL Item

Asian (Asian)

C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)

CL Item

Black Or African American (Black or African American)

C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)

CL Item

Native Hawaiian Or Other Pacific Islander (Native Hawaiian or other Pacific Islander)

C41219 (NCI Thesaurus)
C1513907 (UMLS 2011AA)

CL Item

Not Reported (Not Reported)

C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

CL Item

White (White)

C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)

MaternalRaceCategory

Item

Maternal Race

text

CL.6

Code List

Maternal Race

CL Item

American Indian Or Alaska Native (American Indian or Alaska Native)

C41259 (NCI Thesaurus)
C1515945 (UMLS 2011AA)

CL Item

Asian (Asian)

C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)

CL Item

Black Or African American (Black or African American)

C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)

CL Item

Native Hawaiian Or Other Pacific Islander (Native Hawaiian or other Pacific Islander)

C41219 (NCI Thesaurus)
C1513907 (UMLS 2011AA)

CL Item

Not Reported (Not Reported)

C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

CL Item

White (White)

C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)

PersonMaritalStatusCategory

Item

Marital Status

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25188 (NCI Thesaurus Property)
C0024819 (UMLS 2011AA Property)

CL.7

Code List

Marital Status

CL Item

Divorced: C51776 (Divorced)

C51776 (NCI Thesaurus)
C0086170 (UMLS 2011AA)

CL Item

Domestic Partner (Domestic Partnership)

C53262 (NCI Thesaurus)
C1549111 (UMLS 2011AA)

CL Item

Married: C51773 (Married)

C51773 (NCI Thesaurus)
C0555047 (UMLS 2011AA)

CL Item

Never Married (Never Married)

C51774 (NCI Thesaurus)
C0027952 (UMLS 2011AA)

CL Item

Separated (Separated)

C51777 (NCI Thesaurus)
C0086972 (UMLS 2011AA)

CL Item

Widowed (Widowed)

C51775 (NCI Thesaurus)
C0206275 (UMLS 2011AA)

PatientResidenceRadiationTherapyOncologyGroupType

Item

Where do you live now

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ValueDomain-2)
C1514695 (UMLS 2011AA ValueDomain-2)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)

CL.8

Code List

Where do you live now

CL Item

Homeless Or Homeless Shelter (Homeless or homeless shelter)

CL Item

In A Condominium Or House That You Own (In a condominium or house that you own)

CL Item

In A Rented Apartment Or House Where You Pay All Of The Bills (In a rented apartment or house where you pay all of the bills)

CL Item

In A Rented Apartment Or House Where You Pay Some Of The Bills (In a rented apartment or house where you pay some of the bills)

CL Item

In Public Assistance Housing (In public assistance housing)

CL Item

Living With Relative Or Friends Who Pay All The Bills (Living with relative or friends who pay all the bills)

CL Item

Other (Other)

CurrentEmploymentDescriptionStatus

Item

Which of the following best describes your current work status

text

C25471 (NCI Thesaurus ObjectClass)
C0521116 (UMLS 2011AA ObjectClass)
C25172 (NCI Thesaurus ObjectClass-2)
C0014003 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.9

Code List

Which of the following best describes your current work status

CL Item

Not Working Outside Of The Home (Not working outside of the home)

CL Item

Student, Full-time (Student, full-time)

CL Item

Student, Part-time (Student, part-time)

CL Item

Currently Working In At Least One Full Time Job (Currently working in at least one FULL time job)

CL Item

Currently Working In At Least One Part Time Job (Currently working in at least one PART time job)

CL Item

Unknown (Don't know)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

CL Item

Not Employed (Not employed)

CL Item

On Disability (On disability)

CL Item

On Sick Leave (On sick leave)

CL Item

Other (Other)

CL Item

Retired (Retired)

CurrentEmploymentDescriptionSpecify

Item

Please specify (Other)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus ObjectClass)
C0521116 (UMLS 2011AA ObjectClass)
C25172 (NCI Thesaurus ObjectClass-2)
C0014003 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

PersonEducationLevelSummaryRadiationTherapyOncologyGroupType

Item

Highest educational level

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C17953 (NCI Thesaurus Property)
C0013658 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C19778 (NCI Thesaurus ValueDomain-2)
C1514695 (UMLS 2011AA ValueDomain-2)
C17953 (NCI Thesaurus ValueDomain-3)
C0013658 (UMLS 2011AA ValueDomain-3)
C42581 (NCI Thesaurus ValueDomain-4)
C1706244 (UMLS 2011AA ValueDomain-4)

CL.10

Code List

Highest educational level

CL Item

Graduation Or Professional Degree (Advanced degree)

C37998 (NCI Thesaurus)
C1518602 (UMLS 2011AA)
C52581 (NCI Thesaurus-3)
C1711333 (UMLS 2011AA-4)
C75558 (NCI Thesaurus-5)
C2698884 (UMLS 2011AA-6)
C25354 (NCI Thesaurus-7)
C0542560 (UMLS 2011AA-8)

CL Item

Bachelor's Degree (Bachelor's Degree)

C39327 (NCI Thesaurus)
C1511035 (UMLS 2011AA)

CL Item

Grade School (Grade School)

C80410 (NCI Thesaurus)
C0683859 (UMLS 2011AA)

CL Item

High School Completion Or General Equivalency Diploma (ged) Completion (High school graduate (including equivalency))

C67136 (NCI Thesaurus)
C0870649 (UMLS 2011AA)
C37998 (NCI Thesaurus-3)
C1518602 (UMLS 2011AA-4)
C67135 (NCI Thesaurus-5)
C1880947 (UMLS 2011AA-6)

CL Item

No Formal Schooling (No formal education)

C67122 (NCI Thesaurus)
C0557286 (UMLS 2011AA)

CL Item

Not High School Graduate (Not high school graduate)

C76123 (NCI Thesaurus)
C2825140 (UMLS 2011AA)

CL Item

Some College Or Associates Degree (Some college or associate degree)

C37998 (NCI Thesaurus)
C1518602 (UMLS 2011AA)
C71340 (NCI Thesaurus-3)
C1549943 (UMLS 2011AA-4)
C65099 (NCI Thesaurus-5)
C0205392 (UMLS 2011AA-6)
C61514 (NCI Thesaurus-7)
C0557806 (UMLS 2011AA-8)

CL Item

Went To Vocational/technical School (Went to vocational/technical school)

EmploymentPastInteger::12MonthCount

Item

In the year before you were diagnosed with ORAL/OROPHARYNX cancer, about how many months did you work?

text

C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C45255 (NCI Thesaurus Property)
C1708523 (UMLS 2011AA Property)
C29846 (NCI Thesaurus Property-2)
C0439231 (UMLS 2011AA Property-2)
C25609 (NCI Thesaurus Property-3)
C1444637 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C19778 (NCI Thesaurus ValueDomain-2)
C1514695 (UMLS 2011AA ValueDomain-2)

CL.11

Code List

In the year before you were diagnosed with ORAL/OROPHARYNX cancer, about how many months did you work?

CL Item

I Did Not Do Paid Work (0 Months) (I did not do paid work (0 months))

CL Item

1 Month (1 month)

CL Item

2 Months (2 months)

CL Item

3 Months (3 months)

CL Item

4 Months (4 months)

CL Item

5 Months (5 months)

CL Item

6 Months (6 months)

CL Item

7 Months (7 months)

CL Item

8 Months (8 months)

CL Item

9 Months (9 months)

CL Item

10 Months (10 months)

CL Item

11 Months (11 months)

CL Item

12 Months (12 months)

EmploymentWeekHourCount

Item

How many hours per week do you work?

float

C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus Property)
C0439227 (UMLS 2011AA Property)
C29844 (NCI Thesaurus Property-2)
C0439230 (UMLS 2011AA Property-2)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)

EmploymentDescriptionType

Item

Which industry would you say best describes your workplace?

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.12

Code List

Which industry would you say best describes your workplace?

CL Item

Construction (Construction)

CL Item

Education (Education)

C16529 (NCI Thesaurus)
C0013622 (UMLS 2011AA)

CL Item

Finance, Insurance, Or Real Estate (Finance, insurance, or real estate)

CL Item

Government (Government)

CL Item

Legal (Legal)

C97637 (NCI Thesaurus)

CL Item

Manufacturing (Manufacturing)

CL Item

Medical (Medical)

CL Item

Other (Other)

CL Item

Retail Trade (Retail trade)

CL Item

Service (Service)

CL Item

Transportation And Public Utilities (Transportation and public utilities)

CL Item

Wholesale Trade (Wholesale trade)

EmploymentDescriptionSpecify

Item

Please specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

EmploymentCategoryDescriptionType

Item

Which occupational category best describes your work?

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)

CL.13

Code List

Which occupational category best describes your work?

CL Item

Arts, Media Or Athletics (Arts, media or athletics)

CL Item

Managerial Or Professional Specialty (Managerial or professional specialty)

CL Item

Operator, Fabricator, Or Laborer (Operator, fabricator, or laborer)

CL Item

Other (Other)

CL Item

Sales, Technical, Or Administrative Support (Sales, technical, or administrative support)

CL Item

Service (Service)

EmploymentCategoryDescriptionSpecify

Item

Please specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)

EmploymentHealthInsuranceIndicator

Item

Are you covered by a health plan provided through your current or former employer or union?

text

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16745 (NCI Thesaurus Property)
C0021672 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)

CL.14

Code List

Are you covered by a health plan provided through your current or former employer or union?

CL Item

Don't Know (Don't know)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

EmploymentHealthOtherPersonInsuranceType

Item

In addition to you, who else in your household is covered by your insurance plan?

text

C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25190 (NCI Thesaurus Property-2)
C0027361 (UMLS 2011AA Property-2)
C16745 (NCI Thesaurus Property-3)
C0021672 (UMLS 2011AA Property-3)
C25178 (NCI Thesaurus Property-4)
C0018684 (UMLS 2011AA Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.15

Code List

In addition to you, who else in your household is covered by your insurance plan?

CL Item

Don't Know (Don't know)

CL Item

Myself And Child(ren) (myself and child(ren))

CL Item

Myself And Spouse And Child(ren) (myself and spouse and child(ren))

CL Item

Myself And Spouse Only (myself and spouse only)

CL Item

Myself Only (myself only)

EmploymentBenefitsIndicator

Item

If you needed it, would you get any paid sick leave or disability benefits from your current job

text

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25172 (NCI Thesaurus ObjectClass)
C0014003 (UMLS 2011AA ObjectClass)
C25387 (NCI Thesaurus Property)
C0814225 (UMLS 2011AA Property)

CL.16

Code List

If you needed it, would you get any paid sick leave or disability benefits from your current job

CL Item

Don't Know (Don't know)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

IndividualIncomeRange

Item

Which category is closest to your INDIVIDUAL total income during the year before your oral/oropharynx cancer diagnosis?

text

C41150 (NCI Thesaurus Property)
C0021162 (UMLS 2011AA Property)
C17719 (NCI Thesaurus ObjectClass)
C38013 (NCI Thesaurus ValueDomain)
C1514721 (UMLS 2011AA ValueDomain)

CL.17

Code List

Which category is closest to your INDIVIDUAL total income during the year before your oral/oropharynx cancer diagnosis?

CL Item

$10,000 To $19,999 ($10,000 to $19,999)

CL Item

$100,000 To $149,999 ($100,000 to $149,999)

CL Item

$150,000 To $199,999 ($150,000 to $199,999)

CL Item

$20,000 To $29,999 ($20,000 to $29,999)

CL Item

$200,000 Or More ($200,000 or more)

CL Item

$30,000 To $39,999 ($30,000 to $39,999)

CL Item

$40,000 To $49,999 ($40,000 to $49,999)

CL Item

$50,000 To $59,999 ($50,000 to $59,999)

CL Item

$60,000 To $69,999 ($60,000 to $69,999)

CL Item

$70,000 To $79,999 ($70,000 to $79,999)

CL Item

$80,000 To $89,999 ($80,000 to $89,999)

CL Item

$90,000 To $99,999 ($90,000 to $99,999)

CL Item

Less Than $10,000 (Less than $10,000)

PersonHouseholdIncomeRange

Item

Which category is closest to your household's total COMBINED income during the year before your oral/oropharynx cancer diagnosis?

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C70811 (NCI Thesaurus Property)
C0557163 (UMLS 2011AA Property)
C38013 (NCI Thesaurus ValueDomain)
C1514721 (UMLS 2011AA ValueDomain)

CL.18

Code List

Which category is closest to your household's total COMBINED income during the year before your oral/oropharynx cancer diagnosis?

CL Item

$10,000 To $19,999 ($10,000 to $19,999)

CL Item

$100,000 To $149,999 ($100,000 to $149,999)

CL Item

$150,000 To $199,999 ($150,000 to $199,999)

CL Item

$20,000 To $29,999 ($20,000 to $29,999)

CL Item

$200,000 Or More ($200,000 or more)

CL Item

$30,000 To $39,999 ($30,000 to $39,999)

CL Item

$40,000 To $49,999 ($40,000 to $49,999)

CL Item

$50,000 To $59,999 ($50,000 to $59,999)

CL Item

$60,000 To $69,999 ($60,000 to $69,999)

CL Item

$70,000 To $79,999 ($70,000 to $79,999)

CL Item

$80,000 To $89,999 ($80,000 to $89,999)

CL Item

$90,000 To $99,999 ($90,000 to $99,999)

CL Item

Less Than $10,000 (Less than $10,000)

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Beskrivning

Länk

Nyckelord

Versioner (3)

Uppladdad den

DOI

Licens

Modellkommentarer :

Itemgroup-kommentar för :

Item-kommentar för :

NCT01302834 Quality of Life - RTOG 1016 FQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Work Status Questionnaire - 3160066v1.0

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

Beskrivning

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp

Alias

Beskrivning

Datatyp