Description:

Z6051 EORTC QLQ-CR38 (CR38) Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AECD651-8870-09DC-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AECD651-8870-09DC-E044-0003BA3F9857
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Versions (5)
  1. 8/27/12 8/27/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 8/11/14 8/11/14 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
  5. 9/17/21 9/17/21 -
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September 17, 2021

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Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00726622 Quality of Life - Z6051 EORTC QLQ-CR38 (CR38) - 2741819v1.0

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1 forms  
  1. StudyEvent: Z6051 EORTC QLQ-CR38 (CR38)
    1. No Instruction available.
Header Module
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Additional Concerns
Did you urinate frequently during the day
Did you urinate frequently during the night?
Did you have pain when you urinated?
Did you have a bloated feeling in your abdomen?
Did you have abdominal pain?
Did you have pain in your buttocks?
Were you bothered by gas (flatulence)?
Did you belch?
Have you lost weight?
Did you have a dry mouth?
Have you had thin or lifeless hair as a result of your disease?
Did food and drink taste different from usual?
Have you felt physically less attractive as a result of your disease or treatment?
Have you been feeling less feminine/masculine as a result of your disease or treatment?
Have you been dissatisfied with your body?
Were you worried about your health in the future?
During The Past Four Weeks:
To what extent were you interested in sex?
To what extent were you sexually active (with or without intercourse)?
To what extent was sex enjoyable for you?
Did you have difficulty getting or maintaining an erection?
Did you have problems with ejaculation (e.g., so-called 'dry ejaculation')?
Did you have a dry vagina during intercourse?
Did you have pain during intercourse?
Stoma
Do you have a stoma (colostomy bag)?
Only For Patients Without A Stoma (colostomy Bag):
Did you have frequent bowel movements during the day?
Did you have frequent bowel movements during the night?
Did you feel the urge to move your bowels without actually producing any stools
Have you had any unintentional release of stools
Have you had blood with your stools
Have you had difficulty in moving your bowels
Have you had difficulty in moving your bowels?
Have your bowel movements been painful?
Unnamed 4
Were you afraid that other people would be able to hear your stoma
Were you afraid that other people would be able to smell your stools
Were you worried about possible leakage from the stoma bag?
Did you have problems with caring for your stoma
Was your skin around the stoma irritated
Did you feel embarassed because of your stoma
Did you feel less complete because of your stoma
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