ID

43045

Description

NSABP B-45 Quality of Life Questionnaire Form Studying Biological Markers of Fatigue in Women With Residual Invasive Breast Cancer Enrolled on Clinical Trial NSABP-B-45 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=64B2569C-B533-2D46-E040-BB89AD432515

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=64B2569C-B533-2D46-E040-BB89AD432515

Mots-clés

  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 17/09/2021 17/09/2021 -
Téléchargé le

17 septembre 2021

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00914043 Quality of Life - NSABP B-45 Quality of Life Questionnaire Form - 2847215v1.0

Patients participating in the B-45 QOL study should complete this form at each of the time points listed below. The first page is to be completed by a clinical staff member. Fill in the items listed on this page, print the patient¿s study ID at the top of the remaining pages, and give the questionnaire to the patient for completion. After the patient has completed the questionnaire, verify that the date has been recorded at the top of page 2 and submit the completed questionnaire to the NSABP Biostatistical Center

Header
Description

Header

Patient Initials (Last First Middle)
Description

Patient Initials

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
NSABP Patient ID
Description

Patient ID NSABP

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1513905
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
Institution/Affiliate
Description

Institution Name

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Staff member administering form
Description

PersonFormAdministrationFirstName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C25509
UMLS 2011AA ValueDomain-2
C1279901
Staff member administering form
Description

PersonFormAdministrationLastName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C25551
UMLS 2011AA ValueDomain-2
C1517741
Phone
Description

QualityofLifeContactPersonTelephoneNumber

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C17047
UMLS 2011AA ObjectClass-2
C0518214
NCI Thesaurus ObjectClass-3
C25461
UMLS 2011AA ObjectClass-3
C0337611
NCI Thesaurus Property
C40978
UMLS 2011AA Property
C1515258
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25395
UMLS 2011AA ValueDomain-2
C0039457
Are data amended
Description

Data amended

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Time Point
Description

Time Point

Time point (mark one)
Description

AssessmentPeriodType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
This form is being filled out (mark one)
Description

CaseReportFormPersonCompleteType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property-2
C25250
UMLS 2011AA Property-2
C0205197
Date Questionnaire Completed (MM DD YYYY)
Description

QualityofLifeCompleteAssessmentDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property-2
C25367
Qol
Description

Qol

Nausea
Description

NauseaAssessmentResponseScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3258
UMLS 2011AA ObjectClass-2
C0027497
vomiting
Description

VomitingAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
diarrhea
Description

DiarrheaAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Difficulty with bladder control (when laughing or crying)
Description

BrainQualityofLifeUrinaryIncontinencePatientAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3429
UMLS 2011AA Property
C0021167
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Difficulty with bladder control (at other times)
Description

PatientUrinaryFrequencyAssessmentQualityofLifeScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C26906
UMLS 2011AA Property-2
C0677481
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Hot flashes
Description

QualityofLifeHotFlashesEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C3109
UMLS 2011AA Property-2
C0600142
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
genital itching or irritation
Description

PruritusAssessmentGenitaliaResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
vaginal discharge
Description

VaginalAssessmentDischargeResponse

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Vaginal bleeding or spotting
Description

QualityofLifeVaginaHemorrhageEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C26791
UMLS 2011AA Property-2
C0019080
NCI Thesaurus Property-3
C12407
UMLS 2011AA Property-3
C0042232
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
vaginal dryness
Description

VaginalAssessmentDrynessResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Pain with intercourse
Description

QualityofLifeSexualIntercoursePainEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
NCI Thesaurus Property-3
C72881
UMLS 2011AA Property-3
C0009253
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Easily distracted
Description

Quality-of-LifeAssessmentPatientDifficultyAttentionConcentrationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C15584
UMLS 2011AA ObjectClass
C0281588
NCI Thesaurus Property
C16960
UMLS 2011AA Property
C0030705
NCI Thesaurus Property-2
C62189
UMLS 2011AA Property-2
C1299586
NCI Thesaurus Property-3
C41209
UMLS 2011AA Property-3
C0004268
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
General aches and pains
Description

PatientAcheAssessmentQualityofLifeScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0234238
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Joint pains
Description

NeurotoxicityPatientArthralgiaAssessmentQualityofLifeScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C27961
UMLS 2011AA ObjectClass-2
C0235032
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0003862
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Muscle stiffness
Description

MuscleCrampAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C34827
UMLS 2011AA ObjectClass-2
C0026821
Weight gain
Description

Quality-of-LifeAssessmentPatientWeightGainScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C15584
UMLS 2011AA ObjectClass
C0281588
NCI Thesaurus Property
C16960
UMLS 2011AA Property
C0030705
NCI Thesaurus Property-2
C62754
UMLS 2011AA Property-2
C0043094
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Weight loss
Description

WeightLossAssessmentResponseScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3445
UMLS 2011AA ObjectClass-2
C1262477
Decreased appetite
Description

AppetiteAssessmentResponseScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C25152
UMLS 2011AA ObjectClass-2
C0003618
Unhappy with appearance of my body
Description

QualityofLifeAppearanceChangeDissatisfactionEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C25377
UMLS 2011AA Property-2
C0700364
NCI Thesaurus Property-3
C25446
UMLS 2011AA Property-3
C0392747
NCI Thesaurus Property-4
C62184
UMLS 2011AA Property-4
C0870433
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Forgetfulness
Description

MemoryDysfunctionAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ObjectClass-2
C46084
UMLS 2011AA ObjectClass
C0233794
Night sweats
Description

QualityofLifeNightSweatsEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C3279
UMLS 2011AA Property-2
C0028081
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Cold sweats
Description

QualityofLifeColdSweatEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C62180
UMLS 2011AA Property-2
C0009264
NCI Thesaurus Property-3
C13280
UMLS 2011AA Property-3
C0038984
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Difficulty concentrating
Description

CognitionQualityofLifeDifficultyAttentionConcentrationActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C16446
UMLS 2011AA ObjectClass-2
C0009240
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C43431
UMLS 2011AA Property
C0441655
NCI Thesaurus Property-3
C62189
UMLS 2011AA Property-2
C1299586
NCI Thesaurus Property-4
C41209
UMLS 2011AA Property-3
C0004268
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Abdominal pain or cramping
Description

BowelPatientAbdominalCrampAssessmentQualityofLifeScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C12736
UMLS 2011AA ObjectClass-2
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C34331
UMLS 2011AA Property-2
C0000729
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
mouth sores
Description

MouthAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Numbness or tingling in the hands or feet
Description

NumbnessAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Gas pain
Description

QualityofLifeStomachPainEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
NCI Thesaurus Property-3
C12391
UMLS 2011AA Property-3
C0038351
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
constipation
Description

ConstipationAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
skin problems (rash, irritation, redness)
Description

DermalAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Skin redness or peeling on hands and feet
Description

SkinQualityofLifeDiscomfortAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C12470
UMLS 2011AA ObjectClass-2
C1123023
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C50535
UMLS 2011AA Property
C0234215
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
fever or shivering (shaking, chills)
Description

FeverAssessmentResponseType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Hair loss
Description

BrainQualityofLifeAlopeciaStressPatientAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C2865
NCI Thesaurus Property-3
C35041
UMLS 2011AA Property
C0038435
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Chest pain
Description

PainAssessmentResponseScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3303
UMLS 2011AA ObjectClass-2
C0030193
Shortness of breath
Description

DyspneaAssessmentResponseScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2998
UMLS 2011AA ObjectClass-2
C0013404
Other problems
Description

QualityofLifeOtherEvaluationScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25214
UMLS 2011AA Property-2
C0220825
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
Please specify other problems
Description

QualityofLifeEvaluationSpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
Header
Description

Header

In general, would you say your health is
Description

HealthAssessmentStatus

Type de données

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25178
UMLS 2011AA ObjectClass
C0018684
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Compared to one year ago, how would you rate your health in general now
Description

PriorHealthAssessmentStatus

Type de données

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C25178
UMLS 2011AA ObjectClass-2
C0018684
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Module Question 3
Description

Module Question 3

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Description

ActiveExercisePhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL192338
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Description

ModerateExercisePhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
CL323823
NCI Metathesaurus ObjectClass-2
C0221187
Lifting or carrying groceries
Description

LiftingExercisePhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
C0206244
Climbing several flights of stairs
Description

ClimbingStairsPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
CL299704
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
Climbing one flight of stairs
Description

AbilityWalkStairsPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL240714
Bending, kneeling or stooping
Description

BendDownPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL241453
Walking more than a mile
Description

MaximumWalkedPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL201237
Walking several hundred yards
Description

WalkingDistancePhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL201235
Walking one hundred yards
Description

WalkingPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0080331
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
Bathing or dressing yourself
Description

BathingPhysicalActivityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
C0150141
Module Question 5
Description

Module Question 5

Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
Description

ReducedWorkHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
Description

ReducedWorkHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
Description

ReducedProductivityHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0033269
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
Description

ReducedProductivityHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0033269
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Were limited in the kind of work or other activities (as a result of your physical health)
Description

LimitedWorkHealthAssessmentScale

Type de données

text

Alias
NCI Metathesaurus ObjectClass
CL110648
NCI Metathesaurus ObjectClass-2
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Had difficulty performing the work or other activities (as a result of your physical health)
Description

DifficultyWorkHealthAssessmentScale

Type de données

text

Alias
NCI Metathesaurus ObjectClass
C0043227
NCI Metathesaurus ObjectClass-2
CL308262
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Did work or other activities less carefully than usual (as a result of any emotional problems such as feeling depressed or anxious)
Description

ReducedWorkQualityHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
CL238443
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
Description

FamilySocialBehaviorAssessmentStatus

Type de données

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25173
UMLS 2011AA ObjectClass
C0015576
NCI Metathesaurus ObjectClass
C0037397
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much bodily pain have you had during the past 4 weeks
Description

BodyPainAssessmentAmount

Type de données

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C3303
UMLS 2011AA ObjectClass
C0030193
NCI Thesaurus ObjectClass-2
C13041
UMLS 2011AA ObjectClass-2
C1268086
NCI Thesaurus ValueDomain
C25417
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
Description

PainPatientWorkAssessmentStatus

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C3303
UMLS 2011AA ObjectClass-2
C0030193
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0043227
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Module Question 9
Description

Module Question 9

Did you feel full of life
Description

PatientVitalityAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0291944
Have you been very nervous
Description

PatientNervousnessAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0027769
Have you felt so down in the dumps that nothing could cheer you up
Description

PatientDepressionAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C2982
UMLS 2011AA Property-2
C0011570
Have you felt calm and peaceful
Description

PatientRelaxationAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0035028
Did you have a lot of energy
Description

PatientEnergyAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C48058
UMLS 2011AA Property-2
C0542479
Have you felt downhearted and depressed
Description

PatientMoodAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0026516
Did you feel worn out
Description

PatientFatigueAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property-2
C0015672
Have you been happy
Description

PatientHappinessAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0018592
Did you feel tired
Description

PatientLethargyAssessmentScale

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0023380
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)
Description

SocialBehaviorAssessmentDuration

Type de données

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0037397
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
Module Question 11
Description

Module Question 11

I seem to get sick a little easier than other people
Description

PatientSicknessAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0221423
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
I am as healthy as anybody I know
Description

PatientHealthAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
I expect my health to get worse
Description

PatientWorseAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
CL288707
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
My health is excellent
Description

PatientHealthExcellentAssessmentScale

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
CL286081
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
Qol2
Description

Qol2

Rate your level of fatigue on the day you felt most fatigued during the past week
Description

PatientFatigueMostAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property
C0015672
NCI Thesaurus Property-3
C25258
UMLS 2011AA Property-2
C0205393
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate your level of fatigue on the day you felt least fatigued during the past week
Description

PatientFatigueLowestAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property
C0015672
NCI Thesaurus Property-3
C43517
UMLS 2011AA Property-2
C1708760
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate your level of fatigue on the average during the past week
Description

PatientFatigueAverageAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property
C0015672
NCI Thesaurus Property-3
C37917
UMLS 2011AA Property-2
C1510992
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate your level of fatigue right now
Description

PatientFatigueCurrentAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus Property-3
C3036
UMLS 2011AA Property-2
C0015672
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your general level of activity
Description

PatientGeneralizedActivityInterferenceSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C43431
UMLS 2011AA Property
C0441655
NCI Thesaurus Property-2
C4876
UMLS 2011AA Property-2
C1457887
NCI Thesaurus Property-3
C63764
UMLS 2011AA Property-3
C0205246
NCI Thesaurus Property-4
C72886
UMLS 2011AA Property-4
C0521102
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your ability to bathe and dress yourself
Description

QualityofLifeFatigueWashEvaluationScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property-2
C0015672
NCI Thesaurus Property-3
C65077
UMLS 2011AA Property-3
C0441648
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your normal work activity (includes both work outside the home and housework)
Description

PatientWorkInterferenceSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus Property-2
C74299
UMLS 2011AA Property-2
C0043227
NCI Thesaurus Property-3
C72886
UMLS 2011AA Property-3
C0521102
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your ability to concentrate
Description

Quality-of-LifeAssessmentPatientDifficultyAttentionConcentrationSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C15584
UMLS 2011AA ObjectClass
C0281588
NCI Thesaurus Property
C16960
UMLS 2011AA Property
C0030705
NCI Thesaurus Property-2
C62189
UMLS 2011AA Property-2
C1299586
NCI Thesaurus Property-3
C41209
UMLS 2011AA Property-3
C0004268
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your relations with other people
Description

PatientRelationshipInterferenceSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25648
UMLS 2011AA Property
C0439849
NCI Thesaurus Property-2
C4876
UMLS 2011AA Property-2
C1457887
NCI Thesaurus Property-3
C72886
UMLS 2011AA Property-3
C0521102
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your enjoyment of life
Description

PatientLifeJoyInterferenceSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C37987
UMLS 2011AA Property
C0376558
NCI Thesaurus Property-2
C4876
UMLS 2011AA Property-2
C1457887
NCI Thesaurus Property-3
C77961
UMLS 2011AA Property-3
C0018592
NCI Thesaurus Property-4
C72886
UMLS 2011AA Property-4
C0521102
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much, in the past week, fatigue interfered with your mood
Description

PatientMoodInterferenceSymptomScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus Property-2
C72886
UMLS 2011AA Property-2
C0521102
NCI Thesaurus Property-3
C72883
UMLS 2011AA Property-3
C0026516
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Indicate how many days, in the past week, you felt fatigued for any part of the day
Description

PatientFatigueDayDurationAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property
C0015672
NCI Thesaurus Property-3
C25301
UMLS 2011AA Property-2
C0439228
NCI Thesaurus Property-4
C25330
UMLS 2011AA Property-3
C0449238
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Rate how much of the day, on average, you felt fatigued in the past week
Description

PatientFatigueDurationTimeAssessmentScale

Type de données

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property
C0015672
NCI Thesaurus Property-3
C25207
UMLS 2011AA Property-2
C0040223
NCI Thesaurus Property-4
C25330
UMLS 2011AA Property-3
C0449238
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Please score your overall quality of life as of today on an 11-point scale where 0 indicates being in the worst possible health and 10 indicates being in perfect health
Description

PatientQualityofLifeAssessmentScore

Type de données

text

Alias
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property-2
C20989
UMLS 2011AA Property-2
C0031809
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820

Similar models

Patients participating in the B-45 QOL study should complete this form at each of the time points listed below. The first page is to be completed by a clinical staff member. Fill in the items listed on this page, print the patient¿s study ID at the top of the remaining pages, and give the questionnaire to the patient for completion. After the patient has completed the questionnaire, verify that the date has been recorded at the top of page 2 and submit the completed questionnaire to the NSABP Biostatistical Center

Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Header
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
PersonFormAdministrationFirstName
Item
Staff member administering form
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25509 (NCI Thesaurus ValueDomain-2)
C1279901 (UMLS 2011AA ValueDomain-2)
PersonFormAdministrationLastName
Item
Staff member administering form
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
QualityofLifeContactPersonTelephoneNumber
Item
Phone
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus ObjectClass-2)
C0518214 (UMLS 2011AA ObjectClass-2)
C25461 (NCI Thesaurus ObjectClass-3)
C0337611 (UMLS 2011AA ObjectClass-3)
C40978 (NCI Thesaurus Property)
C1515258 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS 2011AA ValueDomain-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Time Point
Item
Time point (mark one)
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)
Code List
Time point (mark one)
CL Item
Within 2 Weeks Prior To Randomization (Within 2 weeks prior to randomization)
CL Item
3 Months After Randomization (3 months after randomization)
CL Item
6 Months After Randomization (6 months after randomization)
CL Item
12 Months After Randomization (12 months after randomization)
CL Item
18 Months After Randomization (18 months after randomization)
CL Item
24 Months After Randomization (24 months after randomization)
Item
This form is being filled out (mark one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property-2)
C0205197 (UMLS 2011AA Property-2)
Code List
This form is being filled out (mark one)
CL Item
By Clinical Staff On Phone With Participant (By clinical staff on phone with participant)
CL Item
By Patient In Doctor's Office (By participant in doctor's office)
CL Item
By Participant Not In Doctor's Office (By participant not in doctor's office)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
QualityofLifeCompleteAssessmentDate
Item
Date Questionnaire Completed (MM DD YYYY)
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-2)
Item Group
Qol
Item
Nausea
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3258 (NCI Thesaurus ObjectClass-2)
C0027497 (UMLS 2011AA ObjectClass-2)
Code List
Nausea
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
vomiting
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
vomiting
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
diarrhea
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
diarrhea
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Difficulty with bladder control (when laughing or crying)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C3429 (NCI Thesaurus Property-2)
C0021167 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Difficulty with bladder control (when laughing or crying)
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Difficulty with bladder control (at other times)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C26906 (NCI Thesaurus Property-2)
C0677481 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Difficulty with bladder control (at other times)
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Hot flashes
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3109 (NCI Thesaurus Property-2)
C0600142 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Hot flashes
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
genital itching or irritation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
genital itching or irritation
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
vaginal discharge
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
vaginal discharge
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Vaginal bleeding or spotting
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C26791 (NCI Thesaurus Property-2)
C0019080 (UMLS 2011AA Property-2)
C12407 (NCI Thesaurus Property-3)
C0042232 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Vaginal bleeding or spotting
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
vaginal dryness
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
vaginal dryness
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Pain with intercourse
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C72881 (NCI Thesaurus Property-3)
C0009253 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Pain with intercourse
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Easily distracted
text
C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-3)
C0004268 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Easily distracted
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
General aches and pains
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0234238 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
General aches and pains
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Joint pains
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C0235032 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0003862 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Joint pains
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Muscle stiffness
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C34827 (NCI Thesaurus ObjectClass-2)
C0026821 (UMLS 2011AA ObjectClass-2)
Code List
Muscle stiffness
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Weight gain
text
C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C62754 (NCI Thesaurus Property-2)
C0043094 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Weight gain
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Weight loss
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3445 (NCI Thesaurus ObjectClass-2)
C1262477 (UMLS 2011AA ObjectClass-2)
Code List
Weight loss
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Decreased appetite
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25152 (NCI Thesaurus ObjectClass-2)
C0003618 (UMLS 2011AA ObjectClass-2)
Code List
Decreased appetite
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Unhappy with appearance of my body
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25377 (NCI Thesaurus Property-2)
C0700364 (UMLS 2011AA Property-2)
C25446 (NCI Thesaurus Property-3)
C0392747 (UMLS 2011AA Property-3)
C62184 (NCI Thesaurus Property-4)
C0870433 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Unhappy with appearance of my body
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Forgetfulness
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ObjectClass)
C46084 (NCI Thesaurus ObjectClass-2)
C0233794 (UMLS 2011AA ObjectClass)
Code List
Forgetfulness
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Night sweats
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3279 (NCI Thesaurus Property-2)
C0028081 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Night sweats
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Cold sweats
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property-2)
C0009264 (UMLS 2011AA Property-2)
C13280 (NCI Thesaurus Property-3)
C0038984 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Cold sweats
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Difficulty concentrating
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C16446 (NCI Thesaurus ObjectClass-2)
C0009240 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C43431 (NCI Thesaurus Property-2)
C0441655 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-3)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-4)
C0004268 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Difficulty concentrating
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Abdominal pain or cramping
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass-2)
C0021853 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C34331 (NCI Thesaurus Property-2)
C0000729 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Abdominal pain or cramping
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
mouth sores
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
mouth sores
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Numbness or tingling in the hands or feet
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
Numbness or tingling in the hands or feet
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Gas pain
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C12391 (NCI Thesaurus Property-3)
C0038351 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Gas pain
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
constipation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
constipation
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
skin problems (rash, irritation, redness)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
skin problems (rash, irritation, redness)
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Skin redness or peeling on hands and feet
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12470 (NCI Thesaurus ObjectClass-2)
C1123023 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C50535 (NCI Thesaurus Property-2)
C0234215 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Skin redness or peeling on hands and feet
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
fever or shivering (shaking, chills)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
Code List
fever or shivering (shaking, chills)
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Hair loss
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C2865 (NCI Thesaurus Property-2)
C35041 (NCI Thesaurus Property-3)
C0038435 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Hair loss
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Chest pain
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)
Code List
Chest pain
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Shortness of breath
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2998 (NCI Thesaurus ObjectClass-2)
C0013404 (UMLS 2011AA ObjectClass-2)
Code List
Shortness of breath
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
Item
Other problems
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25214 (NCI Thesaurus Property-2)
C0220825 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
Code List
Other problems
CL Item
Not At All Bothered (Not at all bothered)
CL Item
Bothered A Little Bit (Bothered a little bit)
CL Item
Somewhat Bothered (Somewhat bothered)
CL Item
Bothered Quite A Bit (Bothered quite a bit)
CL Item
Bothered Very Much (Bothered very much)
QualityofLifeEvaluationSpecify
Item
Please specify other problems
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
Item Group
Header
Item
In general, would you say your health is
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus ObjectClass)
C0018684 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
In general, would you say your health is
CL Item
Excellent (Excellent)
CL Item
Very Good (Very good)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Compared to one year ago, how would you rate your health in general now
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25178 (NCI Thesaurus ObjectClass-2)
C0018684 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Compared to one year ago, how would you rate your health in general now
CL Item
Much Better Now Than One Year Ago (Much better now than one year ago)
CL Item
Somewhat Better Now Than One Year Ago (Somewhat better now than one year ago)
CL Item
About The Same As One Year Ago (About the same as one year ago)
CL Item
Somewhat Worse Now Than One Year Ago (Somewhat worse now than one year ago)
CL Item
Much Worse Now Than One Year Ago (Much worse now than one year ago)
Item Group
Module Question 3
Item
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL192338 (NCI Metathesaurus ObjectClass)
Code List
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL323823 (NCI Metathesaurus ObjectClass)
C0221187 (NCI Metathesaurus ObjectClass-2)
Code List
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Lifting or carrying groceries
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C0206244 (NCI Metathesaurus ObjectClass)
Code List
Lifting or carrying groceries
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Climbing several flights of stairs
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL299704 (NCI Metathesaurus ObjectClass)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
Code List
Climbing several flights of stairs
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Climbing one flight of stairs
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL240714 (NCI Metathesaurus ObjectClass)
Code List
Climbing one flight of stairs
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Bending, kneeling or stooping
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL241453 (NCI Metathesaurus ObjectClass)
Code List
Bending, kneeling or stooping
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking more than a mile
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL201237 (NCI Metathesaurus ObjectClass)
Code List
Walking more than a mile
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking several hundred yards
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL201235 (NCI Metathesaurus ObjectClass)
Code List
Walking several hundred yards
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking one hundred yards
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0080331 (NCI Metathesaurus ObjectClass)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
Code List
Walking one hundred yards
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Bathing or dressing yourself
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C0150141 (NCI Metathesaurus ObjectClass)
Code List
Bathing or dressing yourself
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item Group
Module Question 5
Item
Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
text
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
text
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Cut down on the amount of time you spent on work or other activities (as a result of any emotional problems such as feeling depressed or anxious)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
text
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0033269 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
text
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0033269 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Accomplished less than you would like (as a result of any emotional problems such as feeling depressed or anxious)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Were limited in the kind of work or other activities (as a result of your physical health)
text
CL110648 (NCI Metathesaurus ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Were limited in the kind of work or other activities (as a result of your physical health)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Had difficulty performing the work or other activities (as a result of your physical health)
text
C0043227 (NCI Metathesaurus ObjectClass)
CL308262 (NCI Metathesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Had difficulty performing the work or other activities (as a result of your physical health)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did work or other activities less carefully than usual (as a result of any emotional problems such as feeling depressed or anxious)
text
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
CL238443 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Did work or other activities less carefully than usual (as a result of any emotional problems such as feeling depressed or anxious)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25173 (NCI Thesaurus ObjectClass)
C0015576 (UMLS 2011AA ObjectClass)
C0037397 (NCI Metathesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
Slightly (Slightly)
CL Item
Moderately (Moderately)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Extremely (Extremely)
Item
How much bodily pain have you had during the past 4 weeks
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C13041 (NCI Thesaurus ObjectClass-2)
C1268086 (UMLS 2011AA ObjectClass-2)
C25417 (NCI Thesaurus ValueDomain)
Code List
How much bodily pain have you had during the past 4 weeks
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Very Mild (Very mild)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
Very Severe (Very severe)
Item
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Moderately (Moderately)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Extremely (Extremely)
Item Group
Module Question 9
Item
Did you feel full of life
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0291944 (NCI Metathesaurus Property)
Code List
Did you feel full of life
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you been very nervous
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0027769 (NCI Metathesaurus Property)
Code List
Have you been very nervous
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt so down in the dumps that nothing could cheer you up
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property-2)
C0011570 (UMLS 2011AA Property-2)
Code List
Have you felt so down in the dumps that nothing could cheer you up
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt calm and peaceful
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0035028 (NCI Metathesaurus Property)
Code List
Have you felt calm and peaceful
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you have a lot of energy
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C48058 (NCI Thesaurus Property-2)
C0542479 (UMLS 2011AA Property-2)
Code List
Did you have a lot of energy
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt downhearted and depressed
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0026516 (NCI Metathesaurus Property)
Code List
Have you felt downhearted and depressed
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you feel worn out
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
Code List
Did you feel worn out
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you been happy
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0018592 (NCI Metathesaurus Property)
Code List
Have you been happy
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you feel tired
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0023380 (NCI Metathesaurus Property)
Code List
Did you feel tired
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0037397 (NCI Metathesaurus ObjectClass)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
Code List
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item Group
Module Question 11
Item
I seem to get sick a little easier than other people
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0221423 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
Code List
I seem to get sick a little easier than other people
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
I am as healthy as anybody I know
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
Code List
I am as healthy as anybody I know
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
I expect my health to get worse
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL288707 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
Code List
I expect my health to get worse
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
My health is excellent
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL286081 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
Code List
My health is excellent
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item Group
Qol2
PatientFatigueMostAssessmentScale
Item
Rate your level of fatigue on the day you felt most fatigued during the past week
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property)
C25258 (NCI Thesaurus Property-3)
C0205393 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientFatigueLowestAssessmentScale
Item
Rate your level of fatigue on the day you felt least fatigued during the past week
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property)
C43517 (NCI Thesaurus Property-3)
C1708760 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientFatigueAverageAssessmentScale
Item
Rate your level of fatigue on the average during the past week
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-3)
C1510992 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientFatigueCurrentAssessmentScale
Item
Rate your level of fatigue right now
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25471 (NCI Thesaurus Property-2)
C0521116 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-3)
C0015672 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientGeneralizedActivityInterferenceSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your general level of activity
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C63764 (NCI Thesaurus Property-3)
C0205246 (UMLS 2011AA Property-3)
C72886 (NCI Thesaurus Property-4)
C0521102 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
QualityofLifeFatigueWashEvaluationScale
Item
Rate how much, in the past week, fatigue interfered with your ability to bathe and dress yourself
float
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
C65077 (NCI Thesaurus Property-3)
C0441648 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientWorkInterferenceSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your normal work activity (includes both work outside the home and housework)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C74299 (NCI Thesaurus Property-2)
C0043227 (UMLS 2011AA Property-2)
C72886 (NCI Thesaurus Property-3)
C0521102 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Quality-of-LifeAssessmentPatientDifficultyAttentionConcentrationSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your ability to concentrate
float
C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-3)
C0004268 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientRelationshipInterferenceSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your relations with other people
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25648 (NCI Thesaurus Property)
C0439849 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C72886 (NCI Thesaurus Property-3)
C0521102 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientLifeJoyInterferenceSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your enjoyment of life
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C37987 (NCI Thesaurus Property)
C0376558 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C77961 (NCI Thesaurus Property-3)
C0018592 (UMLS 2011AA Property-3)
C72886 (NCI Thesaurus Property-4)
C0521102 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientMoodInterferenceSymptomScale
Item
Rate how much, in the past week, fatigue interfered with your mood
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C72886 (NCI Thesaurus Property-2)
C0521102 (UMLS 2011AA Property-2)
C72883 (NCI Thesaurus Property-3)
C0026516 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientFatigueDayDurationAssessmentScale
Item
Indicate how many days, in the past week, you felt fatigued for any part of the day
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property)
C25301 (NCI Thesaurus Property-3)
C0439228 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus Property-4)
C0449238 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
PatientFatigueDurationTimeAssessmentScale
Item
Rate how much of the day, on average, you felt fatigued in the past week
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus Property-4)
C0449238 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Item
Please score your overall quality of life as of today on an 11-point scale where 0 indicates being in the worst possible health and 10 indicates being in perfect health
text
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property-2)
C0031809 (UMLS 2011AA Property-2)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
Code List
Please score your overall quality of life as of today on an 11-point scale where 0 indicates being in the worst possible health and 10 indicates being in perfect health
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
10 (10)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)

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