Description:

GOG-0262: Quality of Life Survey Form Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage II, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6E5EDF6F-8906-E23E-E040-BB89AD435A10

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6E5EDF6F-8906-E23E-E040-BB89AD435A10

Keywords:
Versions (4) ▾
  1. 9/19/12
  2. 8/11/14
  3. 1/9/15
  4. 9/20/21
Uploaded on:

September 20, 2021

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Fallopian Tube Cancer NCT01167712 Quality of Life - GOG-0262: Quality of Life Survey Form - 2917772v1.0

Below is a list of statements that other people with your illness have said are important. By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

Header Module
Physical Well-being
I have a lack of energy.
I have nausea.
Because of my physical condition, I have trouble meeting the needs of my family.
I have pain.
I am bothered by side effects of treatment.
I feel ill
I am forced to spend time in bed
Functional Wellbeing
I am able to work (include work at home)
My work (include work at home) is fulfilling
I am able to enjoy life.
I have accepted my illness
I am sleeping well
I am enjoying the things I usually do for fun
I am content with the quality of my life right now
Additional Concerns
I have swelling in my stomach area
I am losing weight
I have control of my bowels
I have been vomiting
I am bothered by hair loss.
I have a good appetite
I like the appearance of my body
I am able to get around by myself
I am able to feel like a woman.
I have cramps in my stomach area
I am interested in sex
I have concerns about my ability to have children
Ntx4 Subscale
I have numbness or tingling in my hands
I have numbness or tingling in my feet
I feel discomfort in my hands
I feel discomfort in my feet
To Be Completed By Clinical Staff
Status of the QOL assessment

Similar models