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ID

43126

Description

GOG-0241 Quality of Life Survey Form Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine, With or Without Bevacizumab, as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II, Stage III, Stage IV, or Recurrent Stage I Epithelial Ovarian Cancer or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D16EFA4-532E-082B-E040-BB89AD434B01

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D16EFA4-532E-082B-E040-BB89AD434B01

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 9/20/21 9/20/21 -
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September 20, 2021

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Creative Commons BY-NC 3.0 Legacy
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    Fallopian Tube Cancer NCT01081262 Quality of Life - GOG-0241 Quality of Life Survey Form - 3126513v1.0

    English

    Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days

    1 forms  
    Header Module
    Description

    Header Module

    Patient Initials (First, Middle, Last)
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Date Questionnaire Completed (M D Y)
    Description

    QualityofLifeCompleteAssessmentDate

    Data type

    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
    GOG Patient ID
    Description

    Patient ID GOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512288
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25521
    Qol Questionnaire Administration
    Description

    Qol Questionnaire Administration

    Scheduled time to obtain Quality of Life Questionnaire (Mark one)
    Description

    QOLCollectedScheduleType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25211
    UMLS 2011AA Property
    C0086960
    Physical Well-being
    Description

    Physical Well-being

    I have a lack of energy.
    Description

    FatigueAssessmentResponseScale

    Data type

    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
    C3036
    UMLS 2011AA ObjectClass-2
    C0015672
    I have nausea.
    Description

    NauseaAssessmentResponseScale

    Data type

    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
    Because of my physical condition, I have trouble meeting the needs of my family.
    Description

    FamilyAssessmentRequiredResponseType

    Data type

    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
    I have pain.
    Description

    PainAssessmentResponseScale

    Data type

    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
    I am bothered by side effects of treatment.
    Description

    ToxicityAssessmentResponseScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus ObjectClass-2
    C27990
    UMLS 2011AA ObjectClass-2
    C0600688
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel ill
    Description

    PatientMalaiseAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3832
    UMLS 2011AA Property-2
    C0231218
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am forced to spend time in bed
    Description

    PatientBedRestAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    Functional Wellbeing
    Description

    Functional Wellbeing

    I am able to work (include work at home)
    Description

    AbilityPatientWorkAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus ObjectClass
    C0085732
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0043227
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    My work (include work at home) is fulfilling
    Description

    SatisfactionPatientWorkAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C62185
    UMLS 2011AA Property
    C0242428
    NCI Metathesaurus Property
    C0043227
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am able to enjoy life.
    Description

    LifeAssessmentResponseType

    Data type

    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
    I have accepted my illness
    Description

    PatientAcceptanceofIllnessAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL140183
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am sleeping well
    Description

    PatientSleepAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0037313
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am enjoying the things I usually do for fun
    Description

    PleasurePatientRecreationAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus ObjectClass
    C0679105
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0034872
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am content with the quality of my life right now
    Description

    PatientQualityofLifeAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17047
    UMLS 2011AA Property
    C0518214
    NCI Thesaurus Property-2
    C20989
    UMLS 2011AA Property-2
    C0031809
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Additional Concerns
    Description

    Additional Concerns

    I have swelling in my stomach area
    Description

    QualityofLifeStomachSwellingEvaluationScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C12391
    UMLS 2011AA Property-2
    C0038351
    NCI Thesaurus Property-3
    C3399
    UMLS 2011AA Property-3
    C0038999
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am losing weight
    Description

    PatientWeightLossAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3445
    UMLS 2011AA Property-2
    C1262477
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have control of my bowels
    Description

    BowelPatientIncontinenceAssessmentQualityofLifeScale

    Data type

    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 Metathesaurus Property
    C0021167
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have been vomiting
    Description

    VomitingAssessmentResponseType

    Data type

    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
    I am bothered by hair loss.
    Description

    HairAssessmentResponseType

    Data type

    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
    I have a good appetite
    Description

    PatientAppetiteAssessmentQualityofLifeScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C25152
    UMLS 2011AA Property-2
    C0003618
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I like the appearance of my body
    Description

    QualityofLifeBodyDissatisfactionAssessmentScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C13041
    UMLS 2011AA Property
    C1268086
    NCI Thesaurus Property-3
    C62184
    UMLS 2011AA Property-2
    C0870433
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    I am able to get around by myself
    Description

    Quality-of-LifeAssessmentPatientActivityType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C43431
    UMLS 2011AA Property-2
    C0441655
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    I am able to feel like a woman.
    Description

    FeminineAssessmentResponseType

    Data type

    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
    I have cramps in my stomach area
    Description

    QualityofLifeStomachMuscleCrampEvaluationScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C12391
    UMLS 2011AA Property-2
    C0038351
    NCI Thesaurus Property-3
    C34827
    UMLS 2011AA Property-3
    C0026821
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am interested in sex
    Description

    Libido

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS CUI-1
    C0023618
    NCI Thesaurus ObjectClass-2
    C17127
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C25275
    NCI Thesaurus Property-3
    C73522
    NCI Thesaurus ValueDomain
    C25664
    I have concerns about my ability to have children
    Description

    ProbabilityMotherQualityofLifeDistressAssessmentScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus ObjectClass-2
    C25189
    UMLS 2011AA ObjectClass-2
    C0026591
    NCI Thesaurus ObjectClass-3
    C54154
    UMLS 2011AA ObjectClass-3
    C0033204
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C37942
    UMLS 2011AA Property
    C0231303
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Ntx4 Subscale
    Description

    Ntx4 Subscale

    I have numbness or tingling in my hands
    Description

    NeurotoxicityPatientParaesthesiaHandAssessmentQualityofLifeScale

    Data type

    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
    C0239836
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have numbness or tingling in my feet
    Description

    NeurotoxicityPatientParaesthesiaFootAssessmentQualityofLifeScale

    Data type

    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
    CL108114
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel discomfort in my hands
    Description

    NeurotoxicityPatientHandDiscomfortAssessmentQualityofLifeScale

    Data type

    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 Thesaurus Property-2
    C32712
    UMLS 2011AA Property-2
    C0018563
    NCI Metathesaurus Property
    CL047845
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel discomfort in my feet
    Description

    NeurotoxicityPatientFootDiscomfortAssessmentQualityofLifeScale

    Data type

    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
    CL050515
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    Unamed Module 2
    Description

    Unamed Module 2

    Mobility
    Description

    QOLMobilityAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Metathesaurus Property
    C0449580
    Self care
    Description

    QualityofLifeSelfCareAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Thesaurus Property-2
    C15324
    UMLS 2011AA Property-2
    C0518889
    Usual activities (e.g. work, study, housework, family, or leisure activities)
    Description

    QOLPhyscialActivityAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C17708
    UMLS 2011AA Property-2
    C0026606
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Pain/discomfort
    Description

    QOLPainAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Anxiety/depression
    Description

    QOLAnxietyAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C26696
    UMLS 2011AA Property-2
    C0003467
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Unnamed Module 3
    Description

    Unnamed Module 3

    Your own health state today
    Description

    PatientHealthScore

    Data type

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25178
    UMLS 2011AA Property
    C0018684
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    To Be Completed By Clinical Staff
    Description

    To Be Completed By Clinical Staff

    QOL contact person
    Description

    QualityofLifeContactPersonIdentifierName

    Data type

    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
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    Status of the QOL assessment
    Description

    QualityofLifeEvaluationStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Specify reason
    Description

    PatientRefuseIncompleteQuestionnaireSpecify

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus Property
    C0034394
    NCI Thesaurus Property
    C49160
    UMLS 2011AA Property
    C0205257
    NCI Thesaurus Property-2
    C49161
    UMLS 2011AA Property-2
    C1705116
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Other, specify
    Description

    QualityofLifeEvaluationSpecify

    Data type

    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
    Back to the top of the page

    Similar models

    Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header Module
    Patient Initials
    Item
    Patient Initials (First, Middle, Last)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    QualityofLifeCompleteAssessmentDate
    Item
    Date Questionnaire Completed (M D Y)
    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)
    Patient ID GOG
    Item
    GOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512288 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25521 (NCI Thesaurus Property-2)
    Item Group
    Qol Questionnaire Administration
    Item
    Scheduled time to obtain Quality of Life Questionnaire (Mark one)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25211 (NCI Thesaurus Property)
    C0086960 (UMLS 2011AA Property)
    CL.1
    Code List
    Scheduled time to obtain Quality of Life Questionnaire (Mark one)
    CL Item
    Prior To Treatment (Prior to treatment)
    CL Item
    Pre-cycle 4 (Pre-cycle 4)
    CL Item
    Post-cycle 6 (Post-cycle 6)
    CL Item
    6 Months Post-chemo (6 months post-chemo)
    CL Item
    After Bevacizumab Maintenance (After bevacizumab maintenance)
    CL Item
    6 Months After Bevacizumab Maintenance (6 months after bevacizumab maintenance)
    CL Item
    2 Years From Date-on Study (2 years from date-on study)
    CL Item
    3 Years From Date-on Study (3 years from date-on study)
    CL Item
    4 Years From Date-on Study (4 years from date-on study)
    CL Item
    5 Years From Date-on Study (5 years from date-on study)
    Item Group
    Physical Well-being
    Item
    I have a lack of energy.
    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)
    C3036 (NCI Thesaurus ObjectClass-2)
    C0015672 (UMLS 2011AA ObjectClass-2)
    CL.2
    Code List
    I have a lack of energy.
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have 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)
    CL.3
    Code List
    I have nausea.
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    Because of my physical condition, I have trouble meeting the needs of my family.
    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)
    CL.4
    Code List
    Because of my physical condition, I have trouble meeting the needs of my family.
    CL Item
    1 (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    2 (A little bit)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (Somewhat)
    CL Item
    4 (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    5 (Very much)
    C91217 (NCI Thesaurus)
    Item
    I have 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)
    CL.5
    Code List
    I have pain.
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am bothered by side effects of treatment.
    text
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C27990 (NCI Thesaurus ObjectClass-2)
    C0600688 (UMLS 2011AA ObjectClass-2)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.6
    Code List
    I am bothered by side effects of treatment.
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel ill
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3832 (NCI Thesaurus Property-2)
    C0231218 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.7
    Code List
    I feel ill
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am forced to spend time in bed
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    CL.8
    Code List
    I am forced to spend time in bed
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item Group
    Functional Wellbeing
    Item
    I am able to work (include work at home)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0085732 (NCI Metathesaurus ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0043227 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.9
    Code List
    I am able to work (include work at home)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    My work (include work at home) is fulfilling
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C62185 (NCI Thesaurus Property-2)
    C0242428 (UMLS 2011AA Property)
    C0043227 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.10
    Code List
    My work (include work at home) is fulfilling
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am able to enjoy life.
    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)
    CL.11
    Code List
    I am able to enjoy life.
    CL Item
    1 (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    2 (A little bit)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (Somewhat)
    CL Item
    4 (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    5 (Very much)
    C91217 (NCI Thesaurus)
    Item
    I have accepted my illness
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    CL140183 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.12
    Code List
    I have accepted my illness
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am sleeping well
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0037313 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.13
    Code List
    I am sleeping well
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am enjoying the things I usually do for fun
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0679105 (NCI Metathesaurus ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0034872 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.14
    Code List
    I am enjoying the things I usually do for fun
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am content with the quality of my life right now
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17047 (NCI Thesaurus Property)
    C0518214 (UMLS 2011AA Property)
    C20989 (NCI Thesaurus Property-2)
    C0031809 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.15
    Code List
    I am content with the quality of my life right now
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item Group
    Additional Concerns
    Item
    I have swelling in my stomach area
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C12391 (NCI Thesaurus Property-2)
    C0038351 (UMLS 2011AA Property-2)
    C3399 (NCI Thesaurus Property-3)
    C0038999 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.16
    Code List
    I have swelling in my stomach area
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am losing weight
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3445 (NCI Thesaurus Property-2)
    C1262477 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.17
    Code List
    I am losing weight
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have control of my bowels
    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)
    C0021167 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.18
    Code List
    I have control of my bowels
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have been 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)
    CL.19
    Code List
    I have been vomiting
    CL Item
    1 (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    2 (A little bit)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (Somewhat)
    CL Item
    4 (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    5 (Very much)
    C91217 (NCI Thesaurus)
    Item
    I am bothered by hair loss.
    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)
    CL.20
    Code List
    I am bothered by hair loss.
    CL Item
    1 (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    2 (A little bit)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (Somewhat)
    CL Item
    4 (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    5 (Very much)
    C91217 (NCI Thesaurus)
    Item
    I have a good appetite
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25152 (NCI Thesaurus Property-2)
    C0003618 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.21
    Code List
    I have a good appetite
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I like the appearance of my body
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C13041 (NCI Thesaurus Property-2)
    C1268086 (UMLS 2011AA Property)
    C62184 (NCI Thesaurus Property-3)
    C0870433 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    CL.22
    Code List
    I like the appearance of my body
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am able to get around by myself
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C43431 (NCI Thesaurus Property-2)
    C0441655 (UMLS 2011AA Property-2)
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    CL.23
    Code List
    I am able to get around by myself
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    Item
    I am able to feel like a woman.
    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)
    CL.24
    Code List
    I am able to feel like a woman.
    CL Item
    1 (Not at all)
    C91213 (NCI Thesaurus)
    CL Item
    2 (A little bit)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (Somewhat)
    CL Item
    4 (Quite a bit)
    C91216 (NCI Thesaurus)
    CL Item
    5 (Very much)
    C91217 (NCI Thesaurus)
    Item
    I have cramps in my stomach area
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C12391 (NCI Thesaurus Property-2)
    C0038351 (UMLS 2011AA Property-2)
    C34827 (NCI Thesaurus Property-3)
    C0026821 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.25
    Code List
    I have cramps in my stomach area
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I am interested in sex
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0023618 (UMLS CUI-1)
    C17127 (NCI Thesaurus ObjectClass-2)
    C25367 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C73522 (NCI Thesaurus Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    CL.26
    Code List
    I am interested in sex
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have concerns about my ability to have children
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25189 (NCI Thesaurus ObjectClass-2)
    C0026591 (UMLS 2011AA ObjectClass-2)
    C54154 (NCI Thesaurus ObjectClass-3)
    C0033204 (UMLS 2011AA ObjectClass-3)
    C25367 (NCI Thesaurus Property)
    C37942 (NCI Thesaurus Property-2)
    C0231303 (UMLS 2011AA Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.27
    Code List
    I have concerns about my ability to have children
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item Group
    Ntx4 Subscale
    Item
    I have numbness or tingling in my hands
    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)
    C0239836 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.28
    Code List
    I have numbness or tingling in my hands
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I have numbness or tingling in my feet
    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)
    CL108114 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.29
    Code List
    I have numbness or tingling in my feet
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel discomfort in my hands
    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)
    C32712 (NCI Thesaurus Property-2)
    C0018563 (UMLS 2011AA Property-2)
    CL047845 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.30
    Code List
    I feel discomfort in my hands
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item
    I feel discomfort in my feet
    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)
    CL050515 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    CL.31
    Code List
    I feel discomfort in my feet
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    C70543 (NCI Thesaurus-3)
    C2003901 (UMLS 2011AA)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    Item Group
    Unamed Module 2
    Item
    Mobility
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C0449580 (NCI Metathesaurus Property)
    CL.32
    Code List
    Mobility
    CL Item
    I Have No Problems In Walking About (I have no problems in walking about)
    CL Item
    I Have Some Problems In Walking About (I have some problems in walking about)
    CL Item
    I Am Confined To Bed (I am confined to bed)
    Item
    Self care
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C15324 (NCI Thesaurus Property-2)
    C0518889 (UMLS 2011AA Property-2)
    CL.33
    Code List
    Self care
    CL Item
    I Have No Problems With Self Care (I have no problems with self care)
    CL Item
    I Have Some Problems Washing Or Dressing Myself (I have some problems washing or dressing myself)
    CL Item
    I Am Unable To Wash Or Dress Myself (I am unable to wash or dress myself)
    Item
    Usual activities (e.g. work, study, housework, family, or leisure activities)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C17708 (NCI Thesaurus Property-2)
    C0026606 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.34
    Code List
    Usual activities (e.g. work, study, housework, family, or leisure activities)
    CL Item
    I Have No Problems With Performing My Usual Activities (I have no problems with performing my usual activities)
    CL Item
    I Have Some Problems With Performing My Usual Activities (I have some problems with performing my usual activities)
    CL Item
    I Am Unable To Perform My Usual Activities (I am unable to perform my usual activities)
    Item
    Pain/discomfort
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.35
    Code List
    Pain/discomfort
    CL Item
    I Have No Pain Or Discomfort (I have no pain or discomfort)
    CL Item
    I Have Moderate Pain Or Discomfort (I have moderate pain or discomfort)
    CL Item
    I Have Extreme Pain Or Discomfort (I have extreme pain or discomfort)
    Item
    Anxiety/depression
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus Property-2)
    C0003467 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.36
    Code List
    Anxiety/depression
    CL Item
    I Am Not Anxious Or Depressed (I am not anxious or depressed)
    CL Item
    I Am Moderately Anxious Or Depressed (I am moderately anxious or depressed)
    CL Item
    I Am Extremely Anxious Or Depressed (I am extremely anxious or depressed)
    Item Group
    Unnamed Module 3
    PatientHealthScore
    Item
    Your own health state today
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25178 (NCI Thesaurus Property)
    C0018684 (UMLS 2011AA Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Item Group
    To Be Completed By Clinical Staff
    QualityofLifeContactPersonIdentifierName
    Item
    QOL contact person
    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)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    Item
    Status of the QOL assessment
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.37
    Code List
    Status of the QOL assessment
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Patient Died (Patient died)
    CL Item
    Patient Kept Appointment, But Could Not Complete Questionnaire Due To Illness (Patient kept appointment, but could not complete questionnaire due to illness)
    CL Item
    Patient Kept Appointment, But Refused To Complete Questionnaire For Reasons Other Than Illness (Patient kept appointment, but refused to complete questionnaire for reasons other than illness)
    CL Item
    Patient Off Study Treatment And Cannot Be Contacted For Follow-up (Patient off study treatment and cannot be contacted for follow-up)
    CL Item
    Questionnaire Not Administered Due To Clinical Staff Error (Questionnaire not administered due to clinical staff error)
    CL Item
    The Questionnaire Is Complete (The questionnaire is complete)
    PatientRefuseIncompleteQuestionnaireSpecify
    Item
    Specify reason
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0034394 (NCI Metathesaurus Property)
    C49160 (NCI Thesaurus Property)
    C0205257 (UMLS 2011AA Property)
    C49161 (NCI Thesaurus Property-2)
    C1705116 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    QualityofLifeEvaluationSpecify
    Item
    Other, specify
    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)
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