Colorectal Cancer NCT00058474 Quality of Life - NSABP Protocol R-04 Quality of Life - 2086124v3.0 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 Social/family Well-being I feel close to my friends I get emotional support from my family I get support from my friends My family has accepted my illness I am satisfied with family communication about my illness I feel close to my partner (or the person who is my main support) (Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please check this box and go to the next section.) I am satisfied with my sex life Emotional Well-being I feel sad I am satisfied with how I am coping with my illness I am losing hope in the fight against my illness I feel nervous I worry about dying I worry that my condition will get worse Functional Well-being 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 content with the quality of my life right now I am content with the quality of my life right now Additional Concerns Additional Concerns I feel fatigued I feel weak all over I feel listless ("washed out") I feel tired I have trouble starting things because I am tired I have trouble finishing things because I am tired I have energy I am able to do my usual activities I need to sleep during the day I am too tired to eat I need help doing my usual activities I am frustrated by being too tired to do the things I want to do I have to limit my social activity because I am tired Did you feel full of life? Did you have a lot of energy? Did you feel worn out? Did you feel tired? (Please indicate how much you have been bothered by each of the following problems during the past 7 days. ) Diarrhea Abdominal pain or cramping Gas pain Mouth sores Vomiting Constipation Skin problems (rash, irritation, redness) Skin redness or peeling on hands and feet Fever or shivering (shaking, chills) Numbness or tingling in the hands or feet Hair Loss Chest Pain Shortness of breath Pain at intravenous (I.V.) site Eye Problems (irritation or redness) Hearing problems (ringing in the ears) Other problems Did you urinate frequently during the day? Did you urinate frequently during the night? Did you have pain when you urinated? Did you have a bloated feeling in your abdomen? Did you have abdominal pain? Did you have pain in your buttocks? Were you bothered by gas (flatulence)? Did you belch? Have you lost weight? Did you have a dry mouth? Have you had thin or lifeless hair as a result of your disease? Did food and drink taste different from usual? Have you felt physically less attractive as a result of your disease or treatment? Have you been feeling less feminine/masculine as a result of your disease or treatment? Have you been dissatisfied with your body? Were you worried about your health in the future? During The Past Four Weeks: To what extent were you interested in sex? To what extent were you sexually active (with or without intercourse)? To what extent was sex enjoyable for you? During The Past Four Weeks: Ccrr Module For Nsabp Protocol R-04 Quality Of Life 
