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43240

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RTOG-0412 FA: Funcation Assessment Cancer Therapy - Lung Trial Outcome Index (TOI) Cisplatin and Docetaxel With or Without Radiation Therapy in Treating Patients Who Are Undergoing Surgery for Newly Diagnosed Stage III Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E48B0FD8-0824-0529-E034-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E48B0FD8-0824-0529-E034-0003BA3F9857

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-01-22 2015-01-22 - Martin Dugas
  4. 2021-09-20 2021-09-20 -
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20 september 2021

DOI

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Creative Commons BY-NC 3.0 Legacy

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    Lung Cancer NCT00113386 Quality of Life - RTOG-0412 FA: Funcation Assessment Cancer Therapy - Lung Trial Outcome Index (TOI) - 2288075v3.0

    Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

    1. StudyEvent: RTOG-0412 FA: Funcation Assessment Cancer Therapy - Lung Trial Outcome Index (TOI)
      1. Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC
    Module 1
    Beskrivning

    Module 1

    RTOG Study 0412
    Beskrivning

    Protocol ID RTOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Case #
    Beskrivning

    Case#

    Datatyp

    text

    Institution
    Beskrivning

    Institution Name

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Institution No.
    Beskrivning

    Institution Number

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Participant's I.D. No.
    Beskrivning

    Patient Study ID

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    PATIENTS INITIALS
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    PATIENTS INITIALS
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    DATE COMPLETED (INSTRUCTIONS: Below is a list of statements that other people with your illness have said are important. By selecting one 1 box per line, please indicate how true each statement has been for you during the past 7 days. Please select a box by marking an X in it.)
    Beskrivning

    FormCompletionDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Physical Well-being
    Beskrivning

    Physical Well-being

    I have a lack of energy
    Beskrivning

    PatientEnergyAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C20989
    NCI Thesaurus Property-2
    C48058
    NCI Thesaurus ValueDomain
    C25664
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS CUI-1
    C3475789
    I have nausea
    Beskrivning

    PatientNauseaAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C20989
    NCI Thesaurus Property-2
    C3258
    NCI Thesaurus ValueDomain
    C25664
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS CUI-1
    C3475892
    Because of my physical condition, I have trouble meeting the needs of my family
    Beskrivning

    PatientGeneralPhysicalConditionAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL104641
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have pain
    Beskrivning

    PatientPainAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am bothered by side effects of treatment
    Beskrivning

    PatientAdverseEventAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C41331
    UMLS 2011AA Property-2
    C0877248
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I feel ill
    Beskrivning

    PatientMalaiseAssessmentQualityofLifeScale

    Datatyp

    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
    Beskrivning

    PatientBedRestAssessmentQualityofLifeScale

    Datatyp

    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 Well-being
    Beskrivning

    Functional Well-being

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

    AbilityPatientWorkAssessmentQualityofLifeScale

    Datatyp

    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 (including work at home) is fulfilling
    Beskrivning

    SatisfactionPatientWorkAssessmentQualityofLifeScale

    Datatyp

    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
    Beskrivning

    PatientEnjoymentofLifeAssessmentQualityofLifeAssessment

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    CL196329
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I have accepted my illness
    Beskrivning

    Ihaveacceptedmyillness

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am sleeping well
    Beskrivning

    Iamsleepingwell

    Datatyp

    text

    Alias
    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
    Beskrivning

    IamenjoyingthethingsIusuallydoforfun

    Datatyp

    text

    Alias
    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
    Beskrivning

    Iamcontentwiththequalityofmyliferightnow

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Additional Concerns
    Beskrivning

    Additional Concerns

    I have been short of breath
    Beskrivning

    QualityofLifeDyspneaEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C2998
    UMLS 2011AA Property-2
    C0013404
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    I am losing weight
    Beskrivning

    PatientWeightLossAssessmentQualityofLifeScale

    Datatyp

    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
    My thinking is clear
    Beskrivning

    Mythinkingisclear

    Datatyp

    text

    I have been coughing
    Beskrivning

    Ihavebeencoughing

    Datatyp

    text

    I have a good appetite
    Beskrivning

    PatientAppetiteAssessmentQualityofLifeScale

    Datatyp

    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
    NCI Thesaurus Property-2
    C25152
    UMLS 2011AA Property-2
    C0003618
    I feel tightness in my chest
    Beskrivning

    Ifeeltightnessinmychest

    Datatyp

    text

    Breathing is easy for me
    Beskrivning

    Breathingiseasyforme

    Datatyp

    text

    COMMENTS
    Beskrivning

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Completed by
    Beskrivning

    Person Completing Form

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Date form originally completed
    Beskrivning

    Form Completion Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367

    Similar models

    Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

    1. StudyEvent: RTOG-0412 FA: Funcation Assessment Cancer Therapy - Lung Trial Outcome Index (TOI)
      1. Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Module 1
    Protocol ID RTOG
    Item
    RTOG Study 0412
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Case#
    Item
    Case #
    text
    Institution Name
    Item
    Institution
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Study ID
    Item
    Participant's I.D. No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    PATIENTS INITIALS
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient Initials
    Item
    PATIENTS INITIALS
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    FormCompletionDate
    Item
    DATE COMPLETED (INSTRUCTIONS: Below is a list of statements that other people with your illness have said are important. By selecting one 1 box per line, please indicate how true each statement has been for you during the past 7 days. Please select a box by marking an X in it.)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    Item Group
    Physical Well-being
    Item
    I have a lack of energy
    text
    C16960 (NCI Thesaurus ObjectClass)
    C20989 (NCI Thesaurus Property)
    C48058 (NCI Thesaurus Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C3475789 (UMLS CUI-1)
    Code List
    I have a lack of energy
    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 nausea
    text
    C16960 (NCI Thesaurus ObjectClass)
    C20989 (NCI Thesaurus Property)
    C3258 (NCI Thesaurus Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C3475892 (UMLS CUI-1)
    Code List
    I have nausea
    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
    Because of my physical condition, I have trouble meeting the needs of my family
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    CL104641 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    Because of my physical condition, I have trouble meeting the needs of my family
    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 pain
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    I have pain
    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 bothered by side effects of treatment
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus Property-2)
    C0877248 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    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)
    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)
    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 Well-being
    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)
    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 (including 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)
    Code List
    My work (including 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
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    CL196329 (NCI Metathesaurus Property)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    I am able to enjoy life
    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 accepted my illness
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    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
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    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
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    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
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    I am content with the quality of my life right now
    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 Group
    Additional Concerns
    Item
    I have been short of breath
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C2998 (NCI Thesaurus Property-2)
    C0013404 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    I have been short of breath
    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)
    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
    My thinking is clear
    text
    Code List
    My thinking is clear
    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 have been coughing
    text
    Code List
    I have been coughing
    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 have a good appetite
    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)
    C25152 (NCI Thesaurus Property-2)
    C0003618 (UMLS 2011AA Property-2)
    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 feel tightness in my chest
    text
    Code List
    I feel tightness in my chest
    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
    Breathing is easy for me
    text
    Code List
    Breathing is easy for me
    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)
    Research Comments
    Item
    COMMENTS
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Person Completing Form
    Item
    Completed by
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Date form originally completed
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)

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