ID

43464

Description

CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455 Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0D7D5091-6484-2392-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0D7D5091-6484-2392-E044-0003BA3F9857

Keywords

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/21/15 6/21/15 -
  4. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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    CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

    Header
    Description

    Header

    CALGB Form
    Description

    Form ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3262252
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25442
    CALGB Study No
    Description

    Protocol ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    CALGB Patient ID
    Description

    Trial subject ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    Are data amended
    Description

    Data amended

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Patient demographics
    Description

    Patient demographics

    Patient Initials
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Medical Record Number
    Description

    Medical Record Number

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Institution/Affiliate
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group
    Description

    Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Protocol Number
    Description

    Study Number Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Description

    Trial subject ID Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Responsible CRA
    Description

    ClinicalResearchAssociateResponsiblePersonName

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25657
    UMLS 2011AA ObjectClass
    C1273518
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass-2
    C25465
    UMLS 2011AA ObjectClass-2
    C1516627
    Memorial Symptom Assessment
    Description

    Memorial Symptom Assessment

    Lack of energy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    FatigueAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    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
    Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
    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
    Lack of appetite (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    AppetiteAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C25152
    UMLS 2011AA ObjectClass-2
    C0003618
    Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    AppetiteAssessmentResponseScale

    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
    C25152
    UMLS 2011AA ObjectClass-2
    C0003618
    Pain (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    PainAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    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
    Pain (If YES, how much did it DISTRESS or BOTHER you?)
    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
    Dry Mouth (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    PatientDryMouthAssessmentInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C26917
    UMLS 2011AA Property-2
    C0043352
    Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    PatientDryMouthAssessmentScale

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C26917
    UMLS 2011AA Property-2
    C0043352
    Weight loss (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    WeightLossAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C3445
    UMLS 2011AA ObjectClass-2
    C1262477
    Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    WeightLossAssessmentResponseScale

    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
    C3445
    UMLS 2011AA ObjectClass-2
    C1262477
    Feeling drowsy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    SomnolenceAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C26754
    UMLS 2011AA ObjectClass-2
    C2830004
    Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    SomnolenceAssessmentResponseScale

    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
    C26754
    UMLS 2011AA ObjectClass-2
    C2830004
    Difficulty sleeping (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    PatientDifficultySleepingAssessmentInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C73425
    UMLS 2011AA Property
    C0037313
    NCI Thesaurus Property-3
    C62189
    UMLS 2011AA Property-2
    C1299586
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    PatientDifficultySleepingAssessmentScale

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C73425
    UMLS 2011AA Property
    C0037313
    NCI Thesaurus Property-3
    C62189
    UMLS 2011AA Property-2
    C1299586
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    Shortness of breath (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    DyspneaAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C2998
    UMLS 2011AA ObjectClass-2
    C0013404
    Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    DyspneaAssessmentResponseScale

    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
    C2998
    UMLS 2011AA ObjectClass-2
    C0013404
    Nausea (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    NauseaAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    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
    Nausea (If YES, how much did it DISTRESS or BOTHER you?)
    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
    Cough (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    Description

    CoughAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C37935
    UMLS 2011AA ObjectClass-2
    C0010200
    Cough (If YES, how much did it DISTRESS or BOTHER you?)
    Description

    CoughAssessmentResponseScale

    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
    C37935
    UMLS 2011AA ObjectClass-2
    C0010200
    Worrying (During the past 7 days did you have any of the following symptoms?)
    Description

    AnxietyAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C26696
    UMLS 2011AA ObjectClass-2
    C0003467
    Worrying (If YES, how OFTEN did it occur?)
    Description

    AnxietyAssessmentResponseFrequency

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C26696
    UMLS 2011AA ObjectClass-2
    C0003467
    NCI Thesaurus ValueDomain
    C25515
    UMLS 2011AA ValueDomain
    C0439603
    Feeling sad (During the past 7 days did you have any of the following symptoms?)
    Description

    DepressionAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C2982
    UMLS 2011AA ObjectClass-2
    C0011570
    Feeling sad (If YES, how OFTEN did it occur?)
    Description

    DepressionAssessmentResponseFrequency

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ObjectClass-2
    C2982
    UMLS 2011AA ObjectClass-2
    C0011570
    NCI Thesaurus ValueDomain
    C25515
    UMLS 2011AA ValueDomain
    C0439603
    Feeling nervous (During the past 7 days did you have any of the following symptoms?)
    Description

    NervousnessAssessmentResponseInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Metathesaurus ObjectClass
    C0027769
    Feeling nervous (If YES, how OFTEN did it occur?)
    Description

    NervousnessAssessmentResponseFrequency

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ValueDomain
    C25515
    UMLS 2011AA ValueDomain
    C0439603
    NCI Metathesaurus ObjectClass
    C0027769
    Assessment of Quality of Life
    Description

    Assessment of Quality of Life

    How would you rate your overall quality of life during the past week? (Mark one with an X)
    Description

    PatientQualityofLifeAssessmentScale

    Data type

    text

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

    Similar models

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header
    Form ID CALGB
    Item
    CALGB Form
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3262252 (UMLS CUI-1)
    C19464 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus ObjectClass-2)
    Protocol ID CALGB
    Item
    CALGB Study No
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Trial subject ID CALGB
    Item
    CALGB Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Data amended
    Item
    Are data amended
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Patient demographics
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Medical Record Number
    Item
    Patient Medical Record Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Participating Group
    Item
    Participating Group
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    ClinicalResearchAssociateResponsiblePersonName
    Item
    Responsible CRA
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25657 (NCI Thesaurus ObjectClass)
    C1273518 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25465 (NCI Thesaurus ObjectClass-2)
    C1516627 (UMLS 2011AA ObjectClass-2)
    Item Group
    Memorial Symptom Assessment
    FatigueAssessmentResponseInd-2
    Item
    Lack of energy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (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)
    Item
    Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
    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)
    Code List
    Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    AppetiteAssessmentResponseInd-2
    Item
    Lack of appetite (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C25152 (NCI Thesaurus ObjectClass-2)
    C0003618 (UMLS 2011AA ObjectClass-2)
    Item
    Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C25152 (NCI Thesaurus ObjectClass-2)
    C0003618 (UMLS 2011AA ObjectClass-2)
    Code List
    Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    PainAssessmentResponseInd-2
    Item
    Pain (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (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)
    Item
    Pain (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus ObjectClass-2)
    C0030193 (UMLS 2011AA ObjectClass-2)
    Code List
    Pain (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    PatientDryMouthAssessmentInd-2
    Item
    Dry Mouth (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26917 (NCI Thesaurus Property-2)
    C0043352 (UMLS 2011AA Property-2)
    Item
    Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26917 (NCI Thesaurus Property-2)
    C0043352 (UMLS 2011AA Property-2)
    Code List
    Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    WeightLossAssessmentResponseInd-2
    Item
    Weight loss (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C3445 (NCI Thesaurus ObjectClass-2)
    C1262477 (UMLS 2011AA ObjectClass-2)
    Item
    Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C3445 (NCI Thesaurus ObjectClass-2)
    C1262477 (UMLS 2011AA ObjectClass-2)
    Code List
    Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    SomnolenceAssessmentResponseInd-2
    Item
    Feeling drowsy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C26754 (NCI Thesaurus ObjectClass-2)
    C2830004 (UMLS 2011AA ObjectClass-2)
    Item
    Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
    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)
    C26754 (NCI Thesaurus ObjectClass-2)
    C2830004 (UMLS 2011AA ObjectClass-2)
    Code List
    Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    PatientDifficultySleepingAssessmentInd-2
    Item
    Difficulty sleeping (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C73425 (NCI Thesaurus Property-2)
    C0037313 (UMLS 2011AA Property)
    C62189 (NCI Thesaurus Property-3)
    C1299586 (UMLS 2011AA Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    Item
    Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C73425 (NCI Thesaurus Property-2)
    C0037313 (UMLS 2011AA Property)
    C62189 (NCI Thesaurus Property-3)
    C1299586 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    Code List
    Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    DyspneaAssessmentResponseInd-2
    Item
    Shortness of breath (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C2998 (NCI Thesaurus ObjectClass-2)
    C0013404 (UMLS 2011AA ObjectClass-2)
    Item
    Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C2998 (NCI Thesaurus ObjectClass-2)
    C0013404 (UMLS 2011AA ObjectClass-2)
    Code List
    Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    NauseaAssessmentResponseInd-2
    Item
    Nausea (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (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)
    Item
    Nausea (If YES, how much did it DISTRESS or BOTHER you?)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C3258 (NCI Thesaurus ObjectClass-2)
    C0027497 (UMLS 2011AA ObjectClass-2)
    Code List
    Nausea (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    CoughAssessmentResponseInd-2
    Item
    Cough (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C37935 (NCI Thesaurus ObjectClass-2)
    C0010200 (UMLS 2011AA ObjectClass-2)
    Item
    Cough (If YES, how much did it DISTRESS or BOTHER you?)
    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)
    C37935 (NCI Thesaurus ObjectClass-2)
    C0010200 (UMLS 2011AA ObjectClass-2)
    Code List
    Cough (If YES, how much did it DISTRESS or BOTHER you?)
    CL Item
    A Little Bit (A little bit)
    CL Item
    Not At All (Not at all)
    C91213 (NCI Thesaurus)
    C91213 (NCI Thesaurus-2)
    CL Item
    Quite A Bit (Quite a bit)
    C91216 (NCI Thesaurus)
    C91216 (NCI Thesaurus-2)
    CL Item
    Somewhat (Somewhat)
    C91215 (NCI Thesaurus)
    CL Item
    Very Much (Very much)
    C91217 (NCI Thesaurus)
    C91217 (NCI Thesaurus-2)
    AnxietyAssessmentResponseInd-2
    Item
    Worrying (During the past 7 days did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus ObjectClass-2)
    C0003467 (UMLS 2011AA ObjectClass-2)
    Item
    Worrying (If YES, how OFTEN did it occur?)
    text
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus ObjectClass-2)
    C0003467 (UMLS 2011AA ObjectClass-2)
    C25515 (NCI Thesaurus ValueDomain)
    C0439603 (UMLS 2011AA ValueDomain)
    Code List
    Worrying (If YES, how OFTEN did it occur?)
    CL Item
    Almost Constantly (Almost constantly)
    CL Item
    Frequently (Frequently)
    CL Item
    Occasionally (Occasionally)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    DepressionAssessmentResponseInd-2
    Item
    Feeling sad (During the past 7 days did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C2982 (NCI Thesaurus ObjectClass-2)
    C0011570 (UMLS 2011AA ObjectClass-2)
    Item
    Feeling sad (If YES, how OFTEN did it occur?)
    text
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C2982 (NCI Thesaurus ObjectClass-2)
    C0011570 (UMLS 2011AA ObjectClass-2)
    C25515 (NCI Thesaurus ValueDomain)
    C0439603 (UMLS 2011AA ValueDomain)
    Code List
    Feeling sad (If YES, how OFTEN did it occur?)
    CL Item
    Almost Constantly (Almost constantly)
    CL Item
    Frequently (Frequently)
    CL Item
    Occasionally (Occasionally)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    NervousnessAssessmentResponseInd-2
    Item
    Feeling nervous (During the past 7 days did you have any of the following symptoms?)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C0027769 (NCI Metathesaurus ObjectClass)
    Item
    Feeling nervous (If YES, how OFTEN did it occur?)
    text
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C25515 (NCI Thesaurus ValueDomain)
    C0439603 (UMLS 2011AA ValueDomain)
    C0027769 (NCI Metathesaurus ObjectClass)
    Code List
    Feeling nervous (If YES, how OFTEN did it occur?)
    CL Item
    Almost Constantly (Almost constantly)
    CL Item
    Frequently (Frequently)
    CL Item
    Occasionally (Occasionally)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    Item Group
    Assessment of Quality of Life
    Item
    How would you rate your overall quality of life during the past week? (Mark one with an X)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus Property)
    C0518214 (UMLS 2011AA Property)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property-2)
    C0031809 (UMLS 2011AA Property-2)
    Code List
    How would you rate your overall quality of life during the past week? (Mark one with an X)
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    10 (10)
    CL Item
    20 (20)
    CL Item
    30 (30)
    CL Item
    40 (40)
    CL Item
    50 (50)
    CL Item
    60 (60)
    CL Item
    70 (70)
    CL Item
    80 (80)
    CL Item
    90 (90)
    CL Item
    100 (100)

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