ID

44128

Descripción

NSABP Protocol C-09: Quality of Life Form Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer NCT00268463 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7E0FCB-064A-58CD-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7E0FCB-064A-58CD-E034-0003BA3F9857

Palabras clave

Versiones (5)
  1. 27/8/12 27/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 21/3/15 21/3/15 - Martin Dugas
  4. 10/4/21 10/4/21 - Ahmed Rafee, MD
  5. 20/9/21 20/9/21 -
Titular de derechos de autor

folgt

Subido en

20 de septiembre de 2021

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY 4.0
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Colorectal cancer metastases (NCT00268463)

Inglés

All patients in C-09 should complete this questionnaire at: (1) baseline (after consent and prior to randomization) and (2) 4-6 weeks after surgery

1 formularios  
Header
Descripción

Header

Alias
UMLS CUI-1
C1320722
Patient Initials (Last First Middle)
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
NSABP Patient ID
Descripción

Patient ID NSABP

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1513905
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
Institution Name
Descripción

Institution Name

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Affiliate Name
Descripción

Affiliate Name

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS CUI-1
C1510825
NCI Thesaurus ObjectClass-2
C25413
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Staff Member Administering Form Last Name
Descripción

PersonFormAdministrationLastName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C25551
UMLS 2011AA ValueDomain-2
C1517741
Staff Member Administering Form First Name
Descripción

PersonFormAdministrationFirstName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C25509
UMLS 2011AA ValueDomain-2
C1279901
Staff Member Administering Form Phone
Descripción

PersonFormAdministrationPhoneNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
Are data amended (check box if yes, and circle amended items)
Descripción

Data amended

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
This form is being filled out
Descripción

Thisformisbeingfilledout

Tipo de datos

text

Time Point
Descripción

AssessmentPeriodType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
Does the patient have a hepatic pump
Descripción

Doesthepatienthaveahepaticpump

Tipo de datos

boolean

Alias
UMLS CUI-1
C1563226
indicate location of hepatic pump
Descripción

indicatelocationofhepaticpump

Tipo de datos

text

Date this questionnaiare is completed (Month Day Year)
Descripción

QualityofLifeCompleteAssessmentDate

Tipo de datos

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
Treatment satisfaction
Descripción

Treatment satisfaction

Alias
UMLS CUI-1
C3476649
Receiving treatment is convenient for me
Descripción

Receivingtreatmentisconvenientforme

Tipo de datos

integer

Alias
UMLS CUI-1
C3831015
I am satisfied with my current treatment
Descripción

Iamsatisfiedwithmycurrenttreatment

Tipo de datos

text

Alias
UMLS CUI-1
C3476649
Physical Well-being
Descripción

Physical Well-being

Alias
UMLS CUI-1
C0517226
I have a lack of energy
Descripción

PatientEnergyAssessmentQualityofLifeScale

Tipo de datos

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
C3830237
I have nausea
Descripción

PatientNauseaAssessmentQualityofLifeScale

Tipo de datos

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
C0027497
Because of my physical condition, I have trouble meeting the needs of my family
Descripción

PatientGeneralPhysicalConditionAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL104641
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984046
I have pain
Descripción

PatientPainAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3303
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C0030193
I am bothered by side effects of treatment
Descripción

PatientAdverseEventAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C41331
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984047
I feel ill
Descripción

PatientMalaiseAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3832
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C0231218
I am forced to spend time in bed
Descripción

PatientBedRestAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
UMLS CUI-1
C2984055
Social/family Well-being
Descripción

Social/family Well-being

Alias
UMLS CUI-1
C3476515
I feel close to my friends
Descripción

FriendsPatientintimacyAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0079382
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0600015
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984048
I get emotional support from my family
Descripción

FamilyPatientEmotionalSupportAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C25173
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0600015
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984050
I get support from my friends
Descripción

FriendsPatientEmotionalSupportAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0079382
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0600015
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3161725
My family has accepted my illness
Descripción

FamilyPatientAcceptanceofIllnessAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C25173
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL140183
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984053
I am satisfied with family communication about my illness
Descripción

FamilyPatientCommunicationAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C25173
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C16452
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984054
I feel close to my partner (or the person who is my main support)
Descripción

PartnerPatientIntimacyAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0682323
NCI Thesaurus Property
C20989
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984059
I am satisfied with my sex life
Descripción

SatisfactionPatientCurrentSexualActivityAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62185
NCI Metathesaurus Property
C0043227
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984060
Emotional Well-being
Descripción

Emotional Well-being

Alias
UMLS CUI-1
C2984554
I feel sad
Descripción

PatientDepressionAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C2982
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2987511
I am satisfied with how I am coping with my illness
Descripción

SatisfactionPatientAbilitytoCopeAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62185
NCI Metathesaurus Property
C0043227
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984061
I am losing hope in the fight against my illness
Descripción

PatientDespondencyAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0392375
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984056
I feel nervous
Descripción

PatientNervousAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C25584
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3536990
I worry about dying
Descripción

WorryPatientDeathAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0233481
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C28554
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984076
I worry that my condition will get worse
Descripción

WorryPatientDeteriorationAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0233481
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C25751
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984075
Functional Well-being
Descripción

Functional Well-being

Alias
UMLS CUI-1
C2984555
I am able to work (include work at home)
Descripción

WorkAssessmentResponseType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C25755
UMLS CUI-1
C2984044
My work is fulfilling (include work at home)
Descripción

QualityofLifeOccupationSatisfactionAssessmentType

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62185
NCI Thesaurus Property-3
C25193
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2984074
I am able to enjoy life
Descripción

PatientEnjoymentofLifeAssessmentQualityofLifeAssessment

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL196329
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984051
I have accepted my illness
Descripción

PatientAcceptanceofIllnessAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL140183
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984045
I am sleeping well
Descripción

I am sleeping well

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0037313
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984071
I am enjoying the things I usually do for fun
Descripción

PleasurePatientRecreationAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Metathesaurus ObjectClass
C0679105
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0034872
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984052
I am content with the quality of my life right now
Descripción

PatientQualityofLifeAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C17047
NCI Thesaurus Property-2
C20989
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C2984049
Additional Concerns
Descripción

Additional Concerns

Alias
UMLS CUI-1
C3482667
I have swelling or cramps in my stomach area
Descripción

Ihaveswellingorcrampsinmystomacharea

Tipo de datos

text

Alias
UMLS CUI-1
C3641879
I am losing weight
Descripción

PatientWeightLossAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3445
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C1262477
I have control of my bowels
Descripción

I have control of my bowels

Tipo de datos

text

Alias
UMLS CUI-1
C3641881
I can digest my food well
Descripción

Icandigestmyfoodwell

Tipo de datos

text

Alias
UMLS CUI-1
C3641883
I have diarrhea
Descripción

Ihavediarrhea

Tipo de datos

text

Alias
UMLS CUI-1
C0011991
I have a good appetite
Descripción

PatientAppetiteAssessmentQualityofLifeScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C25152
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3274935
I like the appearance of my body
Descripción

Iliketheappearanceofmybody

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3829285
Do you have an ostomy appliance
Descripción

Doyouhaveanostomyappliance

Tipo de datos

boolean

Alias
UMLS CUI-1
C0182096
I am embarrassed by my ostomy appliance
Descripción

QualityofLifeEmbarrassmentOstomyAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus Property
C62187
NCI Thesaurus Property-2
C25217
NCI Thesaurus Property-3
C15290
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3475628
Caring for my ostomy appliance is difficult
Descripción

QualityofLifeOstomyCareAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus Property
C25217
NCI Thesaurus Property-2
C61488
NCI Thesaurus Property-3
C15290
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3482502
I have numbness or tingling in my hands
Descripción

QOLHandNumbnessScore

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus ValueDomain-2
C17047
NCI Thesaurus Property
C25217
UMLS CUI-1
C3829780
I have numbness or tingling in my feet
Descripción

QOLFootNumbnessScore

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus ValueDomain-2
C17047
NCI Thesaurus Property
C25217
UMLS CUI-1
C3829781
I feel discomfort in my hands
Descripción

QOLHandDiscomfortScore

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus ValueDomain-2
C17047
NCI Thesaurus Property
C25217
UMLS CUI-1
C3830164
I feel discomfort in my feet
Descripción

QOLFootDiscomfortScore

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C17047
NCI Thesaurus ValueDomain-2
C17047
NCI Thesaurus Property
C25217
UMLS CUI-1
C3830165
I have joint pain or muscle cramps
Descripción

Ihavejointpainormusclecramps

Tipo de datos

text

Alias
UMLS CUI-1
C3829787
I feel weak all over
Descripción

Ifeelweakallover

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3274923
I have trouble hearing
Descripción

Ihavetroublehearing

Tipo de datos

text

Alias
UMLS CUI-1
C3829759
I get a ringing or buzzing in my ears
Descripción

Igetaringingorbuzzinginmyears

Tipo de datos

text

Alias
UMLS CUI-1
C3829985
I have trouble buttoning buttons
Descripción

Ihavetroublebuttoningbuttons

Tipo de datos

text

Alias
UMLS CUI-1
C3829762
I have trouble feeling the shape of small objects when they are in my hand
Descripción

Ihavetroublefeelingtheshapeofsmallobjectswhentheyareinmyhand

Tipo de datos

text

Alias
UMLS CUI-1
C3829760
I have trouble walking
Descripción

Ihavetroublewalking

Tipo de datos

text

Alias
UMLS CUI-1
C3829756
I have pain in my hands or feet when I am exposed to cold temperatures
Descripción

IhavepaininmyhandsorfeetwhenIamexposedtocoldtemperatures

Tipo de datos

text

Alias
UMLS CUI-1
C3475905
I have difficulty breathing when I am exposed to cold temperatures
Descripción

IhavedifficultybreathingwhenIamexposedtocoldtemperatures

Tipo de datos

text

Alias
UMLS CUI-1
C3475836
Abdominal pain or cramping
Descripción

Abdominalpainorcramping

Tipo de datos

text

Alias
UMLS CUI-1
C0000737
Gas pain
Descripción

Gaspain

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0476289
Mouth sores
Descripción

Mouth sores

Tipo de datos

text

Alias
UMLS CUI-1
C0149745
Vomiting
Descripción

Vomiting

Tipo de datos

text

Alias
UMLS CUI-1
C0042963
Skin problems (including rash, dry skin, itching, irritation or redness)
Descripción

DermalAssessmentResponseType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C25755
UMLS CUI-1
C0281822
Skin redness or peeling on hands and feet
Descripción

Skinrednessorpeelingonhandsandfeet

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0041834
Hair loss
Descripción

Hair loss

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0002170
Pain at intravenous site
Descripción

Painatintravenoussite

Tipo de datos

text

Alias
UMLS CUI-1
C0030193
UMLS CUI-2
C1319047
Eye problems
Descripción

Eye problems

Tipo de datos

text

Alias
UMLS CUI-1
C0262477
Other problems (Specify below)
Descripción

Other problems (Specify below)

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C1273828
Please specify other problems
Descripción

Pleasespecifyotherproblems

Tipo de datos

text

How self conscious have you felt about your body and your appearance
Descripción

Howselfconscioushaveyoufeltaboutyourbodyandyourappearance

Tipo de datos

text

Alias
UMLS CUI-1
C3641178
How satisfied have you been with the way your chemotherapy is being delivered
Descripción

Howsatisfiedhaveyoubeenwiththewayyourchemotherapyisbeingdelivered

Tipo de datos

text

How much have you feared that your pump will be dislodged
Descripción

Howmuchhaveyoufearedthatyourpumpwillbedislodged

Tipo de datos

text

How much discomfort or pain has your pump caused you
Descripción

Howmuchdiscomfortorpainhasyourpumpcausedyou

Tipo de datos

text

How much have you protected your body where the pump is located
Descripción

Howmuchhaveyouprotectedyourbodywherethepumpislocated

Tipo de datos

text

Activity
Descripción

Activity

Did you feel full of life
Descripción

Didyoufeelfulloflife

Tipo de datos

text

Alias
UMLS CUI-1
C3829819
Did you have a lot of energy
Descripción

PatientEnergyAssessmentScale

Tipo de datos

text

Alias
UMLS CUI [1]
C3828394
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C48058
Did you feel worn out
Descripción

PatientFatigueAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3036
UMLS CUI-1
C3828399
Did you feel tired
Descripción

PatientLethargyAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0023380
UMLS CUI-1
C3539029
Your ability to do vigorous activities
Descripción

Yourabilitytodovigorousactivities

Tipo de datos

text

Alias
UMLS CUI-1
C3827557
The position you like to sleep in
Descripción

Thepositionyouliketosleepin

Tipo de datos

text

Alias
UMLS CUI-1
C2964006
Your ability to eat a full meal
Descripción

Yourabilitytoeatafullmeal

Tipo de datos

text

Alias
UMLS CUI-1
C0566304
Your ability to lift things
Descripción

Yourabilitytoliftthings

Tipo de datos

text

Hugging family or friends
Descripción

Hugging family or friends

Tipo de datos

text

Bending over or twisting
Descripción

Bending over or twisting

Tipo de datos

text

Your ability to travel
Descripción

Your ability to travel

Tipo de datos

text

The type of clothing you wear
Descripción

The type of clothing you wear

Tipo de datos

text

Alias
UMLS CUI-1
C0009072
Your comfort in sexual activities
Descripción

Your comfort in sexual activities

Tipo de datos

text

Alias
UMLS CUI-1
C0278109
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Similar models

All patients in C-09 should complete this questionnaire at: (1) baseline (after consent and prior to randomization) and (2) 4-6 weeks after surgery

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Affiliate Name
Item
Affiliate Name
text
C21541 (NCI Thesaurus ObjectClass)
C1510825 (UMLS CUI-1)
C25413 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
PersonFormAdministrationLastName
Item
Staff Member Administering Form Last Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
PersonFormAdministrationFirstName
Item
Staff Member Administering Form First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25509 (NCI Thesaurus ValueDomain-2)
C1279901 (UMLS 2011AA ValueDomain-2)
PersonFormAdministrationPhoneNumber
Item
Staff Member Administering Form Phone
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
Data amended
Item
Are data amended (check box if yes, and circle amended items)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item
This form is being filled out
text
CL.4
Code List
This form is being filled out
CL Item
By participant in doctor's office/clinic (By participant in doctor's office/clinic)
CL Item
By participant not in doctor's office/clinic (By participant not in doctor's office/clinic)
CL Item
By clinical staff, on phone with participant (By clinical staff, on phone with participant)
CL Item
Other (Other)
Item
Time Point
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
CL.5
Code List
Time Point
CL Item
Baseline (Baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
CL Item
18 Weeks (18 weeks)
CL Item
4-6 Weeks After Surgery (4-6 weeks after surgery)
CL Item
Post-chemotherapy (Post chemotherapy)
C0439577 (NCI Metathesaurus)
Hepatic pump
Item
Does the patient have a hepatic pump
boolean
C1563226 (UMLS CUI-1)
Item
indicate location of hepatic pump
text
CL.3
Code List
indicate location of hepatic pump
CL Item
Lower chest (Lower chest)
CL Item
Abdomen (Abdomen)
QualityofLifeCompleteAssessmentDate
Item
Date this questionnaiare is completed (Month Day Year)
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)
Item Group
Treatment satisfaction
C3476649 (UMLS CUI-1)
Item
Receiving treatment is convenient for me
integer
C3831015 (UMLS CUI-1)
CL.6
Code List
Receiving treatment is convenient for me
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
CL Item
I have not received treatment in the past month (6)
C0746919 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
Item
I am satisfied with my current treatment
text
C3476649 (UMLS CUI-1)
CL.6
Code List
I am satisfied with my current treatment
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
CL Item
I have not received treatment in the past month (6)
C0746919 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
Item Group
Physical Well-being
C0517226 (UMLS CUI-1)
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)
C3830237 (UMLS CUI-1)
CL.8
Code List
I have a lack of energy
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
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)
C0027497 (UMLS CUI-1)
CL.8
Code List
I have nausea
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Because of my physical condition, I have trouble meeting the needs of my family
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
CL104641 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984046 (UMLS CUI-1)
CL.8
Code List
Because of my physical condition, I have trouble meeting the needs of my family
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have pain
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C3303 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0030193 (UMLS CUI-1)
CL.8
Code List
I have pain
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am bothered by side effects of treatment
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984047 (UMLS CUI-1)
CL.8
Code List
I am bothered by side effects of treatment
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel ill
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C3832 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0231218 (UMLS CUI-1)
CL.8
Code List
I feel ill
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am forced to spend time in bed
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C2984055 (UMLS CUI-1)
CL.8
Code List
I am forced to spend time in bed
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item Group
Social/family Well-being
C3476515 (UMLS CUI-1)
Item
I feel close to my friends
text
C16960 (NCI Thesaurus ObjectClass)
C0079382 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0600015 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984048 (UMLS CUI-1)
CL.8
Code List
I feel close to my friends
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I get emotional support from my family
text
C16960 (NCI Thesaurus ObjectClass)
C25173 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0600015 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984050 (UMLS CUI-1)
CL.8
Code List
I get emotional support from my family
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I get support from my friends
text
C16960 (NCI Thesaurus ObjectClass)
C0079382 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0600015 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3161725 (UMLS CUI-1)
CL.8
Code List
I get support from my friends
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
My family has accepted my illness
text
C16960 (NCI Thesaurus ObjectClass)
C25173 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
CL140183 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984053 (UMLS CUI-1)
CL.8
Code List
My family has accepted my illness
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am satisfied with family communication about my illness
text
C16960 (NCI Thesaurus ObjectClass)
C25173 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C16452 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984054 (UMLS CUI-1)
CL.8
Code List
I am satisfied with family communication about my illness
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel close to my partner (or the person who is my main support)
text
C16960 (NCI Thesaurus ObjectClass)
C0682323 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984059 (UMLS CUI-1)
CL.8
Code List
I feel close to my partner (or the person who is my main support)
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am satisfied with my sex life
text
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984060 (UMLS CUI-1)
CL.8
Code List
I am satisfied with my sex life
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item Group
Emotional Well-being
C2984554 (UMLS CUI-1)
Item
I feel sad
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C2982 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2987511 (UMLS CUI-1)
CL.8
Code List
I feel sad
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am satisfied with how I am coping with my illness
text
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984061 (UMLS CUI-1)
CL.8
Code List
I am satisfied with how I am coping with my illness
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am losing hope in the fight against my illness
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0392375 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984056 (UMLS CUI-1)
CL.8
Code List
I am losing hope in the fight against my illness
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel nervous
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25584 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3536990 (UMLS CUI-1)
CL.8
Code List
I feel nervous
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I worry about dying
text
C16960 (NCI Thesaurus ObjectClass)
C0233481 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C28554 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984076 (UMLS CUI-1)
CL.8
Code List
I worry about dying
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I worry that my condition will get worse
text
C16960 (NCI Thesaurus ObjectClass)
C0233481 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25751 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984075 (UMLS CUI-1)
CL.8
Code List
I worry that my condition will get worse
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item Group
Functional Well-being
C2984555 (UMLS CUI-1)
Item
I am able to work (include work at home)
text
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C25755 (NCI Thesaurus Property)
C2984044 (UMLS CUI-1)
CL.8
Code List
I am able to work (include work at home)
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
My work is fulfilling (include work at home)
text
C17047 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C25193 (NCI Thesaurus Property-3)
C25284 (NCI Thesaurus ValueDomain)
C2984074 (UMLS CUI-1)
CL.8
Code List
My work is fulfilling (include work at home)
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am able to enjoy life
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
CL196329 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984051 (UMLS CUI-1)
CL.8
Code List
I am able to enjoy life
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have accepted my illness
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
CL140183 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984045 (UMLS CUI-1)
CL.8
Code List
I have accepted my illness
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am sleeping well
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0037313 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984071 (UMLS CUI-1)
CL.8
Code List
I am sleeping well
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am enjoying the things I usually do for fun
text
C16960 (NCI Thesaurus ObjectClass)
C0679105 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0034872 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984052 (UMLS CUI-1)
CL.8
Code List
I am enjoying the things I usually do for fun
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am content with the quality of my life right now
text
C16960 (NCI Thesaurus ObjectClass)
C17047 (NCI Thesaurus Property)
C20989 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C2984049 (UMLS CUI-1)
CL.8
Code List
I am content with the quality of my life right now
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item Group
Additional Concerns
C3482667 (UMLS CUI-1)
Item
I have swelling or cramps in my stomach area
text
C3641879 (UMLS CUI-1)
CL.8
Code List
I have swelling or cramps in my stomach area
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I am losing weight
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C3445 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C1262477 (UMLS CUI-1)
CL.8
Code List
I am losing weight
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have control of my bowels
text
C3641881 (UMLS CUI-1)
CL.8
Code List
I have control of my bowels
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I can digest my food well
text
C3641883 (UMLS CUI-1)
CL.8
Code List
I can digest my food well
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have diarrhea
text
C0011991 (UMLS CUI-1)
CL.8
Code List
I have diarrhea
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have a good appetite
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25152 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3274935 (UMLS CUI-1)
CL.8
Code List
I have a good appetite
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I like the appearance of my body
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829285 (UMLS CUI-1)
CL.8
Code List
I like the appearance of my body
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Ostomy appliance
Item
Do you have an ostomy appliance
boolean
C0182096 (UMLS CUI-1)
Item
I am embarrassed by my ostomy appliance
text
C17047 (NCI Thesaurus ObjectClass)
C62187 (NCI Thesaurus Property)
C25217 (NCI Thesaurus Property-2)
C15290 (NCI Thesaurus Property-3)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3475628 (UMLS CUI-1)
CL.8
Code List
I am embarrassed by my ostomy appliance
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Caring for my ostomy appliance is difficult
text
C17047 (NCI Thesaurus ObjectClass)
C25217 (NCI Thesaurus Property)
C61488 (NCI Thesaurus Property-2)
C15290 (NCI Thesaurus Property-3)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3482502 (UMLS CUI-1)
CL.8
Code List
Caring for my ostomy appliance is difficult
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have numbness or tingling in my hands
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C17047 (NCI Thesaurus ValueDomain-2)
C25217 (NCI Thesaurus Property)
C3829780 (UMLS CUI-1)
CL.8
Code List
I have numbness or tingling in my hands
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have numbness or tingling in my feet
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C17047 (NCI Thesaurus ValueDomain-2)
C25217 (NCI Thesaurus Property)
C3829781 (UMLS CUI-1)
CL.8
Code List
I have numbness or tingling in my feet
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel discomfort in my hands
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C17047 (NCI Thesaurus ValueDomain-2)
C25217 (NCI Thesaurus Property)
C3830164 (UMLS CUI-1)
CL.8
Code List
I feel discomfort in my hands
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel discomfort in my feet
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C17047 (NCI Thesaurus ValueDomain-2)
C25217 (NCI Thesaurus Property)
C3830165 (UMLS CUI-1)
CL.8
Code List
I feel discomfort in my feet
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have joint pain or muscle cramps
text
C3829787 (UMLS CUI-1)
CL.8
Code List
I have joint pain or muscle cramps
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I feel weak all over
text
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3274923 (UMLS CUI-1)
CL.8
Code List
I feel weak all over
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have trouble hearing
text
C3829759 (UMLS CUI-1)
CL.8
Code List
I have trouble hearing
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I get a ringing or buzzing in my ears
text
C3829985 (UMLS CUI-1)
CL.8
Code List
I get a ringing or buzzing in my ears
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have trouble buttoning buttons
text
C3829762 (UMLS CUI-1)
CL.8
Code List
I have trouble buttoning buttons
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have trouble feeling the shape of small objects when they are in my hand
text
C3829760 (UMLS CUI-1)
CL.8
Code List
I have trouble feeling the shape of small objects when they are in my hand
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have trouble walking
text
C3829756 (UMLS CUI-1)
CL.8
Code List
I have trouble walking
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have pain in my hands or feet when I am exposed to cold temperatures
text
C3475905 (UMLS CUI-1)
CL.8
Code List
I have pain in my hands or feet when I am exposed to cold temperatures
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
I have difficulty breathing when I am exposed to cold temperatures
text
C3475836 (UMLS CUI-1)
CL.8
Code List
I have difficulty breathing when I am exposed to cold temperatures
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Abdominal pain or cramping
text
C0000737 (UMLS CUI-1)
CL.58
Code List
Abdominal pain or cramping
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Gas pain
text
C25284 (NCI Thesaurus ValueDomain)
C0476289 (UMLS CUI-1)
CL.58
Code List
Gas pain
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Mouth sores
text
C0149745 (UMLS CUI-1)
CL.8
Code List
Mouth sores
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Vomiting
text
C0042963 (UMLS CUI-1)
CL.8
Code List
Vomiting
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Skin problems (including rash, dry skin, itching, irritation or redness)
text
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C25755 (NCI Thesaurus Property)
C0281822 (UMLS CUI-1)
CL.58
Code List
Skin problems (including rash, dry skin, itching, irritation or redness)
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Skin redness or peeling on hands and feet
text
C25284 (NCI Thesaurus ValueDomain)
C0041834 (UMLS CUI-1)
CL.58
Code List
Skin redness or peeling on hands and feet
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Hair loss
text
C25284 (NCI Thesaurus ValueDomain)
C0002170 (UMLS CUI-1)
CL.58
Code List
Hair loss
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Pain at intravenous site
text
C0030193 (UMLS CUI-1)
C1319047 (UMLS CUI-2)
CL.58
Code List
Pain at intravenous site
CL Item
Not bothered at all (1)
C3828778 (UMLS CUI-1)
CL Item
Bothered a little (2)
C3831310 (UMLS CUI-1)
CL Item
Bothered somewhat (3)
C3831293 (UMLS CUI-1)
CL Item
Quite bothered (4)
C3831294 (UMLS CUI-1)
CL Item
Very bothered (5)
C3831292 (UMLS CUI-1)
Item
Eye problems
text
C0262477 (UMLS CUI-1)
CL.8
Code List
Eye problems
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Item
Other problems (Specify below)
text
C25284 (NCI Thesaurus ValueDomain)
C1273828 (UMLS CUI-1)
CL.8
Code List
Other problems (Specify below)
CL Item
Not at all (1)
C2984077 (UMLS CUI-1)
CL Item
A little bit (2)
C2984078 (UMLS CUI-1)
CL Item
Somewhat (3)
C2984079 (UMLS CUI-1)
CL Item
Quite a bit (4)
C2984080 (UMLS CUI-1)
CL Item
Very much (5)
C2984081 (UMLS CUI-1)
Please specify other problems
Item
Please specify other problems
text
Item
How self conscious have you felt about your body and your appearance
text
C3641178 (UMLS CUI-1)
CL.68
Code List
How self conscious have you felt about your body and your appearance
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
How satisfied have you been with the way your chemotherapy is being delivered
text
CL.69
Code List
How satisfied have you been with the way your chemotherapy is being delivered
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
How much have you feared that your pump will be dislodged
text
CL.83
Code List
How much have you feared that your pump will be dislodged
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
How much discomfort or pain has your pump caused you
text
CL.84
Code List
How much discomfort or pain has your pump caused you
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
How much have you protected your body where the pump is located
text
CL.85
Code List
How much have you protected your body where the pump is located
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item Group
Activity
Item
Did you feel full of life
text
C3829819 (UMLS CUI-1)
CL.70
Code List
Did you feel full of life
CL Item
All of the time (1)
C3812891 (UMLS CUI-1)
CL Item
Most of the time (2)
C3828954 (UMLS CUI-1)
CL Item
Some of the time (3)
C3827992 (UMLS CUI-1)
CL Item
A little of the time (4)
C3831570 (UMLS CUI-1)
CL Item
None of the time (5)
C3812882 (UMLS CUI-1)
Item
Did you have a lot of energy
text
C3828394 (UMLS CUI [1])
C25664 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C48058 (NCI Thesaurus Property-2)
CL.70
Code List
Did you have a lot of energy
CL Item
All of the time (1)
C3812891 (UMLS CUI-1)
CL Item
Most of the time (2)
C3828954 (UMLS CUI-1)
CL Item
Some of the time (3)
C3827992 (UMLS CUI-1)
CL Item
A little of the time (4)
C3831570 (UMLS CUI-1)
CL Item
None of the time (5)
C3812882 (UMLS CUI-1)
Item
Did you feel worn out
text
C25664 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C3036 (NCI Thesaurus Property-2)
C3828399 (UMLS CUI-1)
CL.70
Code List
Did you feel worn out
CL Item
All of the time (1)
C3812891 (UMLS CUI-1)
CL Item
Most of the time (2)
C3828954 (UMLS CUI-1)
CL Item
Some of the time (3)
C3827992 (UMLS CUI-1)
CL Item
A little of the time (4)
C3831570 (UMLS CUI-1)
CL Item
None of the time (5)
C3812882 (UMLS CUI-1)
Item
Did you feel tired
text
C25664 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0023380 (NCI Metathesaurus Property)
C3539029 (UMLS CUI-1)
CL.70
Code List
Did you feel tired
CL Item
All of the time (1)
C3812891 (UMLS CUI-1)
CL Item
Most of the time (2)
C3828954 (UMLS CUI-1)
CL Item
Some of the time (3)
C3827992 (UMLS CUI-1)
CL Item
A little of the time (4)
C3831570 (UMLS CUI-1)
CL Item
None of the time (5)
C3812882 (UMLS CUI-1)
Item
Your ability to do vigorous activities
text
C3827557 (UMLS CUI-1)
CL.74
Code List
Your ability to do vigorous activities
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
The position you like to sleep in
text
C2964006 (UMLS CUI-1)
CL.75
Code List
The position you like to sleep in
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Your ability to eat a full meal
text
C0566304 (UMLS CUI-1)
CL.76
Code List
Your ability to eat a full meal
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Your ability to lift things
text
CL.77
Code List
Your ability to lift things
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Hugging family or friends
text
CL.78
Code List
Hugging family or friends
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Bending over or twisting
text
CL.79
Code List
Bending over or twisting
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Your ability to travel
text
CL.80
Code List
Your ability to travel
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
The type of clothing you wear
text
C0009072 (UMLS CUI-1)
CL.81
Code List
The type of clothing you wear
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Your comfort in sexual activities
text
C0278109 (UMLS CUI-1)
CL.82
Code List
Your comfort in sexual activities
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
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