ID

44128

Beskrivning

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

Länk

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

Nyckelord

Versioner (5)
  1. 2012-08-27 2012-08-27 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-03-21 2015-03-21 - Martin Dugas
  4. 2021-04-10 2021-04-10 - Ahmed Rafee, MD
  5. 2021-09-20 2021-09-20 -
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20 september 2021

DOI

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Creative Commons BY 4.0
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Colorectal cancer metastases (NCT00268463)

Engelsk

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 Formulär  
Header
Beskrivning

Header

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

Patient Initials

Datatyp

text

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

Patient ID NSABP

Datatyp

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
Beskrivning

Institution Name

Datatyp

text

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

Affiliate Name

Datatyp

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
Beskrivning

PersonFormAdministrationLastName

Datatyp

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
Beskrivning

PersonFormAdministrationFirstName

Datatyp

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
Beskrivning

PersonFormAdministrationPhoneNumber

Datatyp

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)
Beskrivning

Data amended

Datatyp

boolean

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

Thisformisbeingfilledout

Datatyp

text

Time Point
Beskrivning

AssessmentPeriodType

Datatyp

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
Beskrivning

Doesthepatienthaveahepaticpump

Datatyp

boolean

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

indicatelocationofhepaticpump

Datatyp

text

Date this questionnaiare is completed (Month Day Year)
Beskrivning

QualityofLifeCompleteAssessmentDate

Datatyp

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
Beskrivning

Treatment satisfaction

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

Receivingtreatmentisconvenientforme

Datatyp

integer

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

Iamsatisfiedwithmycurrenttreatment

Datatyp

text

Alias
UMLS CUI-1
C3476649
Physical Well-being
Beskrivning

Physical Well-being

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

PatientEnergyAssessmentQualityofLifeScale

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C48058
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C3830237
I have nausea
Beskrivning

PatientNauseaAssessmentQualityofLifeScale

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3258
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI-1
C0027497
Because of my physical condition, I have trouble meeting the needs of my family
Beskrivning

PatientGeneralPhysicalConditionAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientPainAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientAdverseEventAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientMalaiseAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientBedRestAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

Social/family Well-being

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

FriendsPatientintimacyAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

FamilyPatientEmotionalSupportAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

FriendsPatientEmotionalSupportAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

FamilyPatientAcceptanceofIllnessAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

FamilyPatientCommunicationAssessmentQualityofLifeScale

Datatyp

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)
Beskrivning

PartnerPatientIntimacyAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

SatisfactionPatientCurrentSexualActivityAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

Emotional Well-being

Alias
UMLS CUI-1
C2984554
I feel sad
Beskrivning

PatientDepressionAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

SatisfactionPatientAbilitytoCopeAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientDespondencyAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientNervousAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

WorryPatientDeathAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

WorryPatientDeteriorationAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

Functional Well-being

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

WorkAssessmentResponseType

Datatyp

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)
Beskrivning

QualityofLifeOccupationSatisfactionAssessmentType

Datatyp

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
Beskrivning

PatientEnjoymentofLifeAssessmentQualityofLifeAssessment

Datatyp

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
Beskrivning

PatientAcceptanceofIllnessAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

I am sleeping well

Datatyp

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
Beskrivning

PleasurePatientRecreationAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

PatientQualityofLifeAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

Additional Concerns

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

Ihaveswellingorcrampsinmystomacharea

Datatyp

text

Alias
UMLS CUI-1
C3641879
I am losing weight
Beskrivning

PatientWeightLossAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

I have control of my bowels

Datatyp

text

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

Icandigestmyfoodwell

Datatyp

text

Alias
UMLS CUI-1
C3641883
I have diarrhea
Beskrivning

Ihavediarrhea

Datatyp

text

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

PatientAppetiteAssessmentQualityofLifeScale

Datatyp

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
Beskrivning

Iliketheappearanceofmybody

Datatyp

text

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

Doyouhaveanostomyappliance

Datatyp

boolean

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

QualityofLifeEmbarrassmentOstomyAssessmentScale

Datatyp

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
Beskrivning

QualityofLifeOstomyCareAssessmentScale

Datatyp

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
Beskrivning

QOLHandNumbnessScore

Datatyp

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
Beskrivning

QOLFootNumbnessScore

Datatyp

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
Beskrivning

QOLHandDiscomfortScore

Datatyp

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
Beskrivning

QOLFootDiscomfortScore

Datatyp

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
Beskrivning

Ihavejointpainormusclecramps

Datatyp

text

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

Ifeelweakallover

Datatyp

text

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

Ihavetroublehearing

Datatyp

text

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

Igetaringingorbuzzinginmyears

Datatyp

text

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

Ihavetroublebuttoningbuttons

Datatyp

text

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

Ihavetroublefeelingtheshapeofsmallobjectswhentheyareinmyhand

Datatyp

text

Alias
UMLS CUI-1
C3829760
I have trouble walking
Beskrivning

Ihavetroublewalking

Datatyp

text

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

IhavepaininmyhandsorfeetwhenIamexposedtocoldtemperatures

Datatyp

text

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

IhavedifficultybreathingwhenIamexposedtocoldtemperatures

Datatyp

text

Alias
UMLS CUI-1
C3475836
Abdominal pain or cramping
Beskrivning

Abdominalpainorcramping

Datatyp

text

Alias
UMLS CUI-1
C0000737
Gas pain
Beskrivning

Gaspain

Datatyp

text

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

Mouth sores

Datatyp

text

Alias
UMLS CUI-1
C0149745
Vomiting
Beskrivning

Vomiting

Datatyp

text

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

DermalAssessmentResponseType

Datatyp

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
Beskrivning

Skinrednessorpeelingonhandsandfeet

Datatyp

text

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

Hair loss

Datatyp

text

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

Painatintravenoussite

Datatyp

text

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

Eye problems

Datatyp

text

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

Other problems (Specify below)

Datatyp

text

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

Pleasespecifyotherproblems

Datatyp

text

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

Howselfconscioushaveyoufeltaboutyourbodyandyourappearance

Datatyp

text

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

Howsatisfiedhaveyoubeenwiththewayyourchemotherapyisbeingdelivered

Datatyp

text

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

Howmuchhaveyoufearedthatyourpumpwillbedislodged

Datatyp

text

How much discomfort or pain has your pump caused you
Beskrivning

Howmuchdiscomfortorpainhasyourpumpcausedyou

Datatyp

text

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

Howmuchhaveyouprotectedyourbodywherethepumpislocated

Datatyp

text

Activity
Beskrivning

Activity

Did you feel full of life
Beskrivning

Didyoufeelfulloflife

Datatyp

text

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

PatientEnergyAssessmentScale

Datatyp

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
Beskrivning

PatientFatigueAssessmentScale

Datatyp

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
Beskrivning

PatientLethargyAssessmentScale

Datatyp

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
Beskrivning

Yourabilitytodovigorousactivities

Datatyp

text

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

Thepositionyouliketosleepin

Datatyp

text

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

Yourabilitytoeatafullmeal

Datatyp

text

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

Yourabilitytoliftthings

Datatyp

text

Hugging family or friends
Beskrivning

Hugging family or friends

Datatyp

text

Bending over or twisting
Beskrivning

Bending over or twisting

Datatyp

text

Your ability to travel
Beskrivning

Your ability to travel

Datatyp

text

The type of clothing you wear
Beskrivning

The type of clothing you wear

Datatyp

text

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

Your comfort in sexual activities

Datatyp

text

Alias
UMLS CUI-1
C0278109
Tillbaka till toppen

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 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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