Description:

GOG-0240 Quality of Life (QOL) Form Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C9230B2-FA5F-0653-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C9230B2-FA5F-0653-E044-0003BA3F9857

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Versions (2) ▾
  1. 8/27/12
  2. 8/11/14
Uploaded on:

August 11, 2014

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Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00803062 Quality of Life - GOG-0240 Quality of Life (QOL) Form - 2746943v1.0

Below is a list of statements that other people with your illness have said are important. By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

Physical Well-being
I have a lack of energy.
I have nausea.
Because of my physical condition, I have trouble meeting the needs of my family.
I have pain.
I am bothered by side effects of treatment.
I feel ill
I am forced to spend time in bed
Functional Wellbeing
I am able to work (include work at home)
My work (include work at home) is fulfilling
I am able to enjoy life.
I have accepted my illness
I am sleeping well
I am enjoying the things I usually do for fun
I am content with the quality of my life right now
Additional Concerns
I am bothered by discharge or bleeding from my vagina
I am bothered by odor coming from my vagina
I am afraid to have sex
I feel sexually attractive.
My vagina feels too narrow or short
I have concerns about my ability to have children
I am afraid the treatment may harm my body
I am interested in having sex
I like the appearance of my body
I am bothered by constipation
I have a good appetite
I have trouble controlling my urine
It burns when I urinate
I have discomfort when I urinate
I am able to eat the foods that I like
Ntx4 Subscale
I have numbness or tingling in my hands
I have numbness or tingling in my feet
I feel discomfort in my hands
I feel discomfort in my feet
Brief Pain Invertory
Please rate your pain by selecting the one number that best describes your pain at its WORST in the past 24 hours.

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