ProtocolRTOGIdentifierNumber
Item
RTOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass)
C1514695 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property)
C1706256 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
InstitutionIdentifierNumber
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientInitialsName
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientRadiationTherapyOncologyGroupIdentifierNumber
Item
RTOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Amended data
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
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 Item
Baseline (baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
CL Item
Pretreatment (Pretreatment)
CL Item
6 Months Of Radiation Therapy (6 months after RT)
CL Item
12 Months After Radiation Therapy (12 months after RT)
CL Item
60 Months After Radiation Therapy (60 months after RT)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentPeriodSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
Item
Did the patient complete any items on the questionnaire?
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
Code List
Did the patient complete any items on the questionnaire?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
QualityofLifeCompleteAssessmentDate
Item
Date Questionnaire Completed
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)
Item
Reason Questionnaire was not Completed
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
Code List
Reason Questionnaire was not Completed
CL Item
Not Applicable, Questionnaire Was Completed (Not applicable, questionnaire was completed)
CL Item
Patient Refused Due To Illness (Patient refused due to illness)
CL Item
Patient Refused For Other Reason (Patient refused for other reason)
CL Item
Patient Unable To Be Contacted (Patient unable to be contacted)
CL Item
Institution Error (Institutional error)
CL Item
Tool Not Availalble In Patient's Language (Tool not available in patient's language)
CL Item
Other Reason (Other reason)
PatientRefuseIncompleteQuestionnaireSpecify
Item
Patient refused for other reason, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
PatientIncompleteQuestionnaireOtherSpecify
Item
Other reason, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
Item
Did the patient require any assistance in completing the questionnaire?
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
Code List
Did the patient require any assistance in completing the questionnaire?
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown If Assistance Given (Unknown if assistance given)
Item
Extent of assistance given
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
Code List
Extent of assistance given
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Read Items To Patient (Read items to patient)
CL Item
Interpreted Items For Patient (Interpreted items for patient)
CL Item
Marked Items Per Patient's Response (Marked items per patient's response)
CL Item
Combination Of Above (Combination of above)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PatientQuestionnaireAssistanceCombinedSpecify
Item
Combination of above, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25454 (NCI Thesaurus ValueDomain)
C0205195 (UMLS 2011AA ValueDomain)
PatientQuestionnaireAssistanceOtherSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
Item
Specify the person who assisted the patient
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
Code List
Specify the person who assisted the patient
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Staff Member (Staff member)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
Item
Specify method of completion
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
Code List
Specify method of completion
CL Item
At Appointment (At appointment)
CL Item
By Mail (By mail)
CL Item
By Telephone (By telephone)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
ResponsiblePersonSignatureText
Item
Signature of Person Completing This Form
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
FormOriginalCompleteDate
Item
Date Form Originally Completed
date
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
CompleteQuestionnaireDate
Item
Today's date (please enter date when survey completed Month Day Year)
date
C25250 (NCI Thesaurus ObjectClass)
C0205197 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus ObjectClass)
C0034394 (UMLS 2011AA ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus ValueDomain)
C0205197 (UMLS 2011AA ValueDomain)
PatientName
Item
Name (optional)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PersonBirthDate
Item
Date of Birth (optional Month Day Year)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
Item
Over the past 4 weeks how often have you leaked urine (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C40416 (NCI Thesaurus Property)
C0015376 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Over the past 4 weeks how often have you leaked urine (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
Over the past 4 weeks, how often have you urinated blood (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3090 (NCI Thesaurus Property)
C0018965 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Over the past 4 weeks, how often have you urinated blood (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
Over the past 4 weeks, how often have you had pain or burning with urination (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Over the past 4 weeks, how often have you had pain or burning with urination (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
Which of the following best describes your urinary control during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C61299 (NCI Thesaurus Property)
C2587213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Which of the following best describes your urinary control during the last 4 weeks (Circle one number)
CL Item
No Urinary Control (No urinary control whatsoever)
CL Item
Frequent Dribbling (Frequent dribbling)
CL Item
Occasional Dribbling (Occasional dribbling)
CL Item
Normal Urinary Control (Total control)
Item
How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C17600 (NCI Thesaurus Property)
C0001675 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C0453880 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
1 Per Day (1 pad per day)
CL Item
2 Per Day (2 pads per day)
CL Item
3+ Per Day (3 or more pads per day)
Item
Dripping or leaking urine (How big a problem, if any, has each of the following been for you during the last 4 weeks? Circle one number on each line)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C40416 (NCI Thesaurus Property)
C0015376 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Dripping or leaking urine (How big a problem, if any, has each of the following been for you during the last 4 weeks? Circle one number on each line)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Pain or burning on urination
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Pain or burning on urination
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Bleeding with urination
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3090 (NCI Thesaurus Property)
C0018965 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Bleeding with urination
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Weak urine stream or incomplete emptying
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25744 (NCI Thesaurus Property)
C0042034 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Weak urine stream or incomplete emptying
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Waking up to urinate
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25744 (NCI Thesaurus Property)
C0042034 (UMLS 2011AA Property)
C64921 (NCI Thesaurus Property)
C1883476 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Waking up to urinate
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Need to urinate frequently during the day
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C26906 (NCI Thesaurus Property)
C0677481 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Need to urinate frequently during the day
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Overall, how big a problem has your urinary function been for you during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem has your urinary function been for you during the last 4 weeks (Circle one number)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
How often have you had rectal urgency (felt like I had to pass stool, but did not) during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C62788 (NCI Thesaurus Property)
C0426636 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had rectal urgency (felt like I had to pass stool, but did not) during the last 4 weeks (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
How often have you had uncontrolled leakage of stool or feces (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C43362 (NCI Thesaurus Property)
C0003461 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C0021167 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had uncontrolled leakage of stool or feces (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
How often have you had stools (bowel movements) that were loose or liquid (no form, watery, mushy) during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C2987 (NCI Thesaurus Property)
C0011991 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had stools (bowel movements) that were loose or liquid (no form, watery, mushy) during the last 4 weeks (Circle one number)
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
About Half The Time (About half the time)
CL Item
Usually (Usually)
Item
How often have you had bloody stools during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C13234 (NCI Thesaurus Property)
C0015733 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had bloody stools during the last 4 weeks (Circle one number)
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
About Half The Time (About half the time)
CL Item
Usually (Usually)
Item
How often have your bowel movements been painful during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C62787 (NCI Thesaurus Property)
C0011135 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have your bowel movements been painful during the last 4 weeks (Circle one number)
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
About Half The Time (About half the time)
CL Item
Usually (Usually)
Item
How many bowel movements have you had on a typical day during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25515 (NCI Thesaurus Property)
C0439603 (UMLS 2011AA Property)
C62787 (NCI Thesaurus Property)
C0011135 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How many bowel movements have you had on a typical day during the last 4 weeks (Circle one number)
CL Item
Two Or Less (Two or less)
CL Item
Three To Four (Three to four)
CL Item
Five Or More (Five or more)
Item
How often have you had crampy pain in your abdomen, pelvis or rectum during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25342 (NCI Thesaurus Property)
C0000726 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had crampy pain in your abdomen, pelvis or rectum during the last 4 weeks (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
Urgency to have a bowel movement (How big a problem, if any, has each of the following been for you? Circle one number on each line)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C62788 (NCI Thesaurus Property)
C0426636 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Urgency to have a bowel movement (How big a problem, if any, has each of the following been for you? Circle one number on each line)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Increased frequency of bowel movements
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25515 (NCI Thesaurus Property)
C0439603 (UMLS 2011AA Property)
C62787 (NCI Thesaurus Property)
C0011135 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Increased frequency of bowel movements
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Watery bowel movements
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C2987 (NCI Thesaurus Property)
C0011991 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Watery bowel movements
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Severe Problem (Big problem)
Item
Losing control of your stools
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C43362 (NCI Thesaurus Property)
C0003461 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C0021167 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Losing control of your stools
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Bloody stools
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C13234 (NCI Thesaurus Property)
C0015733 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Abdominal/pelvic/rectal pain
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25342 (NCI Thesaurus Property)
C0000726 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Abdominal/pelvic/rectal pain
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Overall, how big a problem have your bowel habits been for you during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C12736 (NCI Thesaurus Property)
C0021853 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem have your bowel habits been for you during the last 4 weeks (Circle one number)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Your level of sexual desire (How would you rate each of the following during the last 4 weeks? Circle one number on each line)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C17127 (NCI Thesaurus ObjectClass)
C0036864 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Your level of sexual desire (How would you rate each of the following during the last 4 weeks? Circle one number on each line)
CL Item
Very Poor To None (Very Poor to None)
CL Item
Poor (Poor)
C77959 (NCI Thesaurus)
C2700379 (UMLS 2011AA)
CL Item
Very Good (Very Good)
Item
Your ability to have an erection
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Your ability to have an erection
CL Item
None (Very poor to None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
Your ability to reach orgasm (climax)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C16531 (NCI Thesaurus Property)
C0013746 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Your ability to reach orgasm (climax)
CL Item
None (Very poor to None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
How would you describe the usual QUALITY of your erections during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25283 (NCI Thesaurus Property)
C0332306 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How would you describe the usual QUALITY of your erections during the last 4 weeks (Circle one number)
CL Item
None (None at all)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Not Firm Enough For Any Sexual Activity (Not firm enough for any sexual activity)
CL Item
Firm Enough For Masturbation And Foreplay Only (Firm enough for masturbation and foreplay only)
CL Item
Firm Enough For Intercourse (Firm enough for intercourse)
Item
How would you describe the FREQUENCY of your erections during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How would you describe the FREQUENCY of your erections during the last 4 weeks (Circle one number)
CL Item
Never (I NEVER had an erection when I wanted one)
CL Item
Less Than Half (I had an erection LESS THAN HALF the time I wanted one)
CL Item
About Half (approximately 50%) (I had an erection ABOUT HALF the time I wanted one)
CL Item
More Than Half (I had an erection MORE THAN HALF the time I wanted one)
CL Item
Normal (I had an erection WHENEVER I wanted one)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
How often have you awakened in the morning or night with an erection during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C64921 (NCI Thesaurus Property)
C1883476 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you awakened in the morning or night with an erection during the last 4 weeks (Circle one number)
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Less Than Once A Week (Less than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Several Times A Week (Several times a week)
CL Item
Daily (Daily)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
Item
During the last 4 weeks, how often did you have any sexual activity (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C17127 (NCI Thesaurus ObjectClass)
C0036864 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
During the last 4 weeks, how often did you have any sexual activity (Circle one number)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
Less Than Once A Week (Less than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Several Times A Week (Several times a week)
CL Item
Daily (Daily)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
Item
During the last 4 weeks, how often did you have sexual intercourse (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0036864 (UMLS CUI-1)
C17127 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C72881 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
Code List
During the last 4 weeks, how often did you have sexual intercourse (Circle one number)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
CL Item
Less Than Once A Week (Less than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Several Times A Week (Several times a week)
CL Item
Daily (Daily)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
Item
Overall, how would you rate your ability to function sexually during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Overall, how would you rate your ability to function sexually during the last 4 weeks
CL Item
Very Poor (Very poor)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
Your level of sexual desire (How big a problem during the last 4 weeks, if any, has each of the following been for you? Circle one number on each line)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C17127 (NCI Thesaurus ObjectClass)
C0036864 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Your level of sexual desire (How big a problem during the last 4 weeks, if any, has each of the following been for you? Circle one number on each line)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Your ability to have an erection
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Your ability to have an erection
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Your ability to reach an orgasm
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C16531 (NCI Thesaurus Property)
C0013746 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Your ability to reach an orgasm
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Over the last 4 weeks, how often have you experienced hot flashes (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3109 (NCI Thesaurus Property)
C0600142 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Over the last 4 weeks, how often have you experienced hot flashes (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
How often have you had breast tenderness during the last 4 weeks (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus Property)
C0006141 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How often have you had breast tenderness during the last 4 weeks (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
During the last 4 weeks, how often have you felt depressed (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C2982 (NCI Thesaurus Property)
C0011570 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
During the last 4 weeks, how often have you felt depressed (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
During the last 4 weeks, how often have you felt a lack of energy (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
During the last 4 weeks, how often have you felt a lack of energy (Circle one number)
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
C25473 (NCI Thesaurus)
C0332173 (UMLS 2011AA)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
How much change in your weight have you experienced during the last 4 weeks, if any (Circle one number)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
How much change in your weight have you experienced during the last 4 weeks, if any (Circle one number)
CL Item
Gained 10 Pounds Or More (Gained 10 pounds or more)
CL Item
Gained Less Than 10 Pounds (Gained less than 10 pounds)
CL Item
No Change In Weight (No change in weight)
CL Item
Lost Less Than 10 Pounds (Lost less than 10 pounds)
CL Item
Lost 10 Pounds Or More (Lost 10 pounds or more)
Item
Hot flashes (How big a problem during the last 4 weeks, if any, has each of the following been for you? Circle one number on each line)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3109 (NCI Thesaurus Property)
C0600142 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Hot flashes (How big a problem during the last 4 weeks, if any, has each of the following been for you? Circle one number on each line)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Breast tenderness/enlargement
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus Property)
C0006141 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Breast tenderness/enlargement
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Loss of Body Hair
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C50575 (NCI Thesaurus Property)
C0002170 (UMLS 2011AA Property)
Code List
Loss of Body Hair
CL Item
No Problem (No problem)
CL Item
Very Small Problem (Very small problem)
CL Item
Small Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Big Problem (Big problem)
Item
Feeling depressed
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C2982 (NCI Thesaurus Property)
C0011570 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Feeling depressed
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Lack of energy
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Change in body weight
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Change in body weight
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Overall, how satisfied are you with the treatment you received for your prostate cancer (Circle one number)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C62185 (NCI Thesaurus ObjectClass)
C0242428 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C15368 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Overall, how satisfied are you with the treatment you received for your prostate cancer (Circle one number)
CL Item
Extremely Dissatisfied (Extremely dissatisfied)
CL Item
Dissatisfied (Dissatisfied)
CL Item
Uncertain (Uncertain)
C47944 (NCI Thesaurus)
C0087130 (UMLS 2011AA)
CL Item
Satisfied (Satisfied)
CL Item
Extremely Satisfied (Extremely satisfied)