Description:

Quality of Life Module for Trial 24-02 (Form 24-QLM) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA5B57-DF0D-6356-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA5B57-DF0D-6356-E034-0003BA12F5E7

Keywords:
Versions (1) ▾
  1. 12/15/14
Uploaded on:

December 15, 2014

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Breast Cancer NCT00659373 Quality of Life - Quality of Life Module for Trial 24-02 (Form 24-QLM) - 2073726v3.0

QUALITY OF LIFE MODULE FOR TRIAL 24-02 (Form 24-QLM) Patient Instructions: We would like to know how strongly you are affected by your illness and treatment. Please answer the following questions by placing a vertical mark on the line depending on how you assess yourself. (See the example on the Quality of Life Core Questionnaire.) Your information will be treated as strictly confidential. Thank you for replying!

Within The Last Two Weeks, How Severe Have The Following Problems Been?
Being irritable
Sweats (including night sweats including night)
Vaginal discharge
Vaginal dryness
Vaginal itching / irritation
Sleep disturbance
Feeling dizzy
Headaches
Bone or joint pain
Troubled by weight gain
Loss of sexual interest
Overall, how much are you bothered by any treatment related difficulties?
Have you been sexually active during the past six months?
Did you have difficulties in becoming aroused?
Ccrr Module For Quality Of Life Module For Trial 24-02 (form 24-qlm)

Similar models