Description:

Quality of Life Questionnaire, GOG-0204 Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B58D04F2-7ACB-11E8-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B58D04F2-7ACB-11E8-E034-0003BA12F5E7

Keywords:
Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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.

Cervical Cancer NCT00064077 Quality of Life - Quality of Life Questionnaire, GOG-0204 - 2079887v3.0

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

Header
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
Social/family Well-being
I feel close to my friends
I get emotional support from my family
I get support from my friends and neighbors
My family has accepted my illness
I am satisfied with family communication about my illness
I feel close to my partner (or the person who is my main support)
I am satisfied with my sex life
Emotional Well-being
I feel sad
I am satisfied with how I am coping with my illness
I am losing hope in the fight against my illness
I feel nervous
I worry about dying
I worry that my condition will get worse
Functional Well-being
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
Overall Quality Of Life
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
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 Inventory
Ccrr Module For Quality Of Life Questionnaire, Gog-0204

Similar models