ID

8336

Description

RTOG 1016 PQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer PRO-CTCAE Assessment Radiation Therapy With Cisplatin or Cetuximab in Treating Patients With Oropharyngeal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=95331A4F-A6A2-25A3-E040-BB89AD432C5C

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=95331A4F-A6A2-25A3-E040-BB89AD432C5C

Keywords

Versions (2)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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NCT01302834 Quality of Life - RTOG 1016 PQ: Radiation Therapy Oncology Group Phase III Head and Neck Cancer PRO-CTCAE Assessment - 3159842v1.0

English

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 forms  
Unnamed Module 1
Description

Unnamed Module 1

RTOG Study No.
Description

Protocol ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Case #
Description

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19778
UMLS 2011AA ObjectClass-2
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C49152
UMLS 2011AA Property-2
C1706256
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution No.
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Description

Patient Initials

Data type

text

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

Trial subject ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Amended data
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Eortc Qlq-h&n35
Description

Eortc Qlq-h&n35

How OFTEN did you have NAUSEA?
Description

PatientNauseaAssessmentFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3258
UMLS 2011AA Property-2
C0027497
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
What was the SEVERITY of your NAUSEA at its WORSE
Description

PatientNauseaAssessmentSeverityStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3258
UMLS 2011AA Property-2
C0027497
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Did you LOSE ANY FINGERNAILS OR TOENAILS
Description

NailLossAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C78494
UMLS 2011AA ObjectClass
C0263540
What was the SEVERITY of your ACNE OR PIMPLES ON THE FACE OR CHEST at its WORST
Description

PatientSelf-ReportAcneSeverityStatus

Data type

text

Alias
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25676
UMLS 2011AA Property
C0439793
NCI Thesaurus Property-2
C27195
UMLS 2011AA Property-2
C0702166
What was the SEVERITY of your NUMBNESS OR TINGLING IN YOUR HANDS OR FEET at its WORST
Description

PatientSelf-ReportNumbnessHandFootAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C32622
UMLS 2011AA Property
C0016504
NCI Thesaurus Property-3
C32712
UMLS 2011AA Property-2
C0018563
NCI Thesaurus Property-4
C34857
UMLS 2011AA Property-3
C0028643
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did NUMBNESS OR TINGLING IN YOUR HANDS OR FEET INTERFERE with your usual or daily activities
Description

PatientSelf-ReportNumbnessHandFootAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C32622
UMLS 2011AA Property
C0016504
NCI Thesaurus Property-3
C32712
UMLS 2011AA Property-2
C0018563
NCI Thesaurus Property-4
C34857
UMLS 2011AA Property-3
C0028643
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
What was the SEVERITY of your COUGH at its WORST
Description

PatientSelf-ReportCoughAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C37935
UMLS 2011AA Property
C0010200
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
How much did COUGH INTERFERE with your usual or daily activities
Description

PatientSelf-ReportCoughAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C37935
UMLS 2011AA Property
C0010200
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
Pro-ctcae Assessment (cont.1)
Description

Pro-ctcae Assessment (cont.1)

Did you have any RASH
Description

SkinRashPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C39594
UMLS 2011AA ObjectClass
C0015230
How OFTEN did you FEEL ANXIETY
Description

AnxietyAssessmentResponseFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
What was the SEVERITY of your ANXIETY at its WORST
Description

AnxietyAssessmentResponseStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did ANXIETY INTERFERE with your usual or daily activities
Description

AnxietyAssessmentResponseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
What was the SEVERITY of your INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY) at its WORST
Description

PatientSelf-ReportInsomniaAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C28286
UMLS 2011AA Property
C0917801
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
How much did INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY INTERFERE with your usual or daily activities
Description

PatientSelf-ReportInsomniaAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C28286
UMLS 2011AA Property
C0917801
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
How OFTEN did you have SAD OR UNHAPPY FEELINGS
Description

PatientSelf-ReportSadnessAssessmentFrequency

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C74534
UMLS 2011AA Property
C0344315
What was the SEVERITY of your SAD OR UNHAPPY FEELINGS at their WORST
Description

PatientSelf-ReportSadnessAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C74534
UMLS 2011AA Property
C0344315
How much did SAD OR UNHAPPY FEELINGS INTERFERE with your usual or daily activities
Description

PatientSelf-ReportSadnessAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C74534
UMLS 2011AA Property
C0344315
Pro-ctcae Assessment (cont.2)
Description

Pro-ctcae Assessment (cont.2)

How OFTEN did you FEEL THAT NOTHING COULD CHEER YOU UP
Description

DepressionAssessmentResponseFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2982
UMLS 2011AA ObjectClass-2
C0011570
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
What was the SEVERITY of your FEELINGS THAT NOTHING COULD CHEER YOU UP at their WORST
Description

DepressionAssessmentResponseStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2982
UMLS 2011AA ObjectClass-2
C0011570
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did FEELING THAT NOTHING COULD CHEER YOU UP INTERFERE with your usual or daily activities
Description

DepressionAssessmentResponseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2982
UMLS 2011AA ObjectClass-2
C0011570
What was the SEVERITY of your MOUTH OR THROAT SORES at their WORST
Description

PatientSelf-ReportCankerSoreAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C62546
UMLS 2011AA Property
C0038363
How much did MOUTH OR THROAT SORES INTERFERE with your usual or daily activities
Description

PatientSelf-ReportCankerSoreAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C62546
UMLS 2011AA Property
C0038363
Did you have any HAIR LOSS
Description

PatientSelf-ReportAlopeciaAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C50575
UMLS 2011AA Property
C0002170
What was the SEVERITY of your DIFFICULTY SWALLOWING at its WORST
Description

SwallowingFunctionCurrentDeficitStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C25518
UMLS 2011AA ObjectClass
C0542341
NCI Thesaurus ObjectClass-2
C38028
UMLS 2011AA ObjectClass-2
C0011167
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus Property-2
C37940
UMLS 2011AA Property-2
C0011155
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How OFTEN did you have VOMITING
Description

PatientVomitingSymptomFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3442
UMLS 2011AA Property
C0042963
NCI Thesaurus Property-2
C4876
UMLS 2011AA Property-2
C1457887
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
What was the SEVERITY of your VOMITING at its WORST
Description

PatientVomitingSymptomStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3442
UMLS 2011AA Property
C0042963
NCI Thesaurus Property-2
C4876
UMLS 2011AA Property-2
C1457887
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Pro-ctcae Assessment (cont.3)
Description

Pro-ctcae Assessment (cont.3)

How OFTEN did you have HEARTBURN
Description

PatientSelf-ReportHeartburnAssessmentFrequency

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C34670
UMLS 2011AA Property
C0018834
What was the SEVERITY of your HEARTBURN at its WORST
Description

PatientSelf-ReportHeartburnAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C34670
UMLS 2011AA Property
C0018834
What was the SEVERITY of your FATIGUE, TIREDNESS OR LACK OF ENERGY at its WORST
Description

PatientFatigueAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property-2
C0015672
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did FATIGUE, TIREDNESS, OR LACK OF ENERGY INTERFERE with your usual or daily activities
Description

PatientFatigueAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property-2
C0015672
What was the SEVERITY of your CONSTIPATION at its WORST
Description

PatientSelf-ReportConstipationAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C37930
UMLS 2011AA Property
C0009806
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
What was the SEVERITY of your SKIN BURNS FROM RADIATION at their WORST
Description

PatientSelf-ReportSkinBurnAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C12470
UMLS 2011AA Property
C1123023
NCI Thesaurus Property-3
C34441
UMLS 2011AA Property-2
C0006434
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
What was the SEVERITY of your RINGING IN YOUR EARS at its WORST
Description

PatientSelf-ReportTinnitusAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C50772
UMLS 2011AA Property
C0040264
What was the SEVERITY of your ITCHY SKIN at its WORST
Description

PatientSelf-ReportPruritusAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3344
UMLS 2011AA Property
C0033774
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
Pro-ctcae Assessment (cont.4)
Description

Pro-ctcae Assessment (cont.4)

What was the SEVERITY of your DRY SKIN at its WORST
Description

PatientSelf-ReportDrySkinAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property-2
C74592
UMLS 2011AA Property
C0151908
What was the SEVERITY of your DECREASED APPETITE at their WORST
Description

PatientSelf-ReportLesserAppetiteAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25152
UMLS 2011AA Property
C0003618
NCI Thesaurus Property-3
C61422
UMLS 2011AA Property-2
C0547044
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did DECREASED APPETITE INTERFERE with your usual or daily activities
Description

PatientSelf-ReportLesserAppetiteAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C21089
UMLS 2011AA ObjectClass
C0681906
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25152
UMLS 2011AA Property
C0003618
NCI Thesaurus Property-3
C61422
UMLS 2011AA Property-2
C0547044
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
What was the SEVERITY of your DRY MOUTH at its WORST
Description

PatientDryMouthAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C26917
UMLS 2011AA Property-2
C0043352
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
What was the SEVERITY of your HOARSE VOICE at its WORST
Description

PatientVoiceAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Metathesaurus Property
C0042939
How OFTEN did you have PAIN
Description

PatientPainAssessmentFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
What was the SEVERITY of PAIN at its WORST
Description

PatientPainAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much did PAIN INTERFERE with your usual or daily activities
Description

PatientPainAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
What was the SEVERITY of your PROBLEMS WITH TASTING FOOD OR DRINK at their WORST
Description

PatientFoodorFoodSubstanceTasteWorstProblemStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C38030
NCI Thesaurus ObjectClass-3
C1949
UMLS 2011AA ObjectClass-2
C0016452
NCI Thesaurus Property
C28020
UMLS 2011AA Property
C0033213
NCI Thesaurus Property-2
C25719
UMLS 2011AA Property-2
C1522166
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How OFTEN did you have LOOSE OR WATERY STOOLS (DIARRHEA)
Description

QualityofLifeDiarrheaEvaluationFrequency

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C2987
UMLS 2011AA Property-2
C0011991
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed Module 1
Protocol ID RTOG
Item
RTOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
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)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
RTOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Data amended
Item
Amended data
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Eortc Qlq-h&n35
Item
How OFTEN did you have NAUSEA?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3258 (NCI Thesaurus Property-2)
C0027497 (UMLS 2011AA Property-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.2
Code List
How OFTEN did you have NAUSEA?
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your NAUSEA at its WORSE
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3258 (NCI Thesaurus Property-2)
C0027497 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
What was the SEVERITY of your NAUSEA at its WORSE
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
NailLossAssessmentInd-2
Item
Did you LOSE ANY FINGERNAILS OR TOENAILS
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C78494 (NCI Thesaurus ObjectClass)
C0263540 (UMLS 2011AA ObjectClass)
Item
What was the SEVERITY of your ACNE OR PIMPLES ON THE FACE OR CHEST at its WORST
text
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
C27195 (NCI Thesaurus Property-2)
C0702166 (UMLS 2011AA Property-2)
CL.5
Code List
What was the SEVERITY of your ACNE OR PIMPLES ON THE FACE OR CHEST at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your NUMBNESS OR TINGLING IN YOUR HANDS OR FEET at its WORST
text
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32622 (NCI Thesaurus Property-2)
C0016504 (UMLS 2011AA Property)
C32712 (NCI Thesaurus Property-3)
C0018563 (UMLS 2011AA Property-2)
C34857 (NCI Thesaurus Property-4)
C0028643 (UMLS 2011AA Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.6
Code List
What was the SEVERITY of your NUMBNESS OR TINGLING IN YOUR HANDS OR FEET at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did NUMBNESS OR TINGLING IN YOUR HANDS OR FEET INTERFERE with your usual or daily activities
text
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32622 (NCI Thesaurus Property-2)
C0016504 (UMLS 2011AA Property)
C32712 (NCI Thesaurus Property-3)
C0018563 (UMLS 2011AA Property-2)
C34857 (NCI Thesaurus Property-4)
C0028643 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.7
Code List
How much did NUMBNESS OR TINGLING IN YOUR HANDS OR FEET INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your COUGH at its WORST
text
C25367 (NCI Thesaurus Property)
C37935 (NCI Thesaurus Property-2)
C0010200 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.8
Code List
What was the SEVERITY of your COUGH at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did COUGH INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C37935 (NCI Thesaurus Property-2)
C0010200 (UMLS 2011AA Property)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.9
Code List
How much did COUGH INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item Group
Pro-ctcae Assessment (cont.1)
SkinRashPresentInd-2
Item
Did you have any RASH
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C39594 (NCI Thesaurus ObjectClass)
C0015230 (UMLS 2011AA ObjectClass)
Item
How OFTEN did you FEEL ANXIETY
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.11
Code List
How OFTEN did you FEEL ANXIETY
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your ANXIETY at its WORST
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.12
Code List
What was the SEVERITY of your ANXIETY at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did ANXIETY INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
CL.13
Code List
How much did ANXIETY INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY) at its WORST
text
C25367 (NCI Thesaurus Property)
C28286 (NCI Thesaurus Property-2)
C0917801 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.14
Code List
What was the SEVERITY of your INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY) at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C28286 (NCI Thesaurus Property-2)
C0917801 (UMLS 2011AA Property)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.15
Code List
How much did INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
How OFTEN did you have SAD OR UNHAPPY FEELINGS
text
C25367 (NCI Thesaurus Property)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C74534 (NCI Thesaurus Property-2)
C0344315 (UMLS 2011AA Property)
CL.16
Code List
How OFTEN did you have SAD OR UNHAPPY FEELINGS
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your SAD OR UNHAPPY FEELINGS at their WORST
text
C25367 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C74534 (NCI Thesaurus Property-2)
C0344315 (UMLS 2011AA Property)
CL.17
Code List
What was the SEVERITY of your SAD OR UNHAPPY FEELINGS at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did SAD OR UNHAPPY FEELINGS INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C74534 (NCI Thesaurus Property-2)
C0344315 (UMLS 2011AA Property)
CL.18
Code List
How much did SAD OR UNHAPPY FEELINGS INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item Group
Pro-ctcae Assessment (cont.2)
Item
How OFTEN did you FEEL THAT NOTHING COULD CHEER YOU UP
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2982 (NCI Thesaurus ObjectClass-2)
C0011570 (UMLS 2011AA ObjectClass-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.19
Code List
How OFTEN did you FEEL THAT NOTHING COULD CHEER YOU UP
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your FEELINGS THAT NOTHING COULD CHEER YOU UP at their WORST
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2982 (NCI Thesaurus ObjectClass-2)
C0011570 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.20
Code List
What was the SEVERITY of your FEELINGS THAT NOTHING COULD CHEER YOU UP at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did FEELING THAT NOTHING COULD CHEER YOU UP INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2982 (NCI Thesaurus ObjectClass-2)
C0011570 (UMLS 2011AA ObjectClass-2)
CL.21
Code List
How much did FEELING THAT NOTHING COULD CHEER YOU UP INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your MOUTH OR THROAT SORES at their WORST
text
C25367 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C62546 (NCI Thesaurus Property-2)
C0038363 (UMLS 2011AA Property)
CL.22
Code List
What was the SEVERITY of your MOUTH OR THROAT SORES at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did MOUTH OR THROAT SORES INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C62546 (NCI Thesaurus Property-2)
C0038363 (UMLS 2011AA Property)
CL.23
Code List
How much did MOUTH OR THROAT SORES INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
Did you have any HAIR LOSS
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-2)
C0002170 (UMLS 2011AA Property)
CL.24
Code List
Did you have any HAIR LOSS
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your DIFFICULTY SWALLOWING at its WORST
text
C25518 (NCI Thesaurus ObjectClass)
C0542341 (UMLS 2011AA ObjectClass)
C38028 (NCI Thesaurus ObjectClass-2)
C0011167 (UMLS 2011AA ObjectClass-2)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C37940 (NCI Thesaurus Property-2)
C0011155 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.25
Code List
What was the SEVERITY of your DIFFICULTY SWALLOWING at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How OFTEN did you have VOMITING
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3442 (NCI Thesaurus Property)
C0042963 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.26
Code List
How OFTEN did you have VOMITING
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your VOMITING at its WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3442 (NCI Thesaurus Property)
C0042963 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.27
Code List
What was the SEVERITY of your VOMITING at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item Group
Pro-ctcae Assessment (cont.3)
Item
How OFTEN did you have HEARTBURN
text
C25367 (NCI Thesaurus Property)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C34670 (NCI Thesaurus Property-2)
C0018834 (UMLS 2011AA Property)
CL.28
Code List
How OFTEN did you have HEARTBURN
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of your HEARTBURN at its WORST
text
C25367 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C34670 (NCI Thesaurus Property-2)
C0018834 (UMLS 2011AA Property)
CL.29
Code List
What was the SEVERITY of your HEARTBURN at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your FATIGUE, TIREDNESS OR LACK OF ENERGY at its WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.30
Code List
What was the SEVERITY of your FATIGUE, TIREDNESS OR LACK OF ENERGY at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did FATIGUE, TIREDNESS, OR LACK OF ENERGY INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
CL.31
Code List
How much did FATIGUE, TIREDNESS, OR LACK OF ENERGY INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your CONSTIPATION at its WORST
text
C25367 (NCI Thesaurus Property)
C37930 (NCI Thesaurus Property-2)
C0009806 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.32
Code List
What was the SEVERITY of your CONSTIPATION at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your SKIN BURNS FROM RADIATION at their WORST
text
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C12470 (NCI Thesaurus Property-2)
C1123023 (UMLS 2011AA Property)
C34441 (NCI Thesaurus Property-3)
C0006434 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.33
Code List
What was the SEVERITY of your SKIN BURNS FROM RADIATION at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your RINGING IN YOUR EARS at its WORST
text
C25367 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C50772 (NCI Thesaurus Property-2)
C0040264 (UMLS 2011AA Property)
CL.34
Code List
What was the SEVERITY of your RINGING IN YOUR EARS at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your ITCHY SKIN at its WORST
text
C25367 (NCI Thesaurus Property)
C3344 (NCI Thesaurus Property-2)
C0033774 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
CL.35
Code List
What was the SEVERITY of your ITCHY SKIN at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item Group
Pro-ctcae Assessment (cont.4)
Item
What was the SEVERITY of your DRY SKIN at its WORST
text
C25367 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C74592 (NCI Thesaurus Property-2)
C0151908 (UMLS 2011AA Property)
CL.36
Code List
What was the SEVERITY of your DRY SKIN at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your DECREASED APPETITE at their WORST
text
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25152 (NCI Thesaurus Property-2)
C0003618 (UMLS 2011AA Property)
C61422 (NCI Thesaurus Property-3)
C0547044 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.37
Code List
What was the SEVERITY of your DECREASED APPETITE at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did DECREASED APPETITE INTERFERE with your usual or daily activities
text
C21089 (NCI Thesaurus ObjectClass)
C0681906 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25152 (NCI Thesaurus Property-2)
C0003618 (UMLS 2011AA Property)
C61422 (NCI Thesaurus Property-3)
C0547044 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.38
Code List
How much did DECREASED APPETITE INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your DRY MOUTH at its WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C26917 (NCI Thesaurus Property-2)
C0043352 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.39
Code List
What was the SEVERITY of your DRY MOUTH at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
What was the SEVERITY of your HOARSE VOICE at its WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0042939 (NCI Metathesaurus Property)
CL.40
Code List
What was the SEVERITY of your HOARSE VOICE at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How OFTEN did you have PAIN
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.41
Code List
How OFTEN did you have PAIN
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
Item
What was the SEVERITY of PAIN at its WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.42
Code List
What was the SEVERITY of PAIN at its WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How much did PAIN INTERFERE with your usual or daily activities
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
CL.43
Code List
How much did PAIN INTERFERE with your usual or daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
What was the SEVERITY of your PROBLEMS WITH TASTING FOOD OR DRINK at their WORST
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C38030 (NCI Thesaurus ObjectClass-2)
C1949 (NCI Thesaurus ObjectClass-3)
C0016452 (UMLS 2011AA ObjectClass-2)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.44
Code List
What was the SEVERITY of your PROBLEMS WITH TASTING FOOD OR DRINK at their WORST
CL Item
None (none)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (severe)
CL Item
Very Severe (Very severe)
Item
How OFTEN did you have LOOSE OR WATERY STOOLS (DIARRHEA)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C2987 (NCI Thesaurus Property-2)
C0011991 (UMLS 2011AA Property-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
CL.45
Code List
How OFTEN did you have LOOSE OR WATERY STOOLS (DIARRHEA)
CL Item
Never (Never)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
CL Item
Occasionally (Occasionally)
CL Item
Frequently (Frequently)
CL Item
Almost Constantly (Almost constantly)
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