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8550

Beschreibung

ACOSOG-Z4099 Linear Analogue Self Assessment Form Surgery With or Without Internal Radiation Therapy Compared With Stereotactic Body Radiation Therapy in Treating Patients With High-Risk Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=986A2EC8-D259-882B-E040-BB89AD4356EB

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=986A2EC8-D259-882B-E040-BB89AD4356EB

Stichworte

  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
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9. Januar 2015

DOI

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    Lung Cancer NCT01336894 Quality of Life - ACOSOG-Z4099 Linear Analogue Self Assessment Form - 3178862v1.0

    Directions: Please circle the number (0-10) best reflecting your response to the following that describes your feelings during the past week, including today

    Header Module
    Beschreibung

    Header Module

    Patient Study ID
    Beschreibung

    Patient Study ID

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Patient Initials (L F M)
    Beschreibung

    Patient Initials

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Date Completed (dd MMM yyyy)
    Beschreibung

    FormCompletionDate

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    Unnamed2
    Beschreibung

    Unnamed2

    your overall mental (intellectual) well being?
    Beschreibung

    QualityofLifeOverallPsychologicalHealthAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25605
    UMLS 2011AA Property
    C1561607
    NCI Thesaurus Property-2
    C25367
    NCI Thesaurus Property-3
    C16839
    UMLS 2011AA Property-2
    C0025353
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    your overall physical well being
    Beschreibung

    QualityofLifeOverallPhysicalAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25605
    UMLS 2011AA Property
    C1561607
    NCI Thesaurus Property-2
    C25367
    NCI Thesaurus Property-3
    C25618
    UMLS 2011AA Property-2
    C0205485
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    your overall emotional well being?
    Beschreibung

    QualityofLifeOverallEmotionAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25605
    UMLS 2011AA Property
    C1561607
    NCI Thesaurus Property-2
    C25367
    NCI Thesaurus Property-3
    C54266
    UMLS 2011AA Property-2
    C0013987
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Your level of social activity
    Beschreibung

    Quality-of-LifeAssessmentPatientSocialActivityScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C62650
    UMLS 2011AA Property-2
    C0728831
    NCI Thesaurus Property-3
    C43431
    UMLS 2011AA Property-3
    C0441655
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    your overall spiritual well being?
    Beschreibung

    QualityofLifeOverallReligionAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25605
    UMLS 2011AA Property
    C1561607
    NCI Thesaurus Property-2
    C25367
    NCI Thesaurus Property-3
    C17085
    UMLS 2011AA Property-2
    C0035039
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Your level of support from friends and family
    Beschreibung

    FamilyPatientEmotionalSupportAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C25173
    UMLS 2011AA ObjectClass-2
    C0015576
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0600015
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Your financial concerns
    Beschreibung

    QualityofLifePaymentDifficultyAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C25371
    UMLS 2011AA Property
    C0680264
    NCI Thesaurus Property-3
    C62189
    UMLS 2011AA Property-2
    C1299586
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Your legal concerns (will, advanced directives, etc.)
    Beschreibung

    QualityofLifeLegalConcernAssessmentScore

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25367
    NCI Thesaurus Property-2
    C54074
    UMLS 2011AA Property
    C1301860
    NCI Thesaurus Property-3
    C79892
    UMLS 2011AA Property-2
    C2699424
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820

    Ähnliche Modelle

    Directions: Please circle the number (0-10) best reflecting your response to the following that describes your feelings during the past week, including today

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header Module
    Patient Study ID
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    Patient Initials (L F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    FormCompletionDate
    Item
    Date Completed (dd MMM yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    Item Group
    Unnamed2
    Item
    your overall mental (intellectual) well being?
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25605 (NCI Thesaurus Property)
    C1561607 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus Property-2)
    C16839 (NCI Thesaurus Property-3)
    C0025353 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    your overall mental (intellectual) well being?
    CL Item
    Whole Number (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    Whole Number (1)
    CL Item
    Whole Number (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    Whole Number (3)
    CL Item
    Whole Number (4)
    CL Item
    Whole Number (5)
    CL Item
    Whole Number (6)
    CL Item
    Whole Number (7)
    CL Item
    Whole Number (8)
    CL Item
    Whole Number (9)
    CL Item
    Whole Number (10)
    Item
    your overall physical well being
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25605 (NCI Thesaurus Property)
    C1561607 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus Property-2)
    C25618 (NCI Thesaurus Property-3)
    C0205485 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    your overall physical well being
    CL Item
    Whole Number (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    Whole Number (1)
    CL Item
    Whole Number (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    Whole Number (3)
    CL Item
    Whole Number (4)
    CL Item
    Whole Number (5)
    CL Item
    Whole Number (6)
    CL Item
    Whole Number (7)
    CL Item
    Whole Number (8)
    CL Item
    Whole Number (9)
    CL Item
    Whole Number (10)
    Item
    your overall emotional well being?
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25605 (NCI Thesaurus Property)
    C1561607 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus Property-2)
    C54266 (NCI Thesaurus Property-3)
    C0013987 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    your overall emotional well being?
    CL Item
    Whole Number (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    Whole Number (1)
    CL Item
    Whole Number (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    Whole Number (3)
    CL Item
    Whole Number (4)
    CL Item
    Whole Number (5)
    CL Item
    Whole Number (6)
    CL Item
    Whole Number (7)
    CL Item
    Whole Number (8)
    CL Item
    Whole Number (9)
    CL Item
    Whole Number (10)
    Item
    Your level of social activity
    text
    C15584 (NCI Thesaurus ObjectClass)
    C0281588 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus Property)
    C0030705 (UMLS 2011AA Property)
    C62650 (NCI Thesaurus Property-2)
    C0728831 (UMLS 2011AA Property-2)
    C43431 (NCI Thesaurus Property-3)
    C0441655 (UMLS 2011AA Property-3)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Your level of social activity
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (3)
    CL Item
    4 (4)
    CL Item
    5 (5)
    CL Item
    6 (6)
    CL Item
    7 (7)
    CL Item
    8 (8)
    CL Item
    9 (9)
    CL Item
    10 (10)
    Item
    your overall spiritual well being?
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25605 (NCI Thesaurus Property)
    C1561607 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus Property-2)
    C17085 (NCI Thesaurus Property-3)
    C0035039 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    your overall spiritual well being?
    CL Item
    Whole Number (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    Whole Number (1)
    CL Item
    Whole Number (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    Whole Number (3)
    CL Item
    Whole Number (4)
    CL Item
    Whole Number (5)
    CL Item
    Whole Number (6)
    CL Item
    Whole Number (7)
    CL Item
    Whole Number (8)
    CL Item
    Whole Number (9)
    CL Item
    Whole Number (10)
    Item
    Your level of support from friends and family
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25173 (NCI Thesaurus ObjectClass-2)
    C0015576 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0600015 (NCI Metathesaurus Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Your level of support from friends and family
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (3)
    CL Item
    4 (4)
    CL Item
    5 (5)
    CL Item
    6 (6)
    CL Item
    7 (7)
    CL Item
    8 (8)
    CL Item
    9 (9)
    CL Item
    10 (10)
    Item
    Your financial concerns
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C25371 (NCI Thesaurus Property-2)
    C0680264 (UMLS 2011AA Property)
    C62189 (NCI Thesaurus Property-3)
    C1299586 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Your financial concerns
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (3)
    CL Item
    4 (4)
    CL Item
    5 (5)
    CL Item
    6 (6)
    CL Item
    7 (7)
    CL Item
    8 (8)
    CL Item
    9 (9)
    CL Item
    10 (10)
    Item
    Your legal concerns (will, advanced directives, etc.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C54074 (NCI Thesaurus Property-2)
    C1301860 (UMLS 2011AA Property)
    C79892 (NCI Thesaurus Property-3)
    C2699424 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Your legal concerns (will, advanced directives, etc.)
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (3)
    CL Item
    4 (4)
    CL Item
    5 (5)
    CL Item
    6 (6)
    CL Item
    7 (7)
    CL Item
    8 (8)
    CL Item
    9 (9)
    CL Item
    10 (10)

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