Quality of Life Core Questionnaire (Form 24-QLC) 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:

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00659373 Quality of Life - Quality of Life Core Questionnaire (Form 24-QLC) - 2073639v3.0

QUALITY OF LIFE CORE QUESTIONNAIRE (Form 24-QLC) Patient Instructions: We would like to know how strongly you are affected by your illness and treatment. Please answer all of the following questions by placing a vertical mark on the line depending on how you assess yourself. For example: Have you had trouble sleeping? None A lot This mark would indicate considerable sleeping difficulties. Your information will be treated as strictly confidential. Thank you for replying!

How Have You Been Within The Last Two Weeks?
Physical Well-Being
Hot Flushes
Feeling Sick (nausea/vomiting)
How much effort does it cost you to cope with your illness?
Do you feel supported by the people close to you?
Does the operation restrict the use of your arm?
Imagine that you would have to live the rest of your life in your current condition. Please indicate, on the line below, how you would rate a life in your current condition between perfect health and worst health.Make a vertical mark according to your est
Ccrr Module For Quality Of Life Core Questionnaire (form 24-qlc)

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