Quality of Life Supplement (Form 24-QLS) 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:


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January 9, 2015

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Breast Cancer NCT00659373 Quality of Life - Quality of Life Supplement (Form 24-QLS) - 2073782v3.0

QUALITY OF LIFE SUPPLEMENT (Form 24-QLS) Patient Instructions: The following questions ask your feelings during the past week. For each of the following statements, mark an ?X? in the box that best describes the way you felt.

Ccrr Module For Quality Of Life Supplement (form 24-qls)
I was bothered by things that usually don?t bother me
I did not feel like eating; my appetite was poor
I felt that I could not shake off the blues even with the help of my family and friends
I felt that I was just as good as other people
I had trouble keeping my mind on what I was doing
I felt depressed
I felt that everything I did was an effort
I felt hopeful about the future
I thought my life had been a failure
I felt fearful
My sleep was restless
I was happy
I talked less than usual
I felt lonely
People were unfriendly
I enjoyed life
I had crying spells
I felt sad
I felt that people disliked me
I could not get ?going?
Lack of sexual interest
Unable to relax and enjoy sex
Difficulty in becoming aroused
Difficulty in having an orgasm
Pain or discomfort with intercourse

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