ID

9126

Description

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: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA67FC-7593-635E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA67FC-7593-635E-E034-0003BA12F5E7

Keywords

Clinical Trial

Quality of Life

Breast Neoplasms

8/27/12 8/27/12 -
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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Breast Cancer NCT00659373 Quality of Life - Quality of Life Supplement (Form 24-QLS) - 2073782v3.0

model
Details

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.

1 forms

StudyEvent: Quality of Life Supplement (Form 24-QLS)
1. 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.

Name

Type

Description | Question | Decode (Coded Value)

Data type

Alias

CCRR MODULE

Item Group

Ccrr Module For Quality Of Life Supplement (form 24-qls)

PatientStudyID,CoordinatingGroup

Item

Patient ID Number (Study No.)

text

Patient Initials

Item

Patient Initials (f m fl sl)

text

C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)

PatientBirthDate

Item

Patient's Date of Birth (day)

date

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)

MainMemberInstitution/Affiliate

Item

Participating Center/Affiliate

text

ParticipatingGroupCode

Item

Center Code (During the past week:)

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)

Iwasbotheredbythingsthatusuallydon?tbothermeQualityofLifeDayFrequency

Item

I was bothered by things that usually don?t bother me

text

C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.1

Code List

I was bothered by things that usually don?t bother me

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifePoorAppetiteAssessmentDayFrequency

Item

I did not feel like eating; my appetite was poor

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77959 (NCI Thesaurus Property-2)
C2700379 (UMLS 2011AA Property-2)
C25152 (NCI Thesaurus Property-3)
C0003618 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.2

Code List

I did not feel like eating; my appetite was poor

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeMildPersistentDepressionAssessmentDayFrequency

Item

I felt that I could not shake off the blues even with the help of my family and friends

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C70666 (NCI Thesaurus Property-2)
C2945599 (UMLS 2011AA Property-2)
C2982 (NCI Thesaurus Property-3)
C0011570 (UMLS 2011AA Property-3)
C43623 (NCI Thesaurus Property-4)
C0205322 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.3

Code List

I felt that I could not shake off the blues even with the help of my family and friends

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeEqualityAssessmentDayFrequency

Item

I felt that I was just as good as other people

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C61582 (NCI Thesaurus Property-2)
C0205163 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.4

Code List

I felt that I was just as good as other people

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeDifficultyAttentionConcentrationAssessmentDayFrequency

Item

I had trouble keeping my mind on what I was doing

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-3)
C0004268 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.5

Code List

I had trouble keeping my mind on what I was doing

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeDepressionAssessmentDayFrequency

Item

I felt depressed

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property-2)
C0011570 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.6

Code List

I felt depressed

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeEffortHouseholdActivityAssessmentDayFrequency

Item

I felt that everything I did was an effort

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C53291 (NCI Thesaurus Property-2)
C1708387 (UMLS 2011AA Property-2)
C74530 (NCI Thesaurus Property-3)
C0015264 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.7

Code List

I felt that everything I did was an effort

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeHopeFutureOutlookAssessmentDayFrequency

Item

I felt hopeful about the future

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72885 (NCI Thesaurus Property)
C0004271 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C77962 (NCI Thesaurus Property-3)
C0392347 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.8

Code List

I felt hopeful about the future

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLIfeLifeFailuareThinkingAssessmentDayFrequency

Item

I thought my life had been a failure

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C37987 (NCI Thesaurus Property)
C0376558 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C25745 (NCI Thesaurus Property-3)
C0231174 (UMLS 2011AA Property-3)
C54226 (NCI Thesaurus Property-4)
C0039869 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.9

Code List

I thought my life had been a failure

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeFearAssessmentDayFrequency

Item

I felt fearful

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77960 (NCI Thesaurus Property-2)
C0015726 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.10

Code List

I felt fearful

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeRestlessnessSleepAssessmentDayFrequency

Item

My sleep was restless

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property-2)
C74533 (NCI Thesaurus Property-3)
C0085631 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.11

Code List

My sleep was restless

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeHappinessAssessmentDayFrequency

Item

I was happy

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72670 (NCI Thesaurus Property)
C0018592 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.12

Code List

I was happy

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeSpeechReducedAssessmentDayFrequency

Item

I talked less than usual

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25640 (NCI Thesaurus Property)
C0392756 (UMLS 2011AA Property)
C38025 (NCI Thesaurus Property-2)
C0037817 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.13

Code List

I talked less than usual

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeLonelinessAssessmentDayFrequency

Item

I felt lonely

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C34785 (NCI Thesaurus Property-2)
C0023974 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.14

Code List

I felt lonely

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeNegationFriendlyPersonAssessmentDayFrequency

Item

People were unfriendly

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25594 (NCI Thesaurus Property-2)
C1518422 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C77968 (NCI Thesaurus Property-4)
C2700214 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.15

Code List

People were unfriendly

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeJoyAssessmentDayFrequency

Item

I enjoyed life

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77961 (NCI Thesaurus Property-2)
C0018592 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.16

Code List

I enjoyed life

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeCryingEpisodeAssessmentDayFrequency

Item

I had crying spells

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77963 (NCI Thesaurus Property-2)
C0010399 (UMLS 2011AA Property-2)
C75539 (NCI Thesaurus Property-3)
C0332189 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.17

Code List

I had crying spells

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeSadnessAssessmentDayFrequency

Item

I felt sad

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C74534 (NCI Thesaurus Property-2)
C0344315 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.18

Code List

I felt sad

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeSocialDiscomfortAssessmentDayFrequency

Item

I felt that people disliked me

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C62650 (NCI Thesaurus Property)
C0728831 (UMLS 2011AA Property)
C50535 (NCI Thesaurus Property-2)
C0234215 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.19

Code List

I felt that people disliked me

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

QualityofLifeBeginDailyActivityDifficultyAssessmentDayFrequency

Item

I could not get ?going?

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C25473 (NCI Thesaurus Property-2)
C0332173 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25431 (NCI Thesaurus Property-4)
C0439659 (UMLS 2011AA Property-4)
C62189 (NCI Thesaurus Property-5)
C1299586 (UMLS 2011AA Property-5)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)

CL.20

Code List

I could not get ?going?

CL Item

None Of The Time (Rarely or none of the time (less than 1 day))

CL Item

Some Of The Time (Some or a little of the time (1-2 days))

CL Item

Moderate (Occasionally or a moderate amount of the time (3-4 days))

CL Item

Most Of The Time (Most or all of the time (5-7 days))

Howmuchofaproblemwaseachofthefollowingduringthepastfour(4)weeks?

Item

How much of a problem was each of the following during the past four (4) weeks?

text

Lackofsexualinterest

Item

Lack of sexual interest

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.21

Code List

Lack of sexual interest

CL Item

Not At All (Not a problem)

C91213 (NCI Thesaurus)

CL Item

A Little (Little of a problem)

CL Item

Somewhat (Somewhat of a problem)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much of a problem)

C91217 (NCI Thesaurus)

CL Item

Not applicable (Not applicable)

Unabletorelaxandenjoysex

Item

Unable to relax and enjoy sex

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.22

Code List

Unable to relax and enjoy sex

CL Item

Not At All (Not a problem)

C91213 (NCI Thesaurus)

CL Item

A Little (Little of a problem)

CL Item

Somewhat (Somewhat of a problem)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much of a problem)

C91217 (NCI Thesaurus)

CL Item

Not applicable (Not applicable)

Difficultyinbecomingaroused

Item

Difficulty in becoming aroused

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.23

Code List

Difficulty in becoming aroused

CL Item

Not At All (Not a problem)

C91213 (NCI Thesaurus)

CL Item

A Little (Little of a problem)

CL Item

Somewhat (Somewhat of a problem)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much of a problem)

C91217 (NCI Thesaurus)

CL Item

Not applicable (Not applicable)

Difficultyinhavinganorgasm

Item

Difficulty in having an orgasm

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.24

Code List

Difficulty in having an orgasm

CL Item

Not At All (Not a problem)

C91213 (NCI Thesaurus)

CL Item

A Little (Little of a problem)

CL Item

Somewhat (Somewhat of a problem)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much of a problem)

C91217 (NCI Thesaurus)

CL Item

Not applicable (Not applicable)

Painordiscomfortwithintercourse

Item

Pain or discomfort with intercourse

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.25

Code List

Pain or discomfort with intercourse

CL Item

Not At All (Not a problem)

C91213 (NCI Thesaurus)

CL Item

A Little (Little of a problem)

CL Item

Somewhat (Somewhat of a problem)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much of a problem)

C91217 (NCI Thesaurus)

CL Item

Not applicable (Not applicable)

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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.

Description

Description

Data type

Description

Data type

Alias

Description

Data type

Alias

Description

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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Alias

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