ID

9179

Beskrivning

GOG-0258 Quality of Life Survey Form Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-DE63-D7C8-E040-BB89AD4321CC

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-DE63-D7C8-E040-BB89AD4321CC

Nyckelord

Clinical Trial

D016889

D011788

2012-09-19 2012-09-19 -
2015-01-09 2015-01-09 - Martin Dugas

Uppladdad den

9 januari 2015

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy

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Endometrial Cancer NCT00942357 Quality of Life - GOG-0258 Quality of Life Survey Form - 2844576v1.0

model
Detaljer

Below is a list of statements that other people with your illness have said are important. By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

1 Formulär

StudyEvent: GOG-0258 Quality of Life Survey Form
1. Below is a list of statements that other people with your illness have said are important. By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

Header Module

Item Group

Header Module

Patient Initials

Item

Patient Initials

text

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

QualityofLifeCompleteAssessmentDate

Item

Date

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)

Patient ID GOG

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512288 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25521 (NCI Thesaurus Property-2)

QOLCollectedScheduleType

Item

Scheduled time to obtain Quality of Life Questionnaire

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25211 (NCI Thesaurus Property)
C0086960 (UMLS 2011AA Property)

CL.1

Code List

Scheduled time to obtain Quality of Life Questionnaire

CL Item

Prior To Starting Study Therapy (Prior to starting study therapy)

CL Item

Regimen I: 1 Week After Completion Of Radiation Therapy Or Regimen Ii: Prior To Cycle 3 (Regimen I: 1 week after completion of radiation therapy or Regimen II: Prior to cycle 3)

CL Item

18 Weeks After Starting Study Therapy (18 weeks after starting study therapy)

CL Item

70 Weeks After Starting Study Therapy (70 weeks after starting study therapy)

PHYSICAL WELLBEING

Item Group

Physical Well-being

FatigueAssessmentResponseScale

Item

I have a lack of energy.

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3036 (NCI Thesaurus ObjectClass-2)
C0015672 (UMLS 2011AA ObjectClass-2)

CL.2

Code List

I have a lack of energy.

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

NauseaAssessmentResponseScale

Item

I have nausea.

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3258 (NCI Thesaurus ObjectClass-2)
C0027497 (UMLS 2011AA ObjectClass-2)

CL.3

Code List

I have nausea.

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

FamilyAssessmentRequiredResponseType

Item

Because of my physical condition, I have trouble meeting the needs of my family.

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)

CL.4

Code List

Because of my physical condition, I have trouble meeting the needs of my family.

CL Item

1 (Not at all)

C91213 (NCI Thesaurus)

CL Item

2 (A little bit)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (Somewhat)

CL Item

4 (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

5 (Very much)

C91217 (NCI Thesaurus)

PainAssessmentResponseScale

Item

I have pain.

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)

CL.5

Code List

I have pain.

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

ToxicityAssessmentResponseScale

Item

I am bothered by side effects of treatment.

text

C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C27990 (NCI Thesaurus ObjectClass-2)
C0600688 (UMLS 2011AA ObjectClass-2)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.6

Code List

I am bothered by side effects of treatment.

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientMalaiseAssessmentQualityofLifeScale

Item

I feel ill

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3832 (NCI Thesaurus Property-2)
C0231218 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.7

Code List

I feel ill

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientBedRestAssessmentQualityofLifeScale

Item

I am forced to spend time in bed

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)

CL.8

Code List

I am forced to spend time in bed

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

FUNCTIONAL WELLBEING

Item Group

Functional Wellbeing

AbilityPatientWorkAssessmentQualityofLifeScale

Item

I am able to work (include work at home)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0085732 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.9

Code List

I am able to work (include work at home)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

SatisfactionPatientWorkAssessmentQualityofLifeScale

Item

My work (include work at home) is fulfilling

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0242428 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.10

Code List

My work (include work at home) is fulfilling

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

LifeAssessmentResponseType

Item

I am able to enjoy life.

text

CL.11

Code List

I am able to enjoy life.

CL Item

1 (Not at all)

C91213 (NCI Thesaurus)

CL Item

2 (A little bit)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (Somewhat)

CL Item

4 (Quite a bit)

C91216 (NCI Thesaurus)

CL Item

5 (Very much)

C91217 (NCI Thesaurus)

PatientAcceptanceofIllnessAssessmentQualityofLifeScale

Item

I have accepted my illness

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL140183 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.12

Code List

I have accepted my illness

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientSleepAssessmentQualityofLifeScale

Item

I am sleeping well

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0037313 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.13

Code List

I am sleeping well

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PleasurePatientRecreationAssessmentQualityofLifeScale

Item

I am enjoying the things I usually do for fun

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0679105 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0034872 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.14

Code List

I am enjoying the things I usually do for fun

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

PatientQualityofLifeAssessmentQualityofLifeScale

Item

I am content with the quality of my life right now

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C20989 (NCI Thesaurus Property-2)
C0031809 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.15

Code List

I am content with the quality of my life right now

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

Additional Concerns

Item Group

Additional Concerns

QualityofLifeStomachSwellingEvaluationScale

Item

I have swelling in my stomach area

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C12391 (NCI Thesaurus Property-2)
C0038351 (UMLS 2011AA Property-2)
C3399 (NCI Thesaurus Property-3)
C0038999 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.16

Code List

I have swelling in my stomach area

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeStomachMuscleCrampEvaluationScale

Item

I have cramps in my stomach area

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C12391 (NCI Thesaurus Property-2)
C0038351 (UMLS 2011AA Property-2)
C34827 (NCI Thesaurus Property-3)
C0026821 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.17

Code List

I have cramps in my stomach area

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeStomachPainEvaluationScale

Item

I have discomfort or pain in my stomach area

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C12391 (NCI Thesaurus Property-3)
C0038351 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.18

Code List

I have discomfort or pain in my stomach area

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeVaginaHemorrhageEvaluationScale

Item

I have vaginal bleeding or spotting

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C26791 (NCI Thesaurus Property-2)
C0019080 (UMLS 2011AA Property-2)
C12407 (NCI Thesaurus Property-3)
C0042232 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.19

Code List

I have vaginal bleeding or spotting

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeVaginaFluidDischargeEvaluationScale

Item

I have vaginal discharge

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C12407 (NCI Thesaurus Property-2)
C0042232 (UMLS 2011AA Property-2)
C34548 (NCI Thesaurus Property-3)
C0012621 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.20

Code List

I have vaginal discharge

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeAppearanceChangeDissatisfactionEvaluationScale

Item

I am unhappy about a change in my appearance

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25377 (NCI Thesaurus Property-2)
C0700364 (UMLS 2011AA Property-2)
C25446 (NCI Thesaurus Property-3)
C0392747 (UMLS 2011AA Property-3)
C62184 (NCI Thesaurus Property-4)
C0870433 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.21

Code List

I am unhappy about a change in my appearance

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeHotFlashesEvaluationScale

Item

I have hot flashes

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3109 (NCI Thesaurus Property-2)
C0600142 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.22

Code List

I have hot flashes

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeColdSweatEvaluationScale

Item

I have cold sweats

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property-2)
C0009264 (UMLS 2011AA Property-2)
C13280 (NCI Thesaurus Property-3)
C0038984 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.23

Code List

I have cold sweats

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeNightSweatsEvaluationScale

Item

I have night sweats

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3279 (NCI Thesaurus Property-2)
C0028081 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.24

Code List

I have night sweats

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

Quality-of-LifeAssessmentPatientFatigueScale

Item

I feel fatigued

text

C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.25

Code List

I feel fatigued

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeSexualIntercoursePainEvaluationScale

Item

I have pain or discomfort with intercourse

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C72881 (NCI Thesaurus Property-3)
C0009253 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.26

Code List

I have pain or discomfort with intercourse

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeDigestionDifficultyEvaluationScale

Item

I have trouble digesting food

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C16503 (NCI Thesaurus Property-3)
C0012238 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.27

Code List

I have trouble digesting food

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeDyspneaEvaluationScale

Item

I have been short of breath

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C2998 (NCI Thesaurus Property-2)
C0013404 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.28

Code List

I have been short of breath

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeConstipationDistressEvaluationScale

Item

I am bothered by constipation

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C37930 (NCI Thesaurus Property-2)
C0009806 (UMLS 2011AA Property-2)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.29

Code List

I am bothered by constipation

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeUrinationIncreaseFrequencyEvaluationScale

Item

I urinate more frequently than usual

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25533 (NCI Thesaurus Property-2)
C0442805 (UMLS 2011AA Property-2)
C25515 (NCI Thesaurus Property-3)
C0439603 (UMLS 2011AA Property-3)
C25744 (NCI Thesaurus Property-4)
C0042034 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.30

Code List

I urinate more frequently than usual

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifePelvisPainEvaluationScale

Item

I have discomfort or pain in my pelvic area

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
C12767 (NCI Thesaurus Property-3)
C0030797 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.31

Code List

I have discomfort or pain in my pelvic area

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

BowelPatientIncontinenceAssessmentQualityofLifeScale

Item

I have control of my bowels

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass-2)
C0021853 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0021167 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.32

Code List

I have control of my bowels

CL Item

A Little Bit (A little bit)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

QualityofLifeDiarrheaEvaluationScale

Item

I have 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)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.33

Code List

I have diarrhea

CL Item

A Little Bit (A little bit)

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

CL Item

Quite A Bit (Quite a bit)

C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)

CL Item

Somewhat (Somewhat)

C91215 (NCI Thesaurus)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

NTX4 Subscale

Item Group

Ntx4 Subscale

NeurotoxicityPatientParaesthesiaHandAssessmentQualityofLifeScale

Item

I have numbness or tingling in my hands

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C0235032 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0239836 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.34

Code List

I have numbness or tingling in my hands

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

NeurotoxicityPatientParaesthesiaFootAssessmentQualityofLifeScale

Item

I have numbness or tingling in my feet

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C0235032 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL108114 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.35

Code List

I have numbness or tingling in my feet

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

NeurotoxicityPatientHandDiscomfortAssessmentQualityofLifeScale

Item

I feel discomfort in my hands

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C0235032 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C32712 (NCI Thesaurus Property-2)
C0018563 (UMLS 2011AA Property-2)
CL047845 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.36

Code List

I feel discomfort in my hands

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

NeurotoxicityPatientFootDiscomfortAssessmentQualityofLifeScale

Item

I feel discomfort in my feet

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C0235032 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL050515 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)

CL.37

Code List

I feel discomfort in my feet

CL Item

Not At All (Not at all)

C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
C70543 (NCI Thesaurus-3)
C2003901 (UMLS 2011AA)

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)
C91216 (NCI Thesaurus-2)

CL Item

Very Much (Very much)

C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)

To be Completed by Clinical Staff

Item Group

To Be Completed By Clinical Staff

QualityofLifeContactPersonIdentifierName

Item

QOL contact person

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus ObjectClass-2)
C0518214 (UMLS 2011AA ObjectClass-2)
C25461 (NCI Thesaurus ObjectClass-3)
C0337611 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)

QualityofLifeEvaluationStatus

Item

Status of the QOL assessment

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)

CL.38

Code List

Status of the QOL assessment

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CL Item

Patient Died (Patient died)

CL Item

Patient Kept Appointment, But Could Not Complete Questionnaire Due To Illness (Patient kept appointment, but could not complete questionnaire due to illness)

CL Item

Patient Kept Appointment, But Refused To Complete Questionnaire For Reasons Other Than Illness (Patient kept appointment, but refused to complete questionnaire for reasons other than illness)

CL Item

Patient Off Study Treatment And Cannot Be Contacted For Follow-up (Patient off study treatment and cannot be contacted for follow-up)

CL Item

Questionnaire Not Administered Due To Clinical Staff Error (Questionnaire not administered due to clinical staff error)

CL Item

The Questionnaire Is Complete (The questionnaire is complete)

PatientRefuseIncompleteQuestionnaireSpecify

Item

Specify reason

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C49161 (NCI Thesaurus Property-2)
C1705116 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

QualityofLifeEvaluationSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)

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Endometrial Cancer NCT00942357 Quality of Life - GOG-0258 Quality of Life Survey Form - 2844576v1.0

Below is a list of statements that other people with your illness have said are important. By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

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