Description:

GOG-0263: Quality of Life Questionnaire Radiation Therapy With or Without Chemotherapy in Patients With Stage I or Stage II Cervical Cancer Who Previously Underwent Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7170934C-5F81-20E2-E040-BB89AD434964

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7170934C-5F81-20E2-E040-BB89AD434964

Keywords:

Uterine Cervical Neoplasms

Clinical Trial

Quality of Life

Versions (3) ▾

8/27/12
8/11/14
1/9/15

Uploaded on:

January 9, 2015

DOI:

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License:

Creative Commons BY-NC 3.0 Legacy

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Cervical Cancer NCT01101451 Quality of Life - GOG-0263: Quality of Life Questionnaire - 2933853v1.0

Details

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

StudyEvent: GOG-0263: Quality of Life Questionnaire
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

Header Module

Patient Initials

Date Questionnaire Completed

Patient Study ID

To Be Completed By Clinical Staff

QOL contact person

Status of the QOL assessment

Other (Other)

Patient Died (Patient died)

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

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)

3 more items in the detailed view.

Specify reason

Other, specify

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