Description:

RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Quality of Life Form Chemotherapy and Pelvic Radiation Therapy With or Without Additional Chemotherapy in Treating Patients With High-Risk Early-Stage Cervical Cancer After Radical Hysterectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5D0320C5-F603-076A-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5D0320C5-F603-076A-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 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 NCT00980954 Quality of Life - RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Quality of Life Form - 2807448v1.0

No Instruction available.

  1. StudyEvent: RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Quality of Life Form
    1. No Instruction available.
Unnamed Module 1
Amended Data
Unamed Module 2
Time point
Was patient questionnaire completed
Reason Questionnaire was not Completed
Specify method of completion
Did the patient require any assistance in completing the questionnaire?
Specify the person who assisted the patient
Extent of assistance given
Physical Well-being
I have a lack of energy
I have nausea
Because of my physical condition, I have trouble meeting the needs of my family
I have pain
I am bothered by side effects of treatment
I feel ill
I am forced to spend time in bed
Social/family Well-being
I feel close to my friends
I get emotional support from my family
I get support from my friends
My family has accepted my illness
I am satisfied with family communication about my illness
I feel close to my partner (or the person who is my main support)
I am satisfied with my sex life
Emotional Well-being
I feel sad
I am satisfied with how I am coping with my illness
I am losing hope in the fight against my illness
I feel nervous
I worry about dying
I worry that my condition will get worse
Functional Well-being
I am able to work (include work at home)
My work is fulfilling (include work at home)
I am able to enjoy life
I have accepted my illness
I am sleeping well
I am enjoying the things I usually do for fun
I am content with the quality of my life right now
Additional Concerns
I have control of my bowels
I move my bowels more frequently than usual
I am afraid to be far from a toliet
I have to limit my social activity because of diarrhea
I have to limit my physical activity because of diarrhea
I have to limit my sexual activity because of diarrhea
I am embarrassed by having diarrhea
I have abdominal cramps or discomfort due to my diarrhea
My problem with diarrhea keeps/wakes me up at night
I must move my bowels frequently to avoid accidents
I wear protection for soiling of stool

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