ID

9526

Beskrivning

RTOG 1115 HP: Phase III RT + Standard ADT vs RT + Enhanced ADT + TAK-700 PROMIS Form Hormone Therapy, Radiation Therapy, and Steroid 17alpha-monooxygenase TAK-700 in Treating Patients With High-Risk Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE8F0868-80F7-FEC9-E040-BB89AD4357E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE8F0868-80F7-FEC9-E040-BB89AD4357E7

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

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Creative Commons BY-NC 3.0 Legacy

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    Prostate Cancer NCT01546987 Quality of Life - RTOG 1115 HP: Phase III RT + Standard ADT vs RT + Enhanced ADT + TAK-700 PROMIS Form - 3289372v1.0

    INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

    Unnamed Module 1
    Beskrivning

    Unnamed Module 1

    RTOG Study No.
    Beskrivning

    Protocol ID RTOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Case #
    Beskrivning

    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C19778
    UMLS 2011AA ObjectClass-2
    C1514695
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C49152
    UMLS 2011AA Property-2
    C1706256
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    Institution Name
    Beskrivning

    Institution Name

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Institution No.
    Beskrivning

    Institution Number

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Patient Initials
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    RTOG Patient ID
    Beskrivning

    Trial subject ID RTOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Amended data
    Beskrivning

    Data amended

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Unamed Module 2
    Beskrivning

    Unamed Module 2

    Time point
    Beskrivning

    AssessmentPeriodType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    Other specify
    Beskrivning

    AssessmentPeriodSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    Did the patient complete any items on the questionnaire?
    Beskrivning

    PatientQuestionnaireCompleteInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus Property-2
    C17048
    UMLS 2011AA Property-2
    C0034394
    Date Questionnaire Completed
    Beskrivning

    QualityofLifeCompleteAssessmentDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus Property-2
    C25367
    Reason Questionnaire was not Completed
    Beskrivning

    Incomplete documentation, reason

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1548386
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C0566251
    NCI Metathesaurus Property
    C0034394
    Patient refused for other reason, specify
    Beskrivning

    PatientRefuseIncompleteQuestionnaireSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus Property
    C0034394
    NCI Thesaurus Property
    C49160
    UMLS 2011AA Property
    C0205257
    NCI Thesaurus Property-2
    C49161
    UMLS 2011AA Property-2
    C1705116
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Other reason, specify
    Beskrivning

    PatientIncompleteQuestionnaireOtherSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ValueDomain-2
    C17649
    UMLS 2011AA ValueDomain-2
    C0205394
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus Property
    C0034394
    Did the patient require any assistance in completing the questionnaire?
    Beskrivning

    PatientQuestionnaireAssistanceInd

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17048
    UMLS 2011AA Property
    C0034394
    NCI Metathesaurus Property
    C0018896
    Extent of assistance given
    Beskrivning

    PatientQuestionnaireAssistanceType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17048
    UMLS 2011AA Property
    C0034394
    NCI Metathesaurus Property
    C0018896
    Combination of above, specify
    Beskrivning

    PatientQuestionnaireAssistanceCombinedSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17048
    UMLS 2011AA Property
    C0034394
    NCI Metathesaurus Property
    C0018896
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ValueDomain-2
    C25454
    UMLS 2011AA ValueDomain-2
    C0205195
    Other, specify
    Beskrivning

    PatientQuestionnaireAssistanceOtherSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17048
    UMLS 2011AA Property
    C0034394
    NCI Metathesaurus Property
    C0018896
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ValueDomain-2
    C17649
    UMLS 2011AA ValueDomain-2
    C0205394
    Specify the person who assisted the patient
    Beskrivning

    PatientQuestionnaireAssistancePersonCategory

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C17048
    UMLS 2011AA Property
    C0034394
    NCI Metathesaurus Property
    C0018896
    NCI Thesaurus ValueDomain
    C25190
    UMLS 2011AA ValueDomain
    C0027361
    NCI Thesaurus ValueDomain-2
    C25372
    UMLS 2011AA ValueDomain-2
    C0683312
    Specify method of completion
    Beskrivning

    PatientQuestionnaireCompleteMethodofCollectionType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus Property-2
    C17048
    UMLS 2011AA Property-2
    C0034394
    Comments
    Beskrivning

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Signature of Person Completing This Form
    Beskrivning

    Responsible Person Signature

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus ObjectClass-2
    C25657
    NCI Thesaurus Property
    C25678
    Date Form Originally Completed
    Beskrivning

    Form Completion Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Fatigue - Short Form
    Beskrivning

    Fatigue - Short Form

    How often did you feel tired
    Beskrivning

    Quality-of-LifeAssessmentPatientSmallFatigueScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C15584
    UMLS 2011AA ObjectClass
    C0281588
    NCI Thesaurus Property
    C16960
    UMLS 2011AA Property
    C0030705
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus Property-3
    C25376
    UMLS 2011AA Property-3
    C0700321
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often did you experience extreme exhaustion
    Beskrivning

    QualityofLifeSevereFatigueEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus Property-3
    C70667
    UMLS 2011AA Property-3
    C0205082
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often did you run out of energy
    Beskrivning

    PatientEnergyAssessmentQualityofLifeScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C48058
    UMLS 2011AA Property-2
    C0542479
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often did your fatigue limit you at work (include work at home)
    Beskrivning

    QualityofLifeReducedOccupationFatigueEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C25640
    UMLS 2011AA Property-2
    C0392756
    NCI Thesaurus Property-3
    C3036
    UMLS 2011AA Property-3
    C0015672
    NCI Thesaurus Property-4
    C25193
    UMLS 2011AA Property-4
    C0028811
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often were you too tired to think clearly
    Beskrivning

    QualityofLifeFatigueImpairmentCognitionEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus Property-3
    C21055
    UMLS 2011AA Property-3
    C0684336
    NCI Thesaurus Property-4
    C16446
    UMLS 2011AA Property-4
    C0009240
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often were you too tired to take a bath or shower
    Beskrivning

    QualityofLifeFatigueWashEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C3036
    UMLS 2011AA Property-2
    C0015672
    NCI Thesaurus Property-3
    C65077
    UMLS 2011AA Property-3
    C0441648
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214
    How often did you have enough energy to exercise strenuously
    Beskrivning

    QualityofLifeExerciseEvaluationScale

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus Property-2
    C16567
    UMLS 2011AA Property-2
    C0015259
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ValueDomain-2
    C17047
    UMLS 2011AA ValueDomain-2
    C0518214

    Similar models

    INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Unnamed Module 1
    Protocol ID RTOG
    Item
    RTOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
    Item
    Case #
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C19778 (NCI Thesaurus ObjectClass-2)
    C1514695 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C49152 (NCI Thesaurus Property-2)
    C1706256 (UMLS 2011AA Property-2)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Trial subject ID RTOG
    Item
    RTOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Data amended
    Item
    Amended data
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Unamed Module 2
    Item
    Time point
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    Code List
    Time point
    CL Item
    Baseline (baseline)
    C25213 (NCI Thesaurus)
    C1442488 (UMLS 2011AA)
    CL Item
    Pretreatment (Pretreatment)
    CL Item
    Last Week Of Radiation Therapy (Last week of RT)
    CL Item
    12 Months From Start Of Treatment (12 months from start of treatment)
    CL Item
    30 Months From Start Of Treatment (30 months from start of treatment)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    AssessmentPeriodSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    PatientQuestionnaireCompleteInd-2
    Item
    Did the patient complete any items on the questionnaire?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C17048 (NCI Thesaurus Property-2)
    C0034394 (UMLS 2011AA Property-2)
    QualityofLifeCompleteAssessmentDate
    Item
    Date Questionnaire Completed
    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)
    Item
    Reason Questionnaire was not Completed
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1548386 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C0034394 (NCI Metathesaurus Property)
    Code List
    Reason Questionnaire was not Completed
    CL Item
    Not Applicable, Questionnaire Was Completed (Not applicable, questionnaire was completed)
    CL Item
    Patient Refused Due To Illness (Patient refused due to illness)
    CL Item
    Patient Refused For Other Reason (Patient refused for other reason)
    CL Item
    Patient Unable To Be Contacted (Patient unable to be contacted)
    CL Item
    Institution Error (Institutional error)
    CL Item
    Tool Not Availalble In Patient's Language (Tool not available in patient's language)
    CL Item
    Other Reason (Other reason)
    PatientRefuseIncompleteQuestionnaireSpecify
    Item
    Patient refused for other reason, specify
    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)
    PatientIncompleteQuestionnaireOtherSpecify
    Item
    Other reason, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C17649 (NCI Thesaurus ValueDomain-2)
    C0205394 (UMLS 2011AA ValueDomain-2)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0034394 (NCI Metathesaurus Property)
    Item
    Did the patient require any assistance in completing the questionnaire?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C0018896 (NCI Metathesaurus Property)
    Code List
    Did the patient require any assistance in completing the questionnaire?
    CL Item
    Not Applicable (Not applicable)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    Unknown If Assistance Given (Unknown if assistance given)
    Item
    Extent of assistance given
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C0018896 (NCI Metathesaurus Property)
    Code List
    Extent of assistance given
    CL Item
    Not Applicable (Not applicable)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    CL Item
    Read Items To Patient (Read items to patient)
    CL Item
    Interpreted Items For Patient (Interpreted items for patient)
    CL Item
    Marked Items Per Patient's Response (Marked items per patient's response)
    CL Item
    Combination Of Above (Combination of above)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientQuestionnaireAssistanceCombinedSpecify
    Item
    Combination of above, specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C0018896 (NCI Metathesaurus Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25454 (NCI Thesaurus ValueDomain-2)
    C0205195 (UMLS 2011AA ValueDomain-2)
    PatientQuestionnaireAssistanceOtherSpecify
    Item
    Other, specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C0018896 (NCI Metathesaurus Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C17649 (NCI Thesaurus ValueDomain-2)
    C0205394 (UMLS 2011AA ValueDomain-2)
    Item
    Specify the person who assisted the patient
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C0018896 (NCI Metathesaurus Property)
    C25190 (NCI Thesaurus ValueDomain)
    C0027361 (UMLS 2011AA ValueDomain)
    C25372 (NCI Thesaurus ValueDomain-2)
    C0683312 (UMLS 2011AA ValueDomain-2)
    Code List
    Specify the person who assisted the patient
    CL Item
    Not Applicable (Not applicable)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    CL Item
    Staff Member (Staff member)
    CL Item
    Family (Family)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    Item
    Specify method of completion
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C17048 (NCI Thesaurus Property-2)
    C0034394 (UMLS 2011AA Property-2)
    Code List
    Specify method of completion
    CL Item
    At Appointment (At appointment)
    CL Item
    By Mail (By mail)
    CL Item
    By Telephone (By telephone)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Responsible Person Signature
    Item
    Signature of Person Completing This Form
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C25657 (NCI Thesaurus ObjectClass-2)
    C25678 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Date Form Originally Completed
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Fatigue - Short Form
    Item
    How often did you feel tired
    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)
    C25376 (NCI Thesaurus Property-3)
    C0700321 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often did you feel tired
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often did you experience extreme exhaustion
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C3036 (NCI Thesaurus Property-2)
    C0015672 (UMLS 2011AA Property-2)
    C70667 (NCI Thesaurus Property-3)
    C0205082 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often did you experience extreme exhaustion
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often did you run out of energy
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C48058 (NCI Thesaurus Property-2)
    C0542479 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often did you run out of energy
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often did your fatigue limit you at work (include work at home)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C25640 (NCI Thesaurus Property-2)
    C0392756 (UMLS 2011AA Property-2)
    C3036 (NCI Thesaurus Property-3)
    C0015672 (UMLS 2011AA Property-3)
    C25193 (NCI Thesaurus Property-4)
    C0028811 (UMLS 2011AA Property-4)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often did your fatigue limit you at work (include work at home)
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often were you too tired to think clearly
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C3036 (NCI Thesaurus Property-2)
    C0015672 (UMLS 2011AA Property-2)
    C21055 (NCI Thesaurus Property-3)
    C0684336 (UMLS 2011AA Property-3)
    C16446 (NCI Thesaurus Property-4)
    C0009240 (UMLS 2011AA Property-4)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often were you too tired to think clearly
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often were you too tired to take a bath or shower
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C3036 (NCI Thesaurus Property-2)
    C0015672 (UMLS 2011AA Property-2)
    C65077 (NCI Thesaurus Property-3)
    C0441648 (UMLS 2011AA Property-3)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often were you too tired to take a bath or shower
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)
    Item
    How often did you have enough energy to exercise strenuously
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C16567 (NCI Thesaurus Property-2)
    C0015259 (UMLS 2011AA Property-2)
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ValueDomain-2)
    C0518214 (UMLS 2011AA ValueDomain-2)
    Code List
    How often did you have enough energy to exercise strenuously
    CL Item
    Never (Never)
    C70543 (NCI Thesaurus)
    C2003901 (UMLS 2011AA)
    CL Item
    Rarely (Rarely)
    C73116 (NCI Thesaurus)
    C0522498 (UMLS 2011AA)
    CL Item
    Sometimes (Sometimes)
    CL Item
    Often (Often)
    CL Item
    Always (Always)

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