ID

9536

Beschrijving

RTOG 0920 Phase III Head and Neck Cancer University of Michigan Xerostomia-Related Quality of Life Scale (Xe QOLS) Form (L4) Radiation Therapy With or Without Cetuximab in Treating Patients Who Have Undergone Surgery for Locally Advanced Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5DDB9090-D6EA-C15F-E040-BB89A6435310

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5DDB9090-D6EA-C15F-E040-BB89A6435310

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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NCT00956007 Quality of Life - RTOG 0920 Phase III Head and Neck Cancer University of Michigan Xerostomia-Related Quality of Life Scale (Xe QOLS) Form (L4) - 2815347v1.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: RTOG 0920 Phase III Head and Neck Cancer University of Michigan Xerostomia-Related Quality of Life Scale (Xe QOLS) Form (L4)
    1. No Instruction available.
Header
Beschrijving

Header

RTOG Study No.
Beschrijving

Protocol ID RTOG

Datatype

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 #
Beschrijving

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Datatype

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
Beschrijving

Institution Name

Datatype

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.
Beschrijving

Institution Number

Datatype

text

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

Patient Initials

Datatype

text

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

Trial subject ID RTOG

Datatype

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
Unnamed2
Beschrijving

Unnamed2

Amended Data (This sheet is the cover page used for submission of the Xe-QOLS - questionnaire. This page must be completed by the medical staff nurse, data manager, physician, etc.)
Beschrijving

Data amended

Datatype

boolean

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

Unamed Module 2

Time point
Beschrijving

AssessmentPeriodType

Datatype

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
Was patient questionnaire completed
Beschrijving

PatientQuestionnaireCompleteInd-2

Datatype

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 patient questionnaire completed (MM DD YYYY)
Beschrijving

QualityofLifeCompleteAssessmentDate

Datatype

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
Beschrijving

Incomplete documentation, reason

Datatype

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
Beschrijving

PatientRefuseIncompleteQuestionnaireSpecify

Datatype

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
Beschrijving

PatientIncompleteQuestionnaireOtherSpecify

Datatype

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
Specify method of completion
Beschrijving

PatientQuestionnaireCompleteMethodofCollectionType

Datatype

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
Did the patient require any assistance in completing the questionnaire?
Beschrijving

PatientQuestionnaireAssistanceInd

Datatype

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
Specify the person who assisted the patient
Beschrijving

PatientQuestionnaireAssistancePersonCategory

Datatype

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
Other, specify
Beschrijving

PatientQuestionnaireAssistancePersonSpecify

Datatype

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
C25190
UMLS 2011AA ValueDomain-2
C0027361
Extent of assistance given
Beschrijving

PatientQuestionnaireAssistanceType

Datatype

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
Beschrijving

PatientQuestionnaireAssistanceCombinedSpecify

Datatype

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
Beschrijving

PatientQuestionnaireAssistanceOtherSpecify

Datatype

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
Signature of Person Completing This Form
Beschrijving

Responsible Person Signature

Datatype

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 Completed (MM DD YYYY)
Beschrijving

Date Form Completed

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Xerostomia-related Quality Of Life Scale
Beschrijving

Xerostomia-related Quality Of Life Scale

My mouth/throat dryness limits the kinds or amounts of food I eat
Beschrijving

XerostomiaQualityofLifeReducedFoodConsumptionAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25640
UMLS 2011AA Property
C0392756
NCI Thesaurus Property-3
C62695
UMLS 2011AA Property-2
C0016452
NCI Thesaurus Property-4
C66715
UMLS 2011AA Property-3
C1947907
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness causes discomfort
Beschrijving

XerostomiaQualityofLifeDiscomfortAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C50535
UMLS 2011AA Property
C0234215
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness causes a lot of worry or concern
Beschrijving

XerostomiaQualityofLifeNegativeEmotionActivityAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25247
UMLS 2011AA Property
C0205160
NCI Thesaurus Property-3
C54266
UMLS 2011AA Property-2
C0013987
NCI Thesaurus Property-4
C43431
UMLS 2011AA Property-3
C0441655
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness keeps me from socializing (going out)
Beschrijving

XerostomiaQualityofLifeSocialEventParticipationAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C25499
UMLS 2011AA Property-2
C0441471
NCI Thesaurus Property-4
C62650
UMLS 2011AA Property-3
C0728831
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness makes me uncomfortable when eating in front of other people
Beschrijving

XerostomiaQualityofLifeEmbarrassmentPublicConsumptionAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C66715
UMLS 2011AA Property
C1947907
NCI Thesaurus Property-3
C49060
UMLS 2011AA Property-2
C0678367
NCI Thesaurus Property-4
C62187
UMLS 2011AA Property-3
C0679112
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness makes me uncomfortable speaking in front of other people
Beschrijving

XerostomiaQualityofLifeEmbarrassmentPublicSpeechAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C49060
UMLS 2011AA Property
C0678367
NCI Thesaurus Property-3
C38025
UMLS 2011AA Property-2
C0037817
NCI Thesaurus Property-4
C62187
UMLS 2011AA Property-3
C0679112
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness makes me nervous
Beschrijving

XerostomiaQualityofLifeAnxietyAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C26696
UMLS 2011AA Property
C0003467
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness makes me concerned about the looks of my teeth and mouth
Beschrijving

XerostomiaQualityofLifeAnxietyOralCavityAppearanceAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25377
UMLS 2011AA Property
C0700364
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C12421
UMLS 2011AA Property-2
C0226896
NCI Thesaurus Property-4
C26696
UMLS 2011AA Property-3
C0003467
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness keeps me from enjoying life
Beschrijving

XerostomiaQualityofLifeReducedLifeSatisfactionAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62185
UMLS 2011AA Property
C0242428
NCI Thesaurus Property-3
C25640
UMLS 2011AA Property-2
C0392756
NCI Thesaurus Property-4
C37987
UMLS 2011AA Property-3
C0376558
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness interferes with my daily activities
Beschrijving

XerostomiaQualityofLifeActivitiesofDailyLivingDisruptionAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25486
UMLS 2011AA Property
C0332453
NCI Metathesaurus Property
C0001288
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness interferes with my intimate relationships
Beschrijving

XerostomiaQualityofLifeDisruptionRelationshipSatisfactionAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62185
UMLS 2011AA Property
C0242428
NCI Thesaurus Property-3
C25486
UMLS 2011AA Property-2
C0332453
NCI Thesaurus Property-4
C25648
UMLS 2011AA Property-3
C0439849
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness has a bad effect on tasting food
Beschrijving

XerostomiaQualityofLifeDysgeusiaAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C28145
UMLS 2011AA Property
C0013378
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness reduces my general happiness with life
Beschrijving

XerostomiaQualityofLifeReducedLifeHappinessAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25640
UMLS 2011AA Property
C0392756
NCI Thesaurus Property-3
C37987
UMLS 2011AA Property-2
C0376558
NCI Thesaurus Property-4
C72670
UMLS 2011AA Property-3
C0018592
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
My mouth/throat dryness affects all aspects of my life
Beschrijving

XerostomiaQualityofLifeDisruptionTotalActivityAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C43431
UMLS 2011AA Property
C0441655
NCI Thesaurus Property-3
C25486
UMLS 2011AA Property-2
C0332453
NCI Thesaurus Property-4
C25304
UMLS 2011AA Property-3
C0439810
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
If you were to spend the rest of your life with your mouth/throat dryness just the way it is now, how would you feel about this
Beschrijving

XerostomiaQualityofLifeFutureOutlookAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C26917
UMLS 2011AA ObjectClass-2
C0043352
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C67527
UMLS 2011AA Property
C0016884
NCI Thesaurus Property-3
C72885
UMLS 2011AA Property-2
C0004271
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C17047
UMLS 2011AA ValueDomain-2
C0518214
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1 Formulieren
  1. StudyEvent: RTOG 0920 Phase III Head and Neck Cancer University of Michigan Xerostomia-Related Quality of Life Scale (Xe QOLS) Form (L4)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
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)
Item Group
Unnamed2
Data amended
Item
Amended Data (This sheet is the cover page used for submission of the Xe-QOLS - questionnaire. This page must be completed by the medical staff nurse, data manager, physician, etc.)
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)
CL.2
Code List
Time point
CL Item
Baseline (baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
CL Item
3 Months From Start Of Treatment (3 months from start of treatment)
CL Item
1 Year From Start Of Treatment (1 year from start of treatment)
PatientQuestionnaireCompleteInd-2
Item
Was patient questionnaire completed
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 patient questionnaire completed (MM DD YYYY)
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)
CL.4
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 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
Patient Refused For Other Reason (Patient refused for other reason)
CL Item
Other Reason (Other reason)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
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
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)
CL.5
Code List
Specify method of completion
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
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)
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)
CL.6
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
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)
CL.7
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)
PatientQuestionnaireAssistancePersonSpecify
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)
C25190 (NCI Thesaurus ValueDomain-2)
C0027361 (UMLS 2011AA ValueDomain-2)
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)
CL.8
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)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (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)
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)
Date Form Completed
Item
Date Form Completed (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Item Group
Xerostomia-related Quality Of Life Scale
Item
My mouth/throat dryness limits the kinds or amounts of food I eat
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25640 (NCI Thesaurus Property-2)
C0392756 (UMLS 2011AA Property)
C62695 (NCI Thesaurus Property-3)
C0016452 (UMLS 2011AA Property-2)
C66715 (NCI Thesaurus Property-4)
C1947907 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.9
Code List
My mouth/throat dryness limits the kinds or amounts of food I eat
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness causes discomfort
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C50535 (NCI Thesaurus Property-2)
C0234215 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.10
Code List
My mouth/throat dryness causes discomfort
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness causes a lot of worry or concern
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25247 (NCI Thesaurus Property-2)
C0205160 (UMLS 2011AA Property)
C54266 (NCI Thesaurus Property-3)
C0013987 (UMLS 2011AA Property-2)
C43431 (NCI Thesaurus Property-4)
C0441655 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
My mouth/throat dryness causes a lot of worry or concern
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness keeps me from socializing (going out)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25499 (NCI Thesaurus Property-3)
C0441471 (UMLS 2011AA Property-2)
C62650 (NCI Thesaurus Property-4)
C0728831 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.12
Code List
My mouth/throat dryness keeps me from socializing (going out)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness makes me uncomfortable when eating in front of other people
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C66715 (NCI Thesaurus Property-2)
C1947907 (UMLS 2011AA Property)
C49060 (NCI Thesaurus Property-3)
C0678367 (UMLS 2011AA Property-2)
C62187 (NCI Thesaurus Property-4)
C0679112 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.13
Code List
My mouth/throat dryness makes me uncomfortable when eating in front of other people
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness makes me uncomfortable speaking in front of other people
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C49060 (NCI Thesaurus Property-2)
C0678367 (UMLS 2011AA Property)
C38025 (NCI Thesaurus Property-3)
C0037817 (UMLS 2011AA Property-2)
C62187 (NCI Thesaurus Property-4)
C0679112 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.14
Code List
My mouth/throat dryness makes me uncomfortable speaking in front of other people
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness makes me nervous
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C26696 (NCI Thesaurus Property-2)
C0003467 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.15
Code List
My mouth/throat dryness makes me nervous
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness makes me concerned about the looks of my teeth and mouth
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25377 (NCI Thesaurus Property)
C0700364 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C12421 (NCI Thesaurus Property-3)
C0226896 (UMLS 2011AA Property-2)
C26696 (NCI Thesaurus Property-4)
C0003467 (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
My mouth/throat dryness makes me concerned about the looks of my teeth and mouth
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness keeps me from enjoying life
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0242428 (UMLS 2011AA Property)
C25640 (NCI Thesaurus Property-3)
C0392756 (UMLS 2011AA Property-2)
C37987 (NCI Thesaurus Property-4)
C0376558 (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
My mouth/throat dryness keeps me from enjoying life
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness interferes with my daily activities
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25486 (NCI Thesaurus Property-2)
C0332453 (UMLS 2011AA Property)
C0001288 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.18
Code List
My mouth/throat dryness interferes with my daily activities
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness interferes with my intimate relationships
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62185 (NCI Thesaurus Property-2)
C0242428 (UMLS 2011AA Property)
C25486 (NCI Thesaurus Property-3)
C0332453 (UMLS 2011AA Property-2)
C25648 (NCI Thesaurus Property-4)
C0439849 (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
My mouth/throat dryness interferes with my intimate relationships
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness has a bad effect on tasting food
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C28145 (NCI Thesaurus Property-2)
C0013378 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.20
Code List
My mouth/throat dryness has a bad effect on tasting food
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness reduces my general happiness with life
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25640 (NCI Thesaurus Property-2)
C0392756 (UMLS 2011AA Property)
C37987 (NCI Thesaurus Property-3)
C0376558 (UMLS 2011AA Property-2)
C72670 (NCI Thesaurus Property-4)
C0018592 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.21
Code List
My mouth/throat dryness reduces my general happiness with life
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
My mouth/throat dryness affects all aspects of my life
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C43431 (NCI Thesaurus Property-2)
C0441655 (UMLS 2011AA Property)
C25486 (NCI Thesaurus Property-3)
C0332453 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus Property-4)
C0439810 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.22
Code List
My mouth/throat dryness affects all aspects of my life
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little (A little)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
Item
If you were to spend the rest of your life with your mouth/throat dryness just the way it is now, how would you feel about this
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C26917 (NCI Thesaurus ObjectClass-2)
C0043352 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C67527 (NCI Thesaurus Property-2)
C0016884 (UMLS 2011AA Property)
C72885 (NCI Thesaurus Property-3)
C0004271 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C0518214 (UMLS 2011AA ValueDomain-2)
CL.23
Code List
If you were to spend the rest of your life with your mouth/throat dryness just the way it is now, how would you feel about this
CL Item
Delighted (Delighted)
CL Item
Mostly Satisfied (Mostly satisfied)
CL Item
Mixed: Equally Satisfied/dissatisfied (Mixed: equally satisfied/dissatisfied)
CL Item
Mostly Dissatisfied (Mostly dissatisfied)
CL Item
Terrible (Terrible)
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