QUALITY OF LIFE SUPPLEMENT (Form 24-QLS) Patient Instructions: The following questions ask your feelings during the past week. For each of the following statements, mark an ?X? in the box that best describes the way you felt.

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Quality Of Life Supplement (form 24-qls)
PatientStudyID,CoordinatingGroup
Item
Patient ID Number (Study No.)
text
Patient Initials
Item
Patient Initials (f m fl sl)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
PatientBirthDate
Item
Patient's Date of Birth (day)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
MainMemberInstitution/Affiliate
Item
Participating Center/Affiliate
text
ParticipatingGroupCode
Item
Center Code (During the past week:)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Item
I was bothered by things that usually don?t bother me
text
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.1
Code List
I was bothered by things that usually don?t bother me
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I did not feel like eating; my appetite was poor
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77959 (NCI Thesaurus Property-2)
C2700379 (UMLS 2011AA Property-2)
C25152 (NCI Thesaurus Property-3)
C0003618 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.2
Code List
I did not feel like eating; my appetite was poor
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that I could not shake off the blues even with the help of my family and friends
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C70666 (NCI Thesaurus Property-2)
C2945599 (UMLS 2011AA Property-2)
C2982 (NCI Thesaurus Property-3)
C0011570 (UMLS 2011AA Property-3)
C43623 (NCI Thesaurus Property-4)
C0205322 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.3
Code List
I felt that I could not shake off the blues even with the help of my family and friends
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that I was just as good as other people
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C61582 (NCI Thesaurus Property-2)
C0205163 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.4
Code List
I felt that I was just as good as other people
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I had trouble keeping my mind on what I was doing
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-3)
C0004268 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.5
Code List
I had trouble keeping my mind on what I was doing
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt depressed
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property-2)
C0011570 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.6
Code List
I felt depressed
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that everything I did was an effort
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C53291 (NCI Thesaurus Property-2)
C1708387 (UMLS 2011AA Property-2)
C74530 (NCI Thesaurus Property-3)
C0015264 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.7
Code List
I felt that everything I did was an effort
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt hopeful about the future
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72885 (NCI Thesaurus Property)
C0004271 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C77962 (NCI Thesaurus Property-3)
C0392347 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.8
Code List
I felt hopeful about the future
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I thought my life had been a failure
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C37987 (NCI Thesaurus Property)
C0376558 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C25745 (NCI Thesaurus Property-3)
C0231174 (UMLS 2011AA Property-3)
C54226 (NCI Thesaurus Property-4)
C0039869 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.9
Code List
I thought my life had been a failure
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt fearful
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77960 (NCI Thesaurus Property-2)
C0015726 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.10
Code List
I felt fearful
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
My sleep was restless
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property-2)
C74533 (NCI Thesaurus Property-3)
C0085631 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
My sleep was restless
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I was happy
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C72670 (NCI Thesaurus Property)
C0018592 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.12
Code List
I was happy
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I talked less than usual
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25640 (NCI Thesaurus Property)
C0392756 (UMLS 2011AA Property)
C38025 (NCI Thesaurus Property-2)
C0037817 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.13
Code List
I talked less than usual
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt lonely
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C34785 (NCI Thesaurus Property-2)
C0023974 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.14
Code List
I felt lonely
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
People were unfriendly
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25594 (NCI Thesaurus Property-2)
C1518422 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C77968 (NCI Thesaurus Property-4)
C2700214 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.15
Code List
People were unfriendly
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I enjoyed life
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77961 (NCI Thesaurus Property-2)
C0018592 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.16
Code List
I enjoyed life
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I had crying spells
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C77963 (NCI Thesaurus Property-2)
C0010399 (UMLS 2011AA Property-2)
C75539 (NCI Thesaurus Property-3)
C0332189 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.17
Code List
I had crying spells
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt sad
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C74534 (NCI Thesaurus Property-2)
C0344315 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.18
Code List
I felt sad
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I felt that people disliked me
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C62650 (NCI Thesaurus Property)
C0728831 (UMLS 2011AA Property)
C50535 (NCI Thesaurus Property-2)
C0234215 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.19
Code List
I felt that people disliked me
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Item
I could not get ?going?
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C25473 (NCI Thesaurus Property-2)
C0332173 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C25431 (NCI Thesaurus Property-4)
C0439659 (UMLS 2011AA Property-4)
C62189 (NCI Thesaurus Property-5)
C1299586 (UMLS 2011AA Property-5)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)
C0439603 (UMLS 2011AA ValueDomain-2)
CL.20
Code List
I could not get ?going?
CL Item
None Of The Time (Rarely or none of the time (less than 1 day))
CL Item
Some Of The Time (Some or a little of the time (1-2 days))
CL Item
Moderate (Occasionally or a moderate amount of the time (3-4 days))
CL Item
Most Of The Time (Most or all of the time (5-7 days))
Howmuchofaproblemwaseachofthefollowingduringthepastfour(4)weeks?
Item
How much of a problem was each of the following during the past four (4) weeks?
text
Item
Lack of sexual interest
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.21
Code List
Lack of sexual interest
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Unable to relax and enjoy sex
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.22
Code List
Unable to relax and enjoy sex
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Difficulty in becoming aroused
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.23
Code List
Difficulty in becoming aroused
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Difficulty in having an orgasm
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.24
Code List
Difficulty in having an orgasm
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
Item
Pain or discomfort with intercourse
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.25
Code List
Pain or discomfort with intercourse
CL Item
Not At All (Not a problem)
C91213 (NCI Thesaurus)
CL Item
A Little (Little of a problem)
CL Item
Somewhat (Somewhat of a problem)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much of a problem)
C91217 (NCI Thesaurus)
CL Item
Not applicable (Not applicable)
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