ID

43190

Descrizione

RTOG 0825: QOL M.D. Anderson Symptom Inventory Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5BABD9A9-3DF8-0152-E044-0003BA3F9857

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5BABD9A9-3DF8-0152-E044-0003BA3F9857

Keywords

D33.2

Klinische Studie [Dokumenttyp]

D016543

On-Study Form

Caricato su

20 settembre 2021

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy

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Brain and Central Nervous System Tumors NCT00884741 On-Study - RTOG 0825: QOL M.D. Anderson Symptom Inventory - 2800871v1.0

model
Dettagli

INSTRUCTIONS: This sheet is the cover page used for the submission of the QOL questionnaires. It needs to be completed by the medical staff (nurse, data manager, physician, etc.) and should be submitted with each questionnaire

1 moduli

StudyEvent: RTOG 0825: QOL M.D. Anderson Symptom Inventory
1. INSTRUCTIONS: This sheet is the cover page used for the submission of the QOL questionnaires. It needs to be completed by the medical staff (nurse, data manager, physician, etc.) and should be submitted with each questionnaire

Name

genere

Description | Question | Decode (Coded Value)

Tipo di dati

Alias

Header Module

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)

QOL Cover Sheet

Item Group

Unamed Module 2

AssessmentPeriodType

Item

Time point of this assessment (please check box that applies to this assessment)

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 of this assessment (please check box that applies to this assessment)

CL Item

Registration (Registration)

C25646 (NCI Thesaurus)
C1514821 (UMLS 2011AA)

CL Item

Week 6 (week 6)

CL Item

Week 10 (Week 10)

CL Item

Week 22 (Week 22)

CL Item

Week 34 (Week 34)

CL Item

Week 46 (Week 46)

CL Item

Week 46 (Week 62)

CL Item

Other Followup (Other follow-ups)

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 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)

Incomplete documentation, reason

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

Patient Refused Due To Illness (Patient refused due to illness)

CL Item

Patient Unable To Be Contacted (Patient unable to be contacted)

CL Item

Questionnaire Not Completed Due To Institutional Error (Questionnaire not completed due to 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)

PatientQuestionnaireCompleteMethodofCollectionType

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

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)

PatientQuestionnaireAssistanceInd

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

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)

PatientQuestionnaireAssistancePersonCategory

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

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)

PatientQuestionnaireAssistanceType

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

Read Items To Patient (Read items to 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

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)

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

Form Completion Date, Original (MM DD YYYY)

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)

Part I. M.D. Anderson Symptom Inventory (MDASI-BT)

Item Group

M.d. Anderson Symptom Inventory (mdasi-bt)

PatientWorstPainSymptomScale

Item

Your pain at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)

PatientFatigueAssessmentSymptomScale

Item

Your fatigue at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)

PatientNauseaAssessmentSymptomScale

Item

Your nausea at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3258 (NCI Thesaurus Property-2)
C0027497 (UMLS 2011AA Property-2)

PatientSleepDifficultyAssessmentSymptomScale

Item

Your disturbed sleep at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-3)
C1299586 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientDistressSymptomScale

Item

Your feeling of being distressed at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-2)
C0231303 (UMLS 2011AA Property-2)

PatientDyspneaAssessmentSymptomScale

Item

Your shortness of breath at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C2998 (NCI Thesaurus Property-2)
C0013404 (UMLS 2011AA Property-2)

NeurologicalEvaluationMemorySymptomScale

Item

Your problem with remembering things at its worst

float

C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C25262 (NCI Thesaurus ObjectClass-2)
C0205494 (UMLS 2011AA ObjectClass-2)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C37992 (NCI Thesaurus Property-2)
C0025260 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientAppetiteLossSymptomScale

Item

Your problem with lack of appetite at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25559 (NCI Thesaurus Property)
C1517945 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25152 (NCI Thesaurus Property-3)
C0003618 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientSomnolenceSymptomScale

Item

Your feeling drowsy at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C26754 (NCI Thesaurus Property-2)
C2830004 (UMLS 2011AA Property-2)

PatientDryMouthAssessmentSymptomScale

Item

Your having a dry mouth at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C26917 (NCI Thesaurus Property-2)
C0043352 (UMLS 2011AA Property-2)

PatientDepressionAssessmentSymptomScale

Item

Your feeling sad at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property-2)
C0011570 (UMLS 2011AA Property-2)

PatientVomitingSymptomScale

Item

Your vomiting at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3442 (NCI Thesaurus Property)
C0042963 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)

PatientNumbnessTinglingSymptomScale

Item

Your numbness or tingling at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C34857 (NCI Thesaurus Property-2)
C0028643 (UMLS 2011AA Property-2)
C50771 (NCI Thesaurus Property-3)
C2242996 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

BrainQualityofLifeWeaknessSideBodyAssessmentSymptomScale

Item

Your weakness on one side of body at its worst

float

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C13041 (NCI Thesaurus Property-2)
C1268086 (UMLS 2011AA Property)
C25306 (NCI Thesaurus Property-3)
C0441987 (UMLS 2011AA Property-2)
C50809 (NCI Thesaurus Property-4)
C0004093 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientDifficultyComprehensionSymptomScale

Item

Your difficulty understanding at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C0162340 (NCI Metathesaurus Property)

BrainQualityofLifeDifficultySpeechAssessmentSymptomScale

Item

Your difficulty speaking at its worst

float

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C38025 (NCI Thesaurus Property-2)
C0037817 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-3)
C1299586 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

NeurologicalEvaluationSeizureSymptomScale

Item

Your seizures at its worst

float

C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C25262 (NCI Thesaurus ObjectClass-2)
C0205494 (UMLS 2011AA ObjectClass-2)
C2962 (NCI Thesaurus Property)
C0036572 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

Quality-of-LifeAssessmentPatientDifficultyAttentionConcentrationSymptomScale

Item

Your difficulty concentrating at its worst

float

C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C41209 (NCI Thesaurus Property-3)
C0004268 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientDifficultyVisionSymptomScale

Item

Your vision at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-2)
C1299586 (UMLS 2011AA Property-2)
C0042789 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientAppearanceDeteriorationSymptomScale

Item

Your change in appearance at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus Property)
C0700364 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25751 (NCI Thesaurus Property-3)
C0868945 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientDiarrheaConstipationSymptomScale

Item

Your change in bowel pattern at its worst

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C37930 (NCI Thesaurus Property)
C0009806 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C2987 (NCI Thesaurus Property-3)
C0011991 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientIrritabilitySymptomScale

Item

Your irritability at its worst

float

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C50623 (NCI Thesaurus Property-2)
C0022107 (UMLS 2011AA Property-2)

Part II

Item Group

Part Ii

PatientGeneralizedActivityInterferenceSymptomScale

Item

General activity

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C63764 (NCI Thesaurus Property-3)
C0205246 (UMLS 2011AA Property-3)
C72886 (NCI Thesaurus Property-4)
C0521102 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientMoodInterferenceSymptomScale

Item

Mood

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C72886 (NCI Thesaurus Property-2)
C0521102 (UMLS 2011AA Property-2)
C72883 (NCI Thesaurus Property-3)
C0026516 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientWorkInterferenceSymptomScale

Item

Work

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C74299 (NCI Thesaurus Property-2)
C0043227 (UMLS 2011AA Property-2)
C72886 (NCI Thesaurus Property-3)
C0521102 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientRelationshipInterferenceSymptomScale

Item

Relations with other people

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25648 (NCI Thesaurus Property)
C0439849 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C72886 (NCI Thesaurus Property-3)
C0521102 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientWalkingInterferenceSymptomScale

Item

Walking

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C73554 (NCI Thesaurus Property-2)
C0080331 (UMLS 2011AA Property-2)
C72886 (NCI Thesaurus Property-3)
C0521102 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

PatientLifeJoyInterferenceSymptomScale

Item

Enjoyment of life

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C37987 (NCI Thesaurus Property)
C0376558 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C77961 (NCI Thesaurus Property-3)
C0018592 (UMLS 2011AA Property-3)
C72886 (NCI Thesaurus Property-4)
C0521102 (UMLS 2011AA Property-4)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)

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Brain and Central Nervous System Tumors NCT00884741 On-Study - RTOG 0825: QOL M.D. Anderson Symptom Inventory - 2800871v1.0

INSTRUCTIONS: This sheet is the cover page used for the submission of the QOL questionnaires. It needs to be completed by the medical staff (nurse, data manager, physician, etc.) and should be submitted with each questionnaire

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