ID

43464

Beschreibung

CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455 Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0D7D5091-6484-2392-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0D7D5091-6484-2392-E044-0003BA3F9857

Stichworte

  1. 26.08.12 26.08.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 21.06.15 21.06.15 -
  4. 20.09.21 20.09.21 -
Hochgeladen am

20. September 2021

DOI

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Lizenz

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CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

Header
Beschreibung

Header

CALGB Form
Beschreibung

Form ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3262252
NCI Thesaurus ObjectClass
C19464
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass-2
C25442
CALGB Study No
Beschreibung

Protocol ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Beschreibung

Trial subject ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Are data amended
Beschreibung

Data amended

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient demographics
Beschreibung

Patient demographics

Patient Initials
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Medical Record Number
Beschreibung

Medical Record Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Beschreibung

Institution Name

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group
Beschreibung

Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Protocol Number
Beschreibung

Study Number Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Beschreibung

Trial subject ID Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Responsible CRA
Beschreibung

ClinicalResearchAssociateResponsiblePersonName

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass-2
C25465
UMLS 2011AA ObjectClass-2
C1516627
Memorial Symptom Assessment
Beschreibung

Memorial Symptom Assessment

Lack of energy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

FatigueAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3036
UMLS 2011AA ObjectClass-2
C0015672
Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

FatigueAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3036
UMLS 2011AA ObjectClass-2
C0015672
Lack of appetite (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

AppetiteAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C25152
UMLS 2011AA ObjectClass-2
C0003618
Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

AppetiteAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C25152
UMLS 2011AA ObjectClass-2
C0003618
Pain (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

PainAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3303
UMLS 2011AA ObjectClass-2
C0030193
Pain (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

PainAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3303
UMLS 2011AA ObjectClass-2
C0030193
Dry Mouth (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

PatientDryMouthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C26917
UMLS 2011AA Property-2
C0043352
Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

PatientDryMouthAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C26917
UMLS 2011AA Property-2
C0043352
Weight loss (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

WeightLossAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3445
UMLS 2011AA ObjectClass-2
C1262477
Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

WeightLossAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3445
UMLS 2011AA ObjectClass-2
C1262477
Feeling drowsy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

SomnolenceAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26754
UMLS 2011AA ObjectClass-2
C2830004
Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

SomnolenceAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26754
UMLS 2011AA ObjectClass-2
C2830004
Difficulty sleeping (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

PatientDifficultySleepingAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property-3
C62189
UMLS 2011AA Property-2
C1299586
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

PatientDifficultySleepingAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property-3
C62189
UMLS 2011AA Property-2
C1299586
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Shortness of breath (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

DyspneaAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2998
UMLS 2011AA ObjectClass-2
C0013404
Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

DyspneaAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2998
UMLS 2011AA ObjectClass-2
C0013404
Nausea (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

NauseaAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3258
UMLS 2011AA ObjectClass-2
C0027497
Nausea (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

NauseaAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C3258
UMLS 2011AA ObjectClass-2
C0027497
Cough (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
Beschreibung

CoughAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C37935
UMLS 2011AA ObjectClass-2
C0010200
Cough (If YES, how much did it DISTRESS or BOTHER you?)
Beschreibung

CoughAssessmentResponseScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C37935
UMLS 2011AA ObjectClass-2
C0010200
Worrying (During the past 7 days did you have any of the following symptoms?)
Beschreibung

AnxietyAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
Worrying (If YES, how OFTEN did it occur?)
Beschreibung

AnxietyAssessmentResponseFrequency

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
Feeling sad (During the past 7 days did you have any of the following symptoms?)
Beschreibung

DepressionAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2982
UMLS 2011AA ObjectClass-2
C0011570
Feeling sad (If YES, how OFTEN did it occur?)
Beschreibung

DepressionAssessmentResponseFrequency

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass-2
C2982
UMLS 2011AA ObjectClass-2
C0011570
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
Feeling nervous (During the past 7 days did you have any of the following symptoms?)
Beschreibung

NervousnessAssessmentResponseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Metathesaurus ObjectClass
C0027769
Feeling nervous (If YES, how OFTEN did it occur?)
Beschreibung

NervousnessAssessmentResponseFrequency

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ValueDomain
C25515
UMLS 2011AA ValueDomain
C0439603
NCI Metathesaurus ObjectClass
C0027769
Assessment of Quality of Life
Beschreibung

Assessment of Quality of Life

How would you rate your overall quality of life during the past week? (Mark one with an X)
Beschreibung

PatientQualityofLifeAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property-2
C20989
UMLS 2011AA Property-2
C0031809

Ähnliche Modelle

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header
Form ID CALGB
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
Protocol ID CALGB
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Patient demographics
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Medical Record Number
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
ClinicalResearchAssociateResponsiblePersonName
Item
Responsible CRA
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
Item Group
Memorial Symptom Assessment
FatigueAssessmentResponseInd-2
Item
Lack of energy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3036 (NCI Thesaurus ObjectClass-2)
C0015672 (UMLS 2011AA ObjectClass-2)
Item
Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3036 (NCI Thesaurus ObjectClass-2)
C0015672 (UMLS 2011AA ObjectClass-2)
Code List
Lack of energy (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
AppetiteAssessmentResponseInd-2
Item
Lack of appetite (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25152 (NCI Thesaurus ObjectClass-2)
C0003618 (UMLS 2011AA ObjectClass-2)
Item
Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25152 (NCI Thesaurus ObjectClass-2)
C0003618 (UMLS 2011AA ObjectClass-2)
Code List
Lack of appetite (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
PainAssessmentResponseInd-2
Item
Pain (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)
Item
Pain (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)
Code List
Pain (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
PatientDryMouthAssessmentInd-2
Item
Dry Mouth (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (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)
Item
Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
text
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)
Code List
Dry Mouth (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
WeightLossAssessmentResponseInd-2
Item
Weight loss (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3445 (NCI Thesaurus ObjectClass-2)
C1262477 (UMLS 2011AA ObjectClass-2)
Item
Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3445 (NCI Thesaurus ObjectClass-2)
C1262477 (UMLS 2011AA ObjectClass-2)
Code List
Weight loss (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
SomnolenceAssessmentResponseInd-2
Item
Feeling drowsy (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26754 (NCI Thesaurus ObjectClass-2)
C2830004 (UMLS 2011AA ObjectClass-2)
Item
Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26754 (NCI Thesaurus ObjectClass-2)
C2830004 (UMLS 2011AA ObjectClass-2)
Code List
Feeling drowsy (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
PatientDifficultySleepingAssessmentInd-2
Item
Difficulty sleeping (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
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)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
text
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)
Code List
Difficulty sleeping (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
DyspneaAssessmentResponseInd-2
Item
Shortness of breath (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2998 (NCI Thesaurus ObjectClass-2)
C0013404 (UMLS 2011AA ObjectClass-2)
Item
Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2998 (NCI Thesaurus ObjectClass-2)
C0013404 (UMLS 2011AA ObjectClass-2)
Code List
Shortness of breath (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
NauseaAssessmentResponseInd-2
Item
Nausea (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3258 (NCI Thesaurus ObjectClass-2)
C0027497 (UMLS 2011AA ObjectClass-2)
Item
Nausea (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C3258 (NCI Thesaurus ObjectClass-2)
C0027497 (UMLS 2011AA ObjectClass-2)
Code List
Nausea (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
CoughAssessmentResponseInd-2
Item
Cough (DURING THE PAST 7 DAYS, did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C37935 (NCI Thesaurus ObjectClass-2)
C0010200 (UMLS 2011AA ObjectClass-2)
Item
Cough (If YES, how much did it DISTRESS or BOTHER you?)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C37935 (NCI Thesaurus ObjectClass-2)
C0010200 (UMLS 2011AA ObjectClass-2)
Code List
Cough (If YES, how much did it DISTRESS or BOTHER you?)
CL Item
A Little Bit (A little bit)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
C91216 (NCI Thesaurus-2)
CL Item
Somewhat (Somewhat)
C91215 (NCI Thesaurus)
CL Item
Very Much (Very much)
C91217 (NCI Thesaurus)
C91217 (NCI Thesaurus-2)
AnxietyAssessmentResponseInd-2
Item
Worrying (During the past 7 days did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
Item
Worrying (If YES, how OFTEN did it occur?)
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
Worrying (If YES, how OFTEN did it occur?)
CL Item
Almost Constantly (Almost constantly)
CL Item
Frequently (Frequently)
CL Item
Occasionally (Occasionally)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
DepressionAssessmentResponseInd-2
Item
Feeling sad (During the past 7 days did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2982 (NCI Thesaurus ObjectClass-2)
C0011570 (UMLS 2011AA ObjectClass-2)
Item
Feeling sad (If YES, how OFTEN did it occur?)
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C2982 (NCI Thesaurus ObjectClass-2)
C0011570 (UMLS 2011AA ObjectClass-2)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
Code List
Feeling sad (If YES, how OFTEN did it occur?)
CL Item
Almost Constantly (Almost constantly)
CL Item
Frequently (Frequently)
CL Item
Occasionally (Occasionally)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
NervousnessAssessmentResponseInd-2
Item
Feeling nervous (During the past 7 days did you have any of the following symptoms?)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C0027769 (NCI Metathesaurus ObjectClass)
Item
Feeling nervous (If YES, how OFTEN did it occur?)
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25515 (NCI Thesaurus ValueDomain)
C0439603 (UMLS 2011AA ValueDomain)
C0027769 (NCI Metathesaurus ObjectClass)
Code List
Feeling nervous (If YES, how OFTEN did it occur?)
CL Item
Almost Constantly (Almost constantly)
CL Item
Frequently (Frequently)
CL Item
Occasionally (Occasionally)
CL Item
Rarely (Rarely)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item Group
Assessment of Quality of Life
Item
How would you rate your overall quality of life during the past week? (Mark one with an X)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property-2)
C0031809 (UMLS 2011AA Property-2)
Code List
How would you rate your overall quality of life during the past week? (Mark one with an X)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
10 (10)
CL Item
20 (20)
CL Item
30 (30)
CL Item
40 (40)
CL Item
50 (50)
CL Item
60 (60)
CL Item
70 (70)
CL Item
80 (80)
CL Item
90 (90)
CL Item
100 (100)

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