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Beschrijving:

Quality of Life Questionnaire Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy NCT00053898 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0E240A0-FD2A-46A0-E034-080020C9C0E0

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0E240A0-FD2A-46A0-E034-080020C9C0E0

Trefwoorden:

D016430

D011788

Mammatumoren, Mensch

Versies (5)

26-08-12 26-08-12 -
07-08-14 07-08-14 - Martin Dugas
21-03-15 21-03-15 - Martin Dugas
10-04-21 10-04-21 - Ahmed Rafee, MD
20-09-21 20-09-21 -

Houder van rechten:

folgt

Geüploaded op:

20 september 2021

DOI:

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Licentie :

Creative Commons BY 4.0

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Breast Cancer (NCT00053898)

Engels 1

Engels

Details

NSABP Protocol B-35 [At bottom ] Record the first three letters of patient's last name and study ID on each of the remaining pages before giving the questionnaire to the patient.

1 Formulieren

StudyEvent: Quality of Life Questionnaire
1. NSABP Protocol B-35 [At bottom ] Record the first three letters of patient's last name and study ID on each of the remaining pages before giving the questionnaire to the patient.

Header

First Three Letters of Patient?s Last Name

Patient Study ID

Institution Name

Affiliate Name

Staff member administering form

Phone

Are data amended? (If yes, circle amended items in red.)

Yes

Time Point for this Questionnaire (Check One)

Baseline (Baseline)

6 Month Follow-up (6 month follow-up)

12 Month Follow-up (12 month follow-up)

18 Month Follow-up (18 month follow-up)

9 verdere items in het detailaanzicht

This form is being filled out

0 By Patient In Office (0 By patient in office)

1 By Clinical Staff On Phone With Patient (1 By clinical staff on phone with patient)

2 By Patient, Mailed To Office (2 By patient, mailed to office)

Symptom frequency

I was bothered by things that don't usually bother me.

Rarely Or None Of The Time (less Than 1 Day) (1)

Some Of The Time (1-2 Days) (2)

Occasion (3-4 Days) (3)