Demographic factors
INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported and clinical TYPE: Single answer
date
INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
text
In the original Form response option is N/A. A codelist is not supplemented because it varies by country and should be determined by country (not for cross country comparison) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
text
"This is based upon the International Standard Classification of Education for the United States, and reflects standards in the U.S. Please adapt questions according to your country’s guidelines. Primary refers to the first 8 years of formal education in elementary school in the US. Secondary school refers to the last four years of statutory formal education (grade 9-12) at high school in the US. Tertiary refers to colleges or universities, including undergraduate and postgraduate education in the US." INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
Baseline clinical factors
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
SUPPROTING DEFINITION: Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline and after 5 years REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with "";""
boolean
Degree of health
As a permission is needed for use of this questionnaire, the actual 30 questions are not part of this version of the standard set. Instead you can note the total score. The ICHOM OID's are: EORTC QLQ-C30_Q01 to EORTC QLQ-C30_Q30. INCLUSION CRITERIA: All patients TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
As a permission is needed for use of this questionnaire, the actual 23 questions are not part of this version of the standard set. Instead you can note the total score. The ICHOM OID's are: EORTCQLQBR23_Q31 to EORTCQLQBR23_Q53. INCLUSION CRITERIA: All patients TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
As a license is needed for use of this questionnaire, the actual 4 questions of BREAST-Q (to Mastectomy) are not part of this version of the standard set. Instead you can note the total score. The ICHOM OID's are: BREASTQMAST_Q01 to BREASTQMAST_Q04 INCLUSION CRITERIA: Patients with mastectomy TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
As a license is needed for use of this questionnaire, the actual 4 questions of BREAST-Q (to Breast conserving therapy) are not part of this version of the standard set. Instead you can note the total score. The ICHOM OID's are: BREASTQBCT_Q01 to BREASTQBCT_Q04 INCLUSION CRITERIA: Patients with breast conserving therapy TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
As a license is needed for use of this questionnaire, the actual 4 questions of BREAST-Q (to Reconstruction) are not part of this version of the standard set. Instead you can note the total score. T The ICHOM OID's are: BREASTQREC_Q01 to BREASTQREC_Q04 INCLUSION CRITERIA: Patients with reconstruction TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-LMC21): A license is needed for use of this questionnaire as well, however only one question is used. The ICHOM OID's is: EORTC QLQ-LMC21 INCLUSION CRITERIA: All patients TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer
integer
As a permission is needed for use of this questionnaire, the actual 6 questions are not part of this version of the standard set. Instead you can note the total score. The ICHOM OID's are: FACTES_Q01 (BRM1), FACTES_Q02 to FACTES_Q06 (ES4-ES8) INCLUSION CRITERIA: All patients TIMING: Baseline, 6 months, 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Patient-reported TYPE: Single answer
integer