Description:

PACCT-1 TAILORx FACT - Endocrine Symptoms Form Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=84B85E26-3D9D-5248-E040-BB89AD43122A

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=84B85E26-3D9D-5248-E040-BB89AD43122A
Keywords:
  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 6/8/15 6/8/15 -
Uploaded on:

January 8, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00310180 Quality of Life - PACCT-1 TAILORx FACT - Endocrine Symptoms Form - 3072561v1.0

INSTRUCTIONS: Please complete this form according to the forms submission schedule. Submit original to the ECOG Coordinating Center. Keep a copy for your files. Please submit form to the address below: ECOG Coordinating Center Attn: Data, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215

Header
On Treatment
Report Period (since start of Step 2 Choose one)
Unnamed2
Are data amended
Header
Additional Concerns
I have hot flashes
I have cold sweats
I have night sweats
I have vaginal discharge
I have vaginal itching/irritation
I have vaginal bleeding or spotting
I have vaginal dryness
I have pain or discomfort with intercourse
I have lost interest in sex.
I have gained weight
I feel lightheaded (dizzy).
I have been vomiting
I have diarrhea
I get headaches
I feel bloated
I have breast sensitivity/tenderness
I have mood swings
I am irritable
I have pain in my joints

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