E1105 FACIT-Fatique Subscale (Version 4) First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab in Treating Patients With Metastatic Breast Cancer That Overexpresses HER-2/NEU Source Form: NCI FormBuilder:

  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 6/8/15 6/8/15 -
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August 26, 2012

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00520975 Quality of Life - E1105 FACIT-Fatique Subscale (Version 4) - 2492102v1.0

INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).

Unnamed Module 4
On Treatment Report Period (Maintenance 1 cycle = 3 weeks)
On Treatment Report Period (Maintenance 1 cycle = 3 weeks)
Additional Concerns
I feel fatigued
I feel weak all over
I feel listless ("washed out")
I feel tired
I have trouble starting things because I am tired
I have trouble finishing things because I am tired
I have energy
I am able to do my usual activities
I need to sleep during the day
I am too tired to eat
I need help doing my usual activities
I am frustrated by being too tired to do the things I want to do
I have to limit my social activity because I am tired

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