Add a measure...
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FACIT-TS-BTCSQ - Bone Treatment Convenience and Satisfaction Questionnaire
FACIT-TS-BTCSQ On Therapy - Bone Treatment Convenience and Satisfaction Questionnaire - On Therapy
CCSQ - Chemotherapy Convenience and Satisfaction Questionnaire
CCSQ On Therapy - Chemotherapy Convenience and Satisfaction Questionnaire - On Therapy
COST-FACIT - COST: A FACIT Measure of Financial Toxicity
FACT-CSI - FACT-Carcinoid Symptom Index
FAACT - Functional Assessment of Anorexia/Cachexia Treatment
FACT-An - Functional Assessment of Cancer Therapy - Anemia
FACT-AntiA - Functional Assessment of Cancer Therapy - AntiAngiogenesis
FACT-BRM - Functional Assessment of Cancer Therapy - Biologic Response Modifiers
FACT-Bl - Functional Assessment of Cancer Therapy - Bladder
FACT-Bl-Cys - Functional Assessment of Cancer Therapy - Bladder - Cystectomy
FACT-BMT - Functional Assessment of Cancer Therapy - Bone Marrow Transplantation
FACT-BP - Functional Assessment of Cancer Therapy - Bone Pain
FACT-Br - Functional Assessment of Cancer Therapy - Brain
FACT-B - Functional Assessment of Cancer Therapy - Breast
FACT-CNS - Functional Assessment of Cancer Therapy - Central Nervous System
FACT-Cx - Functional Assessment of Cancer Therapy - Cervix
FACT-Cog - Functional Assessment of Cancer Therapy - Cognitive Function
FACT-C - Functional Assessment of Cancer Therapy - Colorectal
FACT-ES - Functional Assessment of Cancer Therapy - Endocrine Symptoms
FACT-En - Functional Assessment of Cancer Therapy - Endometrial
FACT-EF - Functional Assessment of Cancer Therapy - Enteral Feeding
FACT-EGFRI-18 - Functional Assessment of Cancer Therapy - Epidermal Growth Factor Inhibitors 18 Item Version
FACT-E - Functional Assessment of Cancer Therapy - Esophageal
FACT-Ga - Functional Assessment of Cancer Therapy - Gastric
FACT-G - Functional Assessment of Cancer Therapy - General
FACT-G7 - Functional Assessment of Cancer Therapy - General - 7 Item Version
FACT-GP - Functional Assessment of Cancer Therapy - General Population
FACT-H&N - Functional Assessment of Cancer Therapy - Head & Neck
FACT-Hep - Functional Assessment of Cancer Therapy - Hepatobiliary
FACT-ICM - Functional Assessment of Cancer Therapy - Immune Checkpoint Modulator
FACT-Leu - Functional Assessment of Cancer Therapy - Leukemia
FACT-L - Functional Assessment of Cancer Therapy - Lung
FACT-LCS - Functional Assessment of Cancer Therapy - Lung Cancer Subscale
FACT-B+4 - Functional Assessment of Cancer Therapy - Lymphedema
FACT-Lym - Functional Assessment of Cancer Therapy - Lymphoma
FACT-M - Functional Assessment of Cancer Therapy - Melanoma
FACT-MM - Functional Assessment of Cancer Therapy - Multiple Myeloma
FACT-NP - Functional Assessment of Cancer Therapy - Nasopharyngeal
FACT-N - Functional Assessment of Cancer Therapy - Neutropenia
FACT-O - Functional Assessment of Cancer Therapy - Ovarian
FACT-P - Functional Assessment of Cancer Therapy - Prostate
FACT-PSI - Functional Assessment of Cancer Therapy - Pulmonary Symptom Index
FACT-Taxane - Functional Assessment of Cancer Therapy - Taxane
FACT-Th11 - Functional Assessment of Cancer Therapy - Thrombocytopenia 11 Item Version
FACT-Th18 - Functional Assessment of Cancer Therapy - Thrombocytopenia 18 Item Version
FACT-Th6 - Functional Assessment of Cancer Therapy - Thrombocytopenia 6 Item Version
FACT-V - Functional Assessment of Cancer Therapy - Vulva
FBlSI - Functional Assessment of Cancer Therapy Bladder Cancer Symptom Index - 7 Item Version
FBrSI - Functional Assessment of Cancer Therapy Brain Cancer Symptom Index - 15 Item Version
FBSI - Functional Assessment of Cancer Therapy Breast Cancer Symptom Index - 8 Item Version
FCSI - Functional Assessment of Cancer Therapy Colorectal Cancer Symptom Index - 9 Item Version
FHNSI - Functional Assessment of Cancer Therapy Head & Neck Cancer Symptom Index - 10 Item Version
FHSI - Functional Assessment of Cancer Therapy Hepatobiliary Cancer Symptom Index - 8 Item Version
FKSI-10 - Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index - 10 Item Version
FKSI-15 - Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index - 15 Item Version
FKSI-DRS - Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index - Disease Related Symptoms
FLSI-12 - Functional Assessment of Cancer Therapy Lung Cancer Symptom Index - 12 Item Version
FLSI - Functional Assessment of Cancer Therapy Lung Cancer Symptom Index - 6 Item Version
FOSI - Functional Assessment of Cancer Therapy Ovarian Cancer Symptom Index - 8 Item Version
FPSI-7 - Functional Assessment of Cancer Therapy Prostate Cancer Symptom Index - 7 Item Version
FAPSI-8 - Functional Assessment of Cancer Therapy Prostate Cancer Symptom Index - 8 Item Version
FACT-RNT - Functional Assessment of Cancer Therapy – Radionuclide Therapy
FACT/GOG-NTX - Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity
FACT/GOG-NTX-12 - Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 12 Item Version
FACT/GOG-NTX-13 - Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 13 Item Version
FACT/GOG-NTX-4 - Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 4 Item Version
FACIT-AD - Functional Assessment of Chronic Illness Therapy - Abdominal Discomfort
FACIT-AI - Functional Assessment of Chronic Illness Therapy - Ascites Index
FACIT-CD - Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia
FACIT-D - Functional Assessment of Chronic Illness Therapy - Diarrhea
- Functional Assessment of Chronic Illness Therapy - Dyspnea- 33 item Bank
FACIT-Dyspnea (Dyspnoea) - Functional Assessment of Chronic Illness Therapy - Dyspnea-10 item Short Form
FACIT-F - Functional Assessment of Chronic Illness Therapy - Fatigue
FACIT Fatigue Scale - Functional Assessment of Chronic Illness Therapy - Fatigue Scale
FACIT-Pal - Functional Assessment of Chronic Illness Therapy - Palliative Care
FACIT-Pal-14 - Functional Assessment of Chronic Illness Therapy - Palliative Care 14 Item Version
FACIT-SWiP - Functional Assessment of Chronic Illness Therapy - Satisfaction with Pharmacist
FACIT-Sp - Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being
FACIT-Sp-12 - Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being 12 Item Scale
FACIT-Sp-Ex - Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Expanded Version
FACIT-Sp Non-Illness - Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Non-Illness Version
FACIT-TS-G - Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - General
FACIT-TS-PS - Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - Patient Satisfaction
FAHI - Functional Assessment of HIV Infection
FAIT-F - Functional Assessment of Incontinence Therapy - Fecal
FAIT-U - Functional Assessment of Incontinence Therapy - Urinary
FAMS - Functional Assessment of Multiple Sclerosis
FANLTC - Functional Assessment of Non-Life Threatening Conditions
NFBlSI-18 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Bladder Cancer Symptom Index - 18 Item Version
NFBrSI-24 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Brain Cancer Symptom Index - 24 Item Version
NFBSI-16 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Breast Cancer Symptom Index - 16 Item Version
NFCSI-19 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Colorectal Cancer Symptom Index - 19 Item Version
NFHNSI-22 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Head & Neck Cancer Symptom Index - 22 Item Version
NFHSI-18 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Hepatobiliary Cancer Symptom Index - 18 Item Version
NFKSI-19 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index - 19 Item Version
NFLSI-17 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Lung Cancer Symptom Index - 17 Item Version
NFLymSI-18 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Lymphoma Cancer Symptom Index - 18 Item Version
NFOSI-18 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Ovarian Cancer Symptom Index - 18 Item Version
NFPSI-17 - National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Prostate Cancer Symptom Index - 17 Item Version
Peds-FAACT (12+)-Patient - Pediatric Functional Assessment of Anorexia/Cachexia Treatment
Peds-FAACT (12+)-Parent - Pediatric Functional Assessment of Anorexia/Cachexia Treatment
Peds-FAACT (7-12)-Patient - Pediatric Functional Assessment of Anorexia/Cachexia Treatment
Peds-FAACT-10 - Pediatric Functional Assessment of Anorexia/Cachexia Treatment 10 Item Version
Peds-FACT-Br - Pediatric Functional Assessment of Cancer Therapy - Brain
Peds-FACIT-F - Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue
Peds-FAACT (7-12)-Parent - Peds-FAACT (7-12)-Parent
Add an item...
CCS10 - Are you satisfied with the current results of your chemotherapy?
TS5 - Are you satisfied with the effects of this treatment so far?
BTC11 - Are you satisfied with the results of the treatment for your bone disease so far?
Q8 - Are you sexually active or would you like to be sexually active? If yes, answer the following three questions. If no, skip these questions and move on to the next section
Leu4 - Because of my illness, I have difficulty planning for the future
AA3 - Because of my mouth sores, eating is difficult
GP3 - Because of my physical condition, I have trouble meeting the needs of my family
BP7 - Bone pain interferes with my ability to care for myself (bathing, dressing, eating, etc.)
BP8 - Bone pain interferes with my social activities
BP9 - Bone pain wakes me up at night
L4 - Breathing is easy for me
C9 - Caring for my ostomy appliance is difficult
VCI2 - Caring for my urinary condition is difficult
Dys9 - Carrying something weighing 10-20 lbs (about 4.5-9kg, like a large bag of groceries) from one room to another
ST34 - Changes in my skin condition make daily life difficult
CCS7 - Chemotherapy treatment seems harmful to me
CCS1 - Chemotherapy treatment takes up my time
TS1 - Compared to what you expected, how do you rate the effectiveness of the treatment so far?
TS2 - Compared to what you expected, how do you rate the side effects of treatment so far?
TS22 - Did the treatment staff discuss how your health and treatment may affect you emotionally?
TS20 - Did the treatment staff discuss how your health and treatment may affect your normal daily activities?
TS19 - Did the treatment staff discuss how your health and treatment may affect your normal work (including housework)?
TS21 - Did the treatment staff discuss how your health and treatment may affect your personal relationships?
TS35 - Did the treatment staff respect your privacy?
TS34 - Did you feel that the treatment staff answered your questions honestly?
TS23 - Did you feel your doctor(s) had experience treating your illness?
TS24 - Did you feel your doctor(s) knew about the latest medical developments for your illness?
TS13 - Did you get to say the things that were important to you?
TS12 - Did you have an opportunity to ask questions?
TS36 - Did you have confidence in your doctor(s)?
TS28 - Did you have enough time to make decisions about your health care?
TS37 - Did you trust your doctor(s)’ suggestions for treatment?
TS10 - Did your doctor(s) explain the possible benefits of your treatment?
TS11 - Did your doctor(s) explain the possible side effects or risks of your treatment?
TS9 - Did your doctor(s) give explanations that you could understand?
TS3 - Did your doctor(s) help you evaluate the effects of your treatment so far?
TS30 - Did your doctor(s) seem to respect your opinions?
TS14 - Did your doctor(s) seem to understand what was important to you?
TS16 - Did your doctor(s) seem to understand your needs?
TS15 - Did your doctor(s) show genuine concern for you?
TS31 - Did your nurse(s) give explanations that you could understand?
TS33 - Did your nurse(s) seem to understand your needs?
TS32 - Did your nurse(s) show genuine concern for you?
Sp11NI - Difficult times have strengthened my faith or spiritual beliefs
TS4 - Do you feel you received the treatment that was right for you?
Q2 - Do you have an ostomy appliance?
Dys1 - Dressing yourself without help
EF8 - During the use of tube feeding, I can eat and drink by mouth
Sp12NI - Even during difficult times, I know that things will be okay
Th15 - For women only: I am bothered by vaginal bleeding
EF20 - Getting a feeding tube was the right decision for me
AA5 - Hand pain or tenderness interferes with my daily activities
Q3 - Have you ever smoked?
BTC55 - Having my blood drawn is inconvenient
MS15 - Heat worsens my symptoms
TS40 - How do you rate the care you received?
TS8 - How do you rate this treatment overall?
CCS13 - How would you rate this chemotherapy?
HN10 - I am able to communicate with others
Br1 - I am able to concentrate
An7 - I am able to do my usual activities
Br18 - I am able to drive a vehicle (my car, truck, etc.)
HN5 - I am able to eat as much food as I want
HN1 - I am able to eat the foods that I like
GF3 - I am able to enjoy life
E6 - I am able to enjoy meals with family or friends
P5 - I am able to feel like a man
B9 - I am able to feel like a woman
Br8 - I am able to find the right word(s) to say what I mean
Sp17 - I am able to forgive others for any harm they have ever caused me
BMT5 - I am able to get around by myself
BL5 - I am able to have and maintain an erection (For men only)
CogPMT2 - I am able to keep track of what I am doing, even if I am interrupted
CNS1 - I am able to maintain my balance
Pal12 - I am able to make decisions
Br11 - I am able to make decisions and take responsibility
FT7 - I am able to meet my monthly expenses
Pal14 - I am able to openly discuss my concerns with the people closest to me
CogPF1 - I am able to pay attention and keep track of what I am doing without extra effort
Br15 - I am able to put my thoughts into action
Br13 - I am able to put my thoughts together
Sp6 - I am able to reach down deep into myself for comfort
Br16 - I am able to read like I used to
CogPMT1 - I am able to shift back and forth between two activities that require thinking
CNS2 - I am able to walk
GF1 - I am able to work (include work at home)
Br17 - I am able to write like I used to
Br5 - I am afraid of having a seizure (convulsion)
Cx5 - I am afraid the treatment may harm my body
ITU2 - I am afraid to be far from a toilet
Cx3 - I am afraid to have sex
Ga4 - I am bothered by a change in my eating habits
Br10 - I am bothered by a change in my personality
ST9 - I am bothered by a change in my skin’s sensitivity to the sun
BMT13 - I am bothered by a change in the way food tastes
B8 - I am bothered by a change in weight
AA9 - I am bothered by a skin rash
CS5 - I am bothered by belching (burping)
Th6 - I am bothered by bleeding in my gums or mouth
ICM10 - I am bothered by blistering of my skin
Th8 - I am bothered by blood in my urine or stool
Cx6 - I am bothered by constipation
ICM9 - I am bothered by cracking or peeling of my skin
Cx1 - I am bothered by discharge or bleeding from my vagina
V1 - I am bothered by discharge or bleeding from my vulva
V4 - I am bothered by discomfort in my groin or legs
BRM5 - I am bothered by dry mouth
ICM2 - I am bothered by dry skin
BRM3 - I am bothered by fevers (episodes of high body temperature)
Ga14 - I am bothered by gas (flatulence)
B5 - I am bothered by hair loss
NP6 - I am bothered by having a blocked nose
MS3 - I am bothered by headaches
Cas1 - I am bothered by hot flashes
ST11 - I am bothered by increased facial hair
Lym1 - I am bothered by itching
V5 - I am bothered by itching/burning in my vulva area
Hep2 - I am bothered by jaundice or yellow color to my skin
Leu1 - I am bothered by lumps or swelling in certain parts of my body (e.g., neck, armpits, or groin)
AA2 - I am bothered by mouth sores or tenderness
MS4 - I am bothered by muscle pains
MS16 - I am bothered by muscle spasms
ICM8 - I am bothered by new allergy-like reactions (e.g., to foods, insects, pollen)
Th5 - I am bothered by nosebleeds
Cx2 - I am bothered by odor coming from my vagina
V2 - I am bothered by odor coming from my vulva
V6 - I am bothered by pain or numbness in my vulva area
Th7 - I am bothered by pinpoint bruising beneath my skin
Ga2 - I am bothered by reflux or heartburn
NP2 - I am bothered by ringing in my ear(s)
ST15 - I am bothered by sensitivity around my fingernails or toenails
ICM6 - I am bothered by short-term treatment reactions that I experience immediately after, or within 24 hours of, an infusion (such as chills, dizziness, hives, rashes lasting no more than 24 hours)
GP5 - I am bothered by side effects of treatment
BTC10 - I am bothered by side effects of treatment for bone disease
BMT15 - I am bothered by skin problems
RT(B)9 - I am bothered by skin problems in my underarm area
CS2 - I am bothered by skin redness (from flushing)
BRM10 - I am bothered by sweating
AA10 - I am bothered by swelling in certain areas of my body
RT(B)5 - I am bothered by swelling in my breast
V3 - I am bothered by swelling/fluid in my legs
M12 - I am bothered by the amount of swelling
RT(B)14 - I am bothered by the appearance of the skin in my breast area
BRM2 - I am bothered by the chills
Br12 - I am bothered by the drop in my contribution to the family
CTCL19 - I am bothered by the inconvenience of treatment for my skin condition
CTCL14 - I am bothered by the red or pink appearance of my skin
Tax5 - I am bothered by the way my hands or nails look
CTCL15 - I am bothered by uncertainty about my prognosis
ICM3 - I am bothered by vitiligo (white patches appearing on my skin)
V9 - I am bothered by wearing compression stockings
NP3 - I am bothered by worsening eyesight
ITU1 - I am comfortable discussing my condition with friends
ACT4 - I am concerned about how thin I look
BMT1 - I am concerned about keeping my job (include work at home)
FT9 - I am concerned about keeping my job and income, including work at home
HI5 - I am concerned about what the future holds for me
Pal5 - I am constipated
GF7 - I am content with the quality of my life right now
MS6 - I am depressed about my condition
CD20 - I am depressed about the infection
D4 - I am embarrassed by having diarrhea (diarrhoea)
ITU6 - I am embarrassed by my condition
HI10 - I am embarrassed by my illness
C8 - I am embarrassed by my ostomy appliance
ST24 - I am embarrassed by my skin condition
CTCL7 - I am embarrassed by the appearance of my skin
GF6 - I am enjoying the things I usually do for fun
BP5 - I am forced to rest during the day because of bone pain
GP7 - I am forced to spend time in bed
An15 - I am frustrated by being too tired to do the things I want to do
Leu2 - I am frustrated by being unable to do the things I want to do
CS3 - I am frustrated by having to avoid certain things because they make my symptoms worse
BP10 - I am frustrated by my bone pain
MS9 - I am frustrated by my condition
CTCL8 - I am frustrated by my skin condition
Th12 - I am frustrated by not being able to do my usual activities
CD19 - I am frustrated by the infection
FT5 - I am frustrated that I cannot work or contribute as much as I usually do
HI11 - I am hopeful about the future
Th9 - I am inconvenienced by platelet transfusions
BL4 - I am interested in sex
ES13 - I am irritable
GE3 - I am losing hope in the fight against my illness
C2 - I am losing weight
EF19 - I am more confident about my nutrition because of my feeding tube
An13 - I am motivated to do my usual activities
GS5 - I am satisfied with family communication about my illness
GE2 - I am satisfied with how I am coping with my illness
FT6 - I am satisfied with my current financial situation
P4 - I am satisfied with my present comfort level
GS7 - I am satisfied with my sex life
VC1 - I am satisfied with my urinary condition
B2 - I am self-conscious about the way I dress
GF5 - I am sleeping well
CTCL17 - I am tired of dealing with my skin condition
An12 - I am too tired to eat
ICM7 - I am troubled by not knowing when exactly my side effects will happen, how long they will last and how bad they will be
Hep1 - I am unhappy about a change in my appearance
HN6 - I am unhappy with how my face and neck look
HI1 - I am unhappy with my appearance
ACT2 - I am worried about my weight
ST37 - I avoid going out in public because of how my skin looks
Ga9 - I avoid going out to eat because of my illness
Th10 - I avoid or limit physical activity (because of concern with bleeding or bruising)
Th11 - I avoid or limit social activity (because of concern with bleeding or bruising)
N2 - I avoid public places for fear of getting an infection
CSb7 - I believe chemotherapy treatment will be harmful to me
CSb1 - I believe chemotherapy treatment will take up my time
GPb5 - I believe I will be bothered by side effects of treatment
CSb8 - I believe my chemotherapy schedule will be stressful to me
CSb9 - I believe my chemotherapy schedule will be stressful to my family
CSb4 - I believe my chemotherapy treatment will cause me physical pain
CSb5 - I believe receiving chemotherapy will be inconvenient
BTCb12 - I believe that an infusion for my bone treatment will cause me physical pain
BTCb13 - I believe that having my blood drawn will be inconvenient
BTCb10 - I believe that I will be bothered by side effects of treatment for bone disease
BTCb4 - I believe that my treatment for bone disease will cause me physical pain
BTCb2 - I believe that my treatment for bone disease will take up my family’s time
BTCb8 - I believe that my treatment schedule for bone disease will be stressful to me
BTCb9 - I believe that my treatment schedule for bone disease will be stressful to my family
BTCb5 - I believe that receiving treatment for bone disease will be inconvenient
BTCb7 - I believe that treatment for bone disease will be harmful to me
BTCb1 - I believe that treatment for bone disease will take up my time
BTCb11 - I believe that waiting up to 60 minutes before eating breakfast in the morning will be inconvenient
Th1 - I bleed easily
Th2 - I bruise easily
ITF4 - I can be far from home/work without fearing soilage
C4 - I can digest my food well
HN11 - I can eat solid foods
NP5 - I can enjoy the taste of food
Br3 - I can remember new things
BMT10 - I can remember things
HN7 - I can swallow naturally and easily
E5 - I choke when I swallow
HN9 - I drink alcohol (e.g. beer, wine, etc.)
EF1 - I experience a pleasant feeling of fullness during or after my tube feeding
EF4 - I experience vomiting during or after my tube feeding
Sp22 - I feel a sense of appreciation for the beauty of nature
Sp7 - I feel a sense of harmony within myself
Sp5 - I feel a sense of purpose in my life
Tax1 - I feel bloated
GSX1 - I feel close to my family
GS1 - I feel close to my friends
GS6 - I feel close to my partner (or the person who is my main support)
Sp23 - I feel compassion for others in the difficulties they are facing
Sp13 - I feel connected to a higher power (or God)
Sp14 - I feel connected to other people
EF17 - I feel dependent on others because I have a feeding tube
BP11 - I feel depressed about my bone pain
Ntx4 - I feel discomfort in my feet
Ntx3 - I feel discomfort in my hands
Leu3 - I feel discouraged about my illness
BMT2 - I feel distant from other people
CD15 - I feel embarrassed about the infection
HI7 - I feel fatigued
FT8 - I feel financially stressed
Sp18 - I feel forgiven for any harm I may have ever caused
Sp21 - I feel hopeful
FT4 - I feel I have no choice about the amount of money I spend on care
GP6 - I feel ill
FT11 - I feel in control of my financial situation
Br7 - I feel independent
Leu7 - I feel isolated from others because of my illness or treatment
EF18 - I feel left out when others are eating
An9 - I feel lightheaded (dizzy)
Pal4 - I feel like a burden to my family
An1 - I feel listless ("washed out")
Sp16 - I feel love for others
Sp15 - I feel loved
HI6 - I feel motivated to do things
GE4 - I feel nervous
M16 - I feel numbness at my surgical site
MS8 - I feel overwhelmed by my condition
ICM4 - I feel pain, soreness or aches in some of my muscles
Sp1 - I feel peaceful
GE1 - I feel sad
B4 - I feel sexually attractive
CD9 - I feel that I can manage things that come up around this infection
EF16 - I feel that I have lost control of my food choices because I have a feeding tube
CD6 - I feel that I received the treatment that was right for me
Pal3 - I feel that my family appreciates me
L3 - I feel tightness in my chest
An2 - I feel tired
MS5 - I feel trapped by my condition
ST26 - I feel unattractive because of how my skin looks
Leu5 - I feel uncertain about my future health
EF2 - I feel uncomfortably full during or after my tube feeding
Pal8 - I feel useful
MS7 - I feel useless
HI12 - I feel weak all over
MS14 - I feel “left out” of things
Sp9 - I find comfort in my faith or spiritual beliefs
Sp10 - I find strength in my faith or spiritual beliefs
Ntx7 - I get a ringing or buzzing in my ears
BRM8 - I get annoyed easily
BRM7 - I get depressed easily
CD22 - I get emotional support from family members
GS2 - I get emotional support from my family
CD21 - I get emotional support from my partner/spouse
Br4 - I get frustrated that I cannot do things I used to
An10 - I get headaches
Lym3 - I get nervous about making decisions regarding treatment
GS3 - I get support from my friends
BMT6 - I get tired easily
Ga5 - I have a feeling of fullness or heaviness in my stomach area
C6 - I have a good appetite
GP1 - I have a lack of energy
Ga1 - I have a loss of appetite
B11 - I have a poor range of arm movements on this side
Sp2 - I have a reason for living
D5 - I have abdominal cramps or discomfort due to my diarrhea (diarrhoea)
GF4 - I have accepted my illness
CD10 - I have accepted that I have this infection
M5 - I have aches and pains in my bones
P1 - I have aches and pains that bother me
CogPV1 - I have been able to bring to mind words that I wanted to use while talking to someone
CogPC1 - I have been able to concentrate
Pal13 - I have been able to reconcile (make peace) with other people
CogPM1 - I have been able to remember things, like where I left my keys or wallet
CogPM2 - I have been able to remember to do things, like take medicine or buy something I needed
ICM1 - I have been bothered by diarrhea (diarrhoea)
L2 - I have been coughing
CS7 - I have been coughing up blood
AI1 - I have been emotionally distressed
B1 - I have been short of breath
CogQ35 - I have been upset about these problems
O2 - I have been vomiting
ICM11 - I have been wheezing (whistling sound when I breathe)
CS1 - I have been wheezing (whistling sound when I breathe)
BP1 - I have bone pain
BP3 - I have bone pain even when I sit or lie still
ES11 - I have breast sensitivity/ tenderness
P2 - I have certain parts of my body where I experience pain
ES2 - I have cold sweats
CD13 - I have concerns about my ability to become pregnant
BMT7 - I have concerns about my ability to have children
GR1 - I have confidence in my doctor(s)
BMT8 - I have confidence in my nurse(s)
SWiP3 - I have confidence in my pharmacist(s)
EF3 - I have constipation during or after my tube feeding
C3 - I have control of my bowels
CD3 - I have cramping in my pelvic area
O3 - I have cramps in my stomach area
C5 - I have diarrhea (diarrhoea)
RT(B)10 - I have difficultly raising my arm
RT(B)13 - I have difficulty breathing
Ntx11 - I have difficulty breathing when I am exposed to cold temperatures
CTCL12 - I have difficulty doing things with my hands because of the condition of my skin
ACT7 - I have difficulty eating rich or "heavy" foods
Br9 - I have difficulty expressing my thoughts
RT(B)11 - I have difficulty moving my arm sideways
NP1 - I have difficulty moving my neck and shoulders because of stiffness
E3 - I have difficulty swallowing liquids
E2 - I have difficulty swallowing soft or mashed foods
E1 - I have difficulty swallowing solid foods
M9 - I have difficulty thinking clearly (remembering, concentrating)
P7 - I have difficulty urinating
CTCL13 - I have difficulty walking because of my skin condition
CD1 - I have discomfort in my pelvic area
EN2 - I have discomfort or pain in my pelvic area
Hep8 - I have discomfort or pain in my stomach area
Ga6 - I have discomfort or pain when I eat
V8 - I have discomfort when I am sitting
Cx7 - I have discomfort when I urinate
BRM9 - I have emotional ups and downs
An5 - I have energy
ICM15 - I have episodes of heart racing
Pal2 - I have family members who will take on my responsibilities
CogF24 - I have forgotten names of people soon after being introduced
BMT11 - I have frequent colds/infections
ES10 - I have gained weight
M17 - I have good range of movement in my arm or leg
CS4 - I have greasy/oily stools
Hep5 - I have had a change in the way food tastes
RCC2 - I have had blood in my urine
Hep6 - I have had chills
CD18 - I have had difficulty telling my partner/spouse about the infection
Hep3 - I have had fevers (episodes of high body temperature)
Hep4 - I have had itching
Br2 - I have had seizures (convulsions)
CogC33c - I have had to use written lists more often than usual so I would not forget things
CogC33a - I have had to work harder than usual to express myself clearly
CogC31 - I have had to work harder than usual to keep track of what I was doing
CogF23 - I have had to work really hard to pay attention or I would make a mistake
CogC7 - I have had trouble concentrating
CogM9 - I have had trouble finding my way to a familiar place
CogV15 - I have had trouble finding the right word(s) to express myself
CogA1 - I have had trouble forming thoughts
CogV13 - I have had trouble recalling the name of an object while talking to someone
CogM12 - I have had trouble remembering new information, like phone numbers or simple instructions
CogM10 - I have had trouble remembering where I put things, like my keys or my wallet
CogV17b - I have had trouble saying what I mean in conversations with others
CD12 - I have hidden this problem so others will not notice
ES1 - I have hot flashes/hot flushes
Ntx5 - I have joint pain or muscle cramps
ES9 - I have lost interest in sex
ES12 - I have mood swings
N6 - I have mouth sores
GP2 - I have nausea
ES3 - I have night sweats
M6 - I have noticed blood in my stool
M2 - I have noticed new changes in my skin (lumps, bumps, color (colour))
CNS6 - I have numbness in my legs
RT(B)12 - I have numbness or tingling in my arm, shoulder, or breast
Ntx2 - I have numbness or tingling in my feet
Ntx1 - I have numbness or tingling in my hands
GP4 - I have pain
M1 - I have pain at my melanoma site or surgical site
RT(B)3 - I have pain in my arm and/or shoulder
CNS7 - I have pain in my back
RT(B)2 - I have pain in my breast
An11 - I have pain in my chest
E4 - I have pain in my chest when I swallow
Tax4 - I have pain in my fingertips
Ntx10 - I have pain in my hands or feet when I am exposed to cold temperatures
BRM1 - I have pain in my joints
HN12 - I have pain in my mouth, throat or neck
CD2 - I have pain in my pelvic area
ICM17 - I have pain in my sinus area
ACT11 - I have pain in my stomach area
ES8 - I have pain or discomfort with intercourse
CTCL3 - I have painful cracks in the skin on my hands or feet
CTCL18 - I have painful lesions or tumors on my skin
Pal10 - I have peace of mind
HI3 - I have people to help me if I need it
B13 - I have stiffness of my arm on this side
ICM12 - I have stiffness or tightness in my joints
Ga7 - I have stomach problems that worry me
CNS4 - I have strength in my arm(s)
CNS5 - I have strength in my legs
M11 - I have swelling as a result of surgery
M10 - I have swelling at my melanoma site
O1 - I have swelling in my stomach area
Pal6 - I have swelling in parts of my body
C1 - I have swelling or cramps in my stomach area
EF10 - I have the desire to eat
AA8 - I have to limit my activities because of diarrhea (diarrhoea)
D2 - I have to limit my physical activity because of diarrhea (diarrhoea)
ITU4 - I have to limit my physical activity because of my condition
D3 - I have to limit my sexual activity because of diarrhea (diarrhoea)
ITU5 - I have to limit my sexual activity because of my condition
CD4 - I have to limit my sexual activity because of the infection
An16 - I have to limit my social activity because I am tired
D1 - I have to limit my social activity because of diarrhea (diarrhoea)
ITU3 - I have to limit my social activity because of my condition
MS2 - I have to take my condition into account when making plans
Q10 - I have told family members about my infection
Q9 - I have told my partner/spouse about my infection
BMT14 - I have tremors
V7 - I have trouble bending
HN3 - I have trouble breathing
Ntx8 - I have trouble buttoning buttons
HI8 - I have trouble concentrating
BL1 - I have trouble controlling my urine
EN1 - I have trouble digesting food
Sp4 - I have trouble feeling peace of mind
Br19 - I have trouble feeling sensations in my arm, hands or legs
Ntx9 - I have trouble feeling the shape of small objects when they are in my hand
An4 - I have trouble finishing things because I am tired
MS1 - I have trouble getting around in public places
Ntx6 - I have trouble hearing
CogMT1 - I have trouble keeping track of what I am doing if I am interrupted
MS12 - I have trouble learning new tasks or directions
P6 - I have trouble moving my bowels
HI9 - I have trouble remembering things
CogMT2 - I have trouble shifting back and forth between different activities that require thinking
Lym2 - I have trouble sleeping at night
CTCL10 - I have trouble sleeping because of my skin condition
NP4 - I have trouble smelling
An3 - I have trouble starting things because I am tired
Ga12 - I have trouble swallowing food
An6 - I have trouble walking
BP6 - I have trouble walking because of bone pain
MM1 - I have trouble walking because of pain
Br21 - I have trouble with coordination
BMT16 - I have trouble with my bowels
Br6 - I have trouble with my eyesight
CogV16 - I have used the wrong word when I referred to an object
ES6 - I have vaginal bleeding or spotting
ES4 - I have vaginal discharge
ES7 - I have vaginal dryness
ES5 - I have vaginal itching/irritation
CogF19 - I have walked into a room and forgotten what I meant to get or do there
Br20 - I have weakness in my arms or legs
NCCN3 - I have weakness in my legs
M8 - I isolate myself from others because of my condition
FT1 - I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment
Sp12 - I know that whatever happens with my illness, things will be okay
C7 - I like the appearance of my body
Pal1 - I maintain contact with my friends
Pal9 - I make each day count
EF9 - I miss being able to take more food or drink by mouth now that I have a feeding tube
ITF1 - I move my bowels more frequently than usual
ITF3 - I must move my bowels frequently to avoid accidents
ITU8 - I must urinate frequently to avoid leaking
An14 - I need help doing my usual activities
BP4 - I need help doing my usual activities because of bone pain
Br14 - I need help in caring for myself (bathing, dressing, eating, etc.)
MS10 - I need to rest during the day
An8 - I need to sleep during the day
BMT9 - I regret having the bone marrow transplant
L5 - I regret my smoking
HN8 - I smoke cigarettes or other tobacco products
CD16 - I tend to blame myself for the infection
BL2 - I urinate more frequently than usual
E7 - I wake at night because of coughing
CD17 - I was careful who I told about the infection
ITF5 - I wear pads or protection to prevent soiling my underwear
ITU9 - I wear protection for leakage of urine
Leu8 - I worry about being able to support myself or my family due to my illness
GE5 - I worry about dying
EF14 - I worry about getting an infection from the feeding tube
N3 - I worry about getting infections
N1 - I worry about getting sick due to low blood counts
EF15 - I worry about losing weight because I have a feeding tube
ICM5 - I worry about negative impacts that my treatment may have upon my long-term health
CD14 - I worry about other people’s attitudes towards me
Th3 - I worry about problems with bruising or bleeding
CCS3 - I worry about side effects from chemotherapy treatment
BTC3 - I worry about side effects from treatment for bone disease
HI4 - I worry about spreading my infection
CD5 - I worry about spreading the infection
M3 - I worry about the appearance of surgical scars
B7 - I worry about the effect of stress on my illness
FT3 - I worry about the financial problems I will have in the future as a result of my illness or treatment
Th4 - I worry about the possibility of serious bleeding
EF12 - I worry about the tube coming out by accident
EF13 - I worry about the tube getting plugged or blocked
N4 - I worry my condition will not improve if my treatment is delayed
EF11 - I worry that having a feeding tube means my health is worse
Leu6 - I worry that I might get new symptoms of my illness
BP12 - I worry that my bone pain will get worse
CCS6 - I worry that my chemotherapy will not be effective
GE6 - I worry that my condition will get worse
CTCL5 - I worry that my skin condition may get worse
Th14 - I worry that my treatment dose will be reduced (because of low blood counts)
BTC6 - I worry that my treatment for bone disease will not be effective
Th13 - I worry that my treatment will be delayed (because of low blood counts)
B6 - I worry that other members of my family might someday get the same illness I have
CD11 - I worry that the infection will get worse
BMT3 - I worry that the transplant will not work
Q7 - In how many places in your body have you felt bone pain?
BL3 - It burns when I urinate
BP2 - It hurts when I put weight or pressure on the place where I have bone pain
HI2 - It is hard to tell other people about my infection
RT(B)1 - It is inconvenient for me to come for my radiation treatments
ICM14 - Joint pain limits my usual activities
ICM13 - Joint stiffness or tightness limits my usual activities
Dys8 - Lifting something weighing 10-20 lbs (about 4.5-9kg, like a large bag of groceries)
Dys7 - Making a bed
ACT3 - Most food tastes unpleasant to me
B10 - Movement of my arm on this side is painful
M13 - Movement of my swollen area is painful
B12 - My arm on this side feels numb
RT(B)6 - My breast is sensitive/tender
Cas3 - My breasts are painful
Cas2 - My breasts are swollen
FT10 - My cancer or treatment has reduced my satisfaction with my present financial situation
CCS8 - My chemotherapy schedule is stressful to me
CCS9 - My chemotherapy schedule is stressful to my family
CCS4 - My chemotherapy treatment causes me physical pain
CCS2 - My chemotherapy treatment takes up my family’s time
RT(B)4 - My chest area (not including the breast itself) is sore
ITU7 - My condition wakes me up at night
ITF2 - My condition wakes or keeps me up at night
Ga10 - My digestive problems interfere with my usual activities
CD8 - My doctor explained the possible benefits of my treatment
CD7 - My doctor gave me explanations that I could understand
GR2 - My doctor is available to answer my questions
ST16 - My eyes are dry
ICM16 - My eyes feel sandy or gritty
BMT12 - My eyesight is blurry
GS4 - My family has accepted my illness
BP13 - My family has trouble understanding when my bone pain interferes with my activity
MS13 - My family has trouble understanding when my condition gets worse
CTCL11 - My family is bothered by my skin condition
GSX2 - My family is doing well despite my illness
ACT9 - My family or friends are pressuring me to eat
AA1 - My fatigue keeps me from doing the things I want to do
ACT13 - My general health is improving
Tax2 - My hands are swollen
FT12 - My illness has been a financial hardship to my family and me
Sp11 - My illness has strengthened my faith or spiritual beliefs
BMT17 - My illness is a personal hardship for my close family members
GSX3 - My illness or treatment has caused problems with my sex life
ACT6 - My interest in food drops as soon as I try to eat
Tax3 - My legs or feet are swollen
Sp3 - My life has been productive
Sp8 - My life lacks meaning and purpose
N8 - My low blood counts interfere with my intimate relationships
CogPCH2 - My memory is as good as it has always been
CogPCH1 - My mind is as sharp as it has always been
Pal7 - My mouth and throat are dry
HN2 - My mouth is dry
FT2 - My out-of-pocket medical expenses are more than I thought they would be
P3 - My pain keeps me from doing things I want to do
N7 - My partner worries about me when my blood counts are low
SWiP2 - My pharmacist advises me on the adverse (side) effects of my medicines
SWiP1 - My pharmacist advises me on the proper use of my medicines
SWiP5 - My pharmacist helps with the arrangements necessary to obtain my medicines
SWiP4 - My pharmacist is available to answer my questions
SWiP6 - My pharmacist is aware of my treatment-related needs
SWiP7 - My pharmacist responds to my treatment-related needs
D6 - My problem with diarrhea (diarrhoea) keeps/wakes me up at night
P8 - My problems with urinating limit my activities
CogF25 - My reactions in everyday situations have been slow
ST7 - My skin bleeds easily
ST22 - My skin condition affects my mood
ST32 - My skin condition interferes with my ability to sleep
ST17 - My skin condition interferes with my social life
CTCL4 - My skin feels irritated
CTCL2 - My skin feels sensitive or "raw"
CTCL9 - My skin is dry or "flaky"
CTCL1 - My skin itches
ST4 - My skin or scalp feels irritated
ST5 - My skin or scalp is dry or “flaky”
ST6 - My skin or scalp itches
CogA3 - My thinking has been slow
CogC32 - My thinking has been slower than usual
L1 - My thinking is clear
MS11 - My thinking is slower than before
BTC4 - My treatment for bone disease causes me physical pain
BTC2 - My treatment for bone disease takes up my family’s time
BTC8 - My treatment schedule for bone disease is stressful to me
BTC9 - My treatment schedule for bone disease is stressful to my family
RT(B)7 - My underarm area is sensitive/tender
Cx4 - My vagina feels too narrow or short
HN4 - My voice has its usual quality and strength
GF2 - My work (include work at home) is fulfilling
Q6 - On which side was your breast operation?
B3 - One or both of my arms are swollen or tender
CogO4 - Other people have told me I seemed confused
CogO1 - Other people have told me I seemed to have trouble remembering information
CogO2 - Other people have told me I seemed to have trouble speaking clearly
CogO3 - Other people have told me I seemed to have trouble thinking clearly
AA7 - Pain on the bottom of my feet interferes with my walking
Dys4 - Preparing meals
CCS5 - Receiving chemotherapy is inconvenient
BTC5 - Receiving treatment for bone disease is inconvenient
Q1 - Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box □ and go to the next section.
ST29 - Sensitivity around my fingernails makes it difficult to perform household tasks
AD1 - Stomach pain interferes with my daily functioning
Dys6 - Sweeping or mopping
M14 - Swelling keeps me from doing the things I want to do
M15 - Swelling keeps me from wearing clothes or shoes I want to wear
BTC34a - Taking the drug by infusion is inconvenient
ACT1 - The amount I eat is sufficient to meet my needs
BMT18 - The cost of my treatment is a burden on me or my family
BTC34b - The infusion for my bone treatment causes me physical pain
BMT4 - The side effects of treatment are worse than I had imagined
RT(B)8 - The skin in my breast area is itchy, flaky or dry
AA6 - The skin on my feet hurts
AA4 - The skin on my hands hurts
ST38 - The skin side effects from treatment have interfered with household tasks
CogQ38 - These problems have interfered with my ability to do things I enjoy
CogQ37 - These problems have interfered with my ability to work
CogQ41 - These problems have interfered with the quality of my life
Sp19 - Throughout the course of my day, I feel a sense of thankfulness for my life
Sp20 - Throughout the course of my day, I feel a sense of thankfulness for what others bring to my life
BTC7 - Treatment for bone disease seems harmful to me
BTC1 - Treatment for bone disease takes up my time
EF7 - Tube feeding limits my activities with my friends
EF5 - Tube feeding limits what I can do inside the house (for example housework, watching TV or reading)
EF6 - Tube feeding limits what I can do outside of the house (for example shopping, driving or yard work)
BTC54a - Waiting up to 60 minutes before eating breakfast in the morning is inconvenient
Dys10 - Walking (faster than your usual speed) for ½ mile (almost 1 km) without stopping
Dys2 - Walking 50 steps/paces on flat ground at a normal speed without stopping
Dys3 - Walking up 20 stairs (2 flights) without stopping
TS25 - Was the treatment staff thorough in examining and treating you?
Dys5 - Washing dishes
TS18 - Were you able to talk to your doctor(s) when you needed to?
TS27 - Were you encouraged to participate in decisions about your health care?
ACT10 - When I eat, I seem to get full quickly
CCS12 - Would you choose this chemotherapy again?
TS39 - Would you choose this clinic or office again?
TS7 - Would you choose this treatment again?
BTC13 - Would you choose this treatment for bone disease again?
CCS11 - Would you recommend this chemotherapy to others with your illness?
TS38 - Would you recommend this clinic or office to others?
BTC12 - Would you recommend this treatment for bone disease to others with your illness?
TS6 - Would you recommend this treatment to others with your illness?