Structure LinkId Text Cardinality Type Description & Constraints EORTCQLQ Questionnaire https://connect.ichom.org/fhir/Questionnaire/EORTCQLQ#0.0.1 EORTCQLQC30_Timing What is the timing of the response of this questionnaire? 1..1 choice Value Set: Timing of the response of the patient reported outcome measures Group_Q01-Q05 We are interested in some things about you and your health. Please answer all of the questions yourself by selecting the answer that best applies to you. There are no 'right' or 'wrong' answers. The information that you provide will remain strictly confidential. 0..1 group EORTCQLQC30_Q01 Do you have any trouble doing strenuous activities, like carrying a heavy shopping bag or a suitcase? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q02 Do you have any trouble taking a long walk? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q03 Do you have any trouble taking a short walk outside of the house? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q04 Do you need to stay in bed or a chair during the day? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q05 Do you need help with eating, dressing, washing yourself or using the toilet? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response Group_Q06-Q28 During the past week: 0..1 group EORTCQLQC30_Q06 Were you limited in doing either your work or other daily activities? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q07 Were you limited in pursuing your hobbies or other leisure time activities? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q08 Were you short of breath? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q09 Have you had pain? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q10 Did you need to rest? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q11 Have you had trouble sleeping? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q12 Have you felt weak? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q13 Have you lacked appetite? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q14 Have you felt nauseated? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q15 Have you vomited? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q16 Have you been constipated? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q17 Have you had diarrhea? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q18 Were you tired? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q19 Did pain interfere with your daily activities? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q20 Have you had difficulty in concentrating on things, like reading a newspaper or watching television? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q21 Did you feel tense? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q22 Did you worry? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q23 Did you feel irritable? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q24 Did you feel depressed? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q25 Have you had difficulty remembering things? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q26 Has your physical condition or medical treatment interfered with your family life? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q27 Has your physical condition or medical treatment interfered with your social activities? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQC30_Q28 Has your physical condition or medical treatment caused you financial difficulties? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response Group_Q29-Q30 For the following questions please select the number between 1 and 7 that best applies to you, with 1 = Very poor and 7 = Excellent. 0..1 group EORTCQLQC30_Q29 How would you rate your overall health during the past week? 1..1 choice Options: 7 options EORTCQLQC30_Q30 How would you rate your overall quality of life during the past week? 1..1 choice Options: 7 options Group_Q31-Q43 Patients sometimes report that they have the following symptoms or problems. Please indicate the extent to which you have experienced these symptoms or problems during the past week. Please answer by selecting the answer that best applies to you. During the past week: 0..1 group EORTCQLQBR23_Q31 Did you have a dry mouth? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q32 Did food and drink taste different than usual? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q33 Were your eyes painful, irritated or watery? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q34 Have you lost any hair? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q35 Were you upset by the loss of your hair? 0..1 choice Enable When: EORTCQLQBR23_Q34 = true Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q36 Did you feel ill or unwell? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q37 Did you have hot flushes? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q38 Did you have headaches? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q39 Have you felt physically less attractive as a result of your disease or treatment? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q40 Have you been feeling less feminine as a result of your disease or treatment? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q41 Did you find it difficult to look at yourself naked? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q42 Have you been dissatisfied with your body? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q43 Were you worried about your health in the future? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response Group_Q44-Q46 During the past four weeks: 0..1 group EORTCQLQBR23_Q44 To what extent were you interested in sex? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q45 To what extent were you sexually active? (with or without intercourse) 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q46 To what extent was sex enjoyable for you? 0..1 choice Enable When: EORTCQLQBR23_Q45 = true Value Set: Values used in EORTC-QLQ questionnaire response Group_Q47-Q53 During the past week: 0..1 group EORTCQLQBR23_Q48 Did you have a swollen arm or hand? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q49 Was it difficult to raise your arm or to move it sideways? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q50 Have you had any pain in the area of your affected breast? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q51 Was the area of your affected breast swollen? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q52 Was the area of your affected breast oversensitive? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTCQLQBR23_Q53 Have you had skin problems on or in the area of your affected breast (e.g., itchy, dry, flaky)? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response EORTC QLQ-LMC21 Have you had tingling hands or feet? 1..1 choice Value Set: Values used in EORTC-QLQ questionnaire response Documentation for this format Option Sets Answer options for EORTCQLQC30_Q29 1 2 3 4 5 6 7 Answer options for EORTCQLQC30_Q30 1 2 3 4 5 6 7
European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire
What is the timing of the response of this questionnaire?
We are interested in some things about you and your health. Please answer all of the questions yourself by selecting the answer that best applies to you. There are no 'right' or 'wrong' answers. The information that you provide will remain strictly confidential.
Do you have any trouble doing strenuous activities, like carrying a heavy shopping bag or a suitcase?
Do you have any trouble taking a long walk?
Do you have any trouble taking a short walk outside of the house?
Do you need to stay in bed or a chair during the day?
Do you need help with eating, dressing, washing yourself or using the toilet?
Were you limited in doing either your work or other daily activities?
Were you limited in pursuing your hobbies or other leisure time activities?
Did pain interfere with your daily activities?
Have you had difficulty in concentrating on things, like reading a newspaper or watching television?
Have you had difficulty remembering things?
Has your physical condition or medical treatment interfered with your family life?
Has your physical condition or medical treatment interfered with your social activities?
Has your physical condition or medical treatment caused you financial difficulties?
For the following questions please select the number between 1 and 7 that best applies to you, with 1 = Very poor and 7 = Excellent.
How would you rate your overall health during the past week?
How would you rate your overall quality of life during the past week?
Patients sometimes report that they have the following symptoms or problems. Please indicate the extent to which you have experienced these symptoms or problems during the past week. Please answer by selecting the answer that best applies to you. During the past week:
Did food and drink taste different than usual?
Were your eyes painful, irritated or watery?
Were you upset by the loss of your hair?
Have you felt physically less attractive as a result of your disease or treatment?
Have you been feeling less feminine as a result of your disease or treatment?
Did you find it difficult to look at yourself naked?
Have you been dissatisfied with your body?
Were you worried about your health in the future?
To what extent were you interested in sex?
To what extent were you sexually active? (with or without intercourse)
To what extent was sex enjoyable for you?
Was it difficult to raise your arm or to move it sideways?
Have you had any pain in the area of your affected breast?
Was the area of your affected breast swollen?
Was the area of your affected breast oversensitive?
Have you had skin problems on or in the area of your affected breast (e.g., itchy, dry, flaky)?