Structure LinkId Text Cardinality Type Description & Constraints PatientReportedFollowUp Patient-reported response at every 6 months for first 2 years post-treatment, after 2 years tracked annually for up to 10 years Questionnaire http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/PatientReportedFollowUp#1.0.0 General-Information-Clinical General information 1..1 group NA-Clinical What is the patient's medical record number? 1..1 string LastName-Clinical What is the patient's last name? 1..1 string Degree-of-Health-EORTC-QLQ Degree of Health - EORTC-QLQ 0..1 group EORTCQLQ-Question01-05 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: Agreement response ValueSet EORTCQLQC30_Q02 Do you have any trouble taking a long walk? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q03 Do you have any trouble taking a short walk outside of the house? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q04 Do you need to stay in bed or a chair during the day? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q05 Do you need help with eating, dressing, washing yourself or using the toilet? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question06-28 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: Agreement response ValueSet EORTCQLQC30_Q07 Were you limited in pursuing your hobbies or other leisure time activities? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q08 Were you short of breath? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q09 Have you had pain? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q10 Did you need to rest? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q11 Have you had trouble sleeping? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q12 Have you felt weak? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q13 Have you lacked appetite? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q14 Have you felt nauseated? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q15 Have you vomited? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q16 Have you been constipated? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q17 Have you had diarrhea? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q18 Were you tired? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q19 Did pain interfere with your daily activities? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q20 Have you had difficulty in concentrating on things, like reading a newspaper or watching television? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q21 Did you feel tense? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q22 Did you worry? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q23 Did you feel irritable? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q24 Did you feel depressed? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q25 Have you had difficulty remembering things? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q26 Has your physical condition or medical treatment interfered with your family life? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q27 Has your physical condition or medical treatment interfered with your social activities? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQC30_Q28 Has your physical condition or medical treatment caused you financial difficulties? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question29-30 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 EORTCQLQ-Question31-43 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 EORTCQLQBR45_Q31 Have you had dry mouth? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q32 Have food and drink tasted different than usual? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q33 Have your eyes been painful, irritated or watery? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q34 Have you lost any hair? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q35 Have you been upset by the loss of your hair? 0..1 choice Enable When: EORTCQLQBR45_Q34 != Not at all (Agreement response CodeSystem#no) Value Set: Agreement response ValueSet EORTCQLQBR45_Q36 Have you felt ill or unwell? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q37 Have you had hot flushes? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q38 Have you had headaches? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q39 Have you felt physically less attractive as a result of your disease or treatment? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q40 Have you felt less feminine as a result of your disease or treatment? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q41 Have you had problems looking at yourself naked? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q42 Have you been dissatisfied with your body? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q43 Have you worried about your health in the future? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question44-46 During the past four weeks: 0..1 group EORTCQLQBR45_Q44 Have you been sexually active? (with or without intercourse) 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q45 To what extent were you sexually active? (with or without intercourse) 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q46 Has sex been enjoyable for you? 0..1 choice Enable When: EORTCQLQBR45_Q45 != Not at all (Agreement response CodeSystem#no) Value Set: Agreement response ValueSet EORTCQLQ-Question47-69 During the past week: 0..1 group EORTCQLQBR45_Q48 Have you had a swollen arm or hand? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q49 Have you had problems raising your arm or moving it sideways? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q50 Have you had any pain in the area of your affected breast? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q51 Has the area of your affected breast been swollen? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q52 Has the area of your affected breast been oversensitive? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_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: Agreement response ValueSet EORTCQLQBR45_Q54 Have you sweated excessively? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q55 Have you had mood swings? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q56 Have you been dizzy? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q57 Have you had soreness in your mouth? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q58 Have you had any reddening in your mouth? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q59 Have you had pain in your hands or feet? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q60 Have you had any redenning on your hands or feet? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q61 Have you had tingling in your fingers or toes? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q62 Have you had numbness in your fingers or toes? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q63 Have you had problems with your joints? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q64 Have you had stiffness in your joints? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q65 Have you had pain in your joints? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q66 Have you had aches or pains in your bones? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q67 Have you had aches or pains in your muscles? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q68 Have you gained weight? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q69 Has weight gain been a problem for you? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question70-71 During the past four weeks: 0..1 group EORTCQLQBR45_Q70 Have you had a dry vagina? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q71 Have you had discomfort in your vagina? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question72-73 Please answer the following two questions only if you have been sexually active: 0..1 group EORTCQLQBR45_Q72 Have you had pain in your vagina during sexual activity? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q73 Have you experienced a dry vagina during sexual activity? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQ-Question74-75 During the past week: 0..1 group EORTCQLQBR45_Q74 Have you been satisfied with the cosmetic result of the surgery? 1..1 choice Value Set: Agreement response ValueSet EORTCQLQBR45_Q75 Have you been satisfied with the appearance of the skin of your affected breast (thoracic area)? 1..1 choice Value Set: Agreement response ValueSet Degree-of-Health-BreastQ Degree of Health BreastQ 0..1 group BreastQ_Surgery Which type of surgery did you receive? 1..1 choice Value Set: Types of breast surgery ValueSet MastectomyFollowUp With your breast area in mind, in the past 2 weeks, how satisfied or dissatisfied have you been with: 0..1 group Enable When: BreastQ_Surgery = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) BREASTQMASTP_Q01 How you look in the mirror clothed? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQMASTP_Q02 How comfortably your bras fit? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQMASTP_Q03 Being able to wear clothing that is more fitted? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQMASTP_Q04 How you look in the mirror unclothed? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Satisfaction response ValueSet BreastConservingTherapyFollowUp The following questions are about your breasts and your breast cancer treatment (by treatment, we mean lumpectomy with or without radiation). If you have had a lumpectomy and radiation of both breasts, answer these questions thinking of the breast you are least satisfied with. With your breasts in mind, in the past week, how satisfied or dissatisfied have you been with: 0..1 group Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) BREASTQBCTP_Q01 How you look in the mirror clothed? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q02 The shape of your lumpectomy breast when you are wearing a bra? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q03 How normal you feel in your clothes? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q04 Being able to wear clothing that is more fitted? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q05 How your lumpectomy breast sits/hangs? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q06 How smoothly shaped your lumpectomy breast looks? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q07 The contour (outline) of your lumpectomy breast? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q08 How equal in size your breasts are to each other? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q09 How normal your lumpectomy breast looks? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q10 How much your breast look the same? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet BREASTQBCTP_Q11 How you look in the mirror unclothed? 0..1 choice Enable When: BreastQ_Surgery = Breast conserving surgery (BCS) (Breast surgery types CodeSystem#bcs) BreastQ_Surgery = BCS with mammoplasty (Breast surgery types CodeSystem#bcs-with-mammoplasty) Value Set: Satisfaction response ValueSet ReconstructionFollowUp If you have had a mastectomy and reconstruction of both breasts, answer these questions thinking of the breast you are least satisfied with. With your breasts in mind ,in the past week, how satisfied or dissatisfied have you been with: 0..1 group Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) BREASTQRECP_Q01 How you look in the mirror clothed? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q02 The shape of your reconstructed breast(s) when you are wearing a bra? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q03 How normal you feel in your clothes? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q04 The size of your reconstructed breast(s)? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q05 Being able to wear clothing that is more fitted? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q06 How your breasts are lined up in relation to each other? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q07 How comfortably your bras fit? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q08 The softness of your reconstructed breast(s)? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q09 How equal in size your breasts are to each other? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q10 How natural your reconstructed breast(s) looks? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q11 How naturally your reconstructed breast(s) sits/hangs? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q12 How your reconstructed breast(s) feel to touch? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q13 How much your reconstructed breast(s) feels like a natural part of your body? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q14 How closely matched (similar) your breasts are to each other? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q15 How your reconstructed breast(s) look now compared to before you had any breast surgery? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet BREASTQRECP_Q16 How you look in the mirror unclothed? 0..1 choice Enable When: BreastQ_Surgery = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Satisfaction response ValueSet 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
Patient reported response at post-treatment follow-up
HL7 International - Clinical Interoperability Council Group
Patient-reported response at every 6 months for first 2 years post-treatment, after 2 years tracked annually for up to 10 years
What is the patient's medical record number?
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:
Have food and drink tasted different than usual?
Have your eyes been painful, irritated or watery?
Have you been upset by the loss of your hair?
Have you felt physically less attractive as a result of your disease or treatment?
Have you felt less feminine as a result of your disease or treatment?
Have you had problems looking at yourself naked?
Have you been dissatisfied with your body?
Have you worried about your health in the future?
Have you been sexually active? (with or without intercourse)
To what extent were you sexually active? (with or without intercourse)
Have you had problems raising your arm or moving it sideways?
Have you had any pain in the area of your affected breast?
Has the area of your affected breast been swollen?
Has the area of your affected breast been oversensitive?
Have you had skin problems on or in the area of your affected breast (e.g., itchy, dry, flaky)?
Have you had any reddening in your mouth?
Have you had pain in your hands or feet?
Have you had any redenning on your hands or feet?
Have you had tingling in your fingers or toes?
Have you had numbness in your fingers or toes?
Have you had aches or pains in your bones?
Have you had aches or pains in your muscles?
Please answer the following two questions only if you have been sexually active:
Have you had pain in your vagina during sexual activity?
Have you experienced a dry vagina during sexual activity?
Have you been satisfied with the cosmetic result of the surgery?
Have you been satisfied with the appearance of the skin of your affected breast (thoracic area)?
With your breast area in mind, in the past 2 weeks, how satisfied or dissatisfied have you been with:
Being able to wear clothing that is more fitted?
The following questions are about your breasts and your breast cancer treatment (by treatment, we mean lumpectomy with or without radiation). If you have had a lumpectomy and radiation of both breasts, answer these questions thinking of the breast you are least satisfied with. With your breasts in mind, in the past week, how satisfied or dissatisfied have you been with:
The shape of your lumpectomy breast when you are wearing a bra?
How smoothly shaped your lumpectomy breast looks?
The contour (outline) of your lumpectomy breast?
How equal in size your breasts are to each other?
How normal your lumpectomy breast looks?
If you have had a mastectomy and reconstruction of both breasts, answer these questions thinking of the breast you are least satisfied with. With your breasts in mind ,in the past week, how satisfied or dissatisfied have you been with:
The shape of your reconstructed breast(s) when you are wearing a bra?
The size of your reconstructed breast(s)?
How your breasts are lined up in relation to each other?
The softness of your reconstructed breast(s)?
How natural your reconstructed breast(s) looks?
How naturally your reconstructed breast(s) sits/hangs?
How your reconstructed breast(s) feel to touch?
How much your reconstructed breast(s) feels like a natural part of your body?
How closely matched (similar) your breasts are to each other?
How your reconstructed breast(s) look now compared to before you had any breast surgery?