Table 1. Dexamethasone symptom questionnaire.

Dexamethasone questionnaire		Patient number:		□
Patient Initials:
	□□□
Date of birth (day, month, year):
	□□□
Today's date (day, month, year):
	□□□
We are interested in some things about you and your health. Please answer all the questions by circling the number that best applies to you. There are no “right” or “wrong” answers. The information that you provide will remain strictly confidential.
DURING THE WEEK AFTER YOUR CHEMOTHERAPY:
		Not at all	A little	Quite a bit	Very much
1.	Did you have indigestion/heartburn/reflux or discomfort in the upper abdomen?	1	2	3	4
2.	Did you have trouble getting to sleep?	1	2	3	4
3.	Have you felt nauseated?	1	2	3	4
4.	Have you vomited?	1	2	3	4
5.	Have you lacked appetite?	1	2	3	4
6.	Have you had increased appetite?	1	2	3	4
7.	Have you had hiccups?	1	2	3	4
8.	Have you lost weight?	1	2	3	4
9.	Have you gained weight?	1	2	3	4
10.	Have you felt agitated/nervous?	1	2	3	4
11.	Have you had a rash/acne on your face?	1	2	3	4
12.	Have you had thrush/yeast infection in your mouth?	1	2	3	4
13.	Did you experience feelings of depression on stopping the dexamethasone?	1	2	3	4