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. 2015 Oct 29;3(1):1169. doi: 10.13063/2327-9214.1169
DOMAIN 21 ITEMS THAT UNDERWENT COGNITIVE INTERVIEWING FINAL VERSION OF THE 21-ITEM SCREENER APPLICABLE ACROSS ALL CANCER AND TREATMENT TYPES
Agenda Setting for Visit “What would you like to talk to nurse or doctor about today?”3 What would you like to talk to nurse or doctor about today?
Insomnia What was the SEVERITY of your INSOMNIA (INCLUDING DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR WAKING UP EARLY) at its WORST?1 Rate your worst insomnia (trouble sleeping).
Decreased Appetite What was the SEVERITY of your DECREASED APPETITE?1 Rate your worst decreased appetite.
Nausea What was the SEVERITY of your NAUSEA at its WORST?1 Rate your worst upset stomach.
Pain Frequency How OFTEN did you have PAIN?1 How often did you have pain?
Pain Intensity What was the SEVERITY of your PAIN at its WORST?1 Rate your worst pain.
Depression What was the SEVERITY of your SAD or UNHAPPY FEELINGS at their WORST?1 Rate your worst sad or unhappy feelings.
Fatigue What was the SEVERITY of your FATIGUE, TIREDNESS, OR LACK OF ENERGY at its WORST?1 Rate your worst tiredness, lack of energy, fatigue.
Headache What was the SEVERITY of your HEADACHE at its WORST?1 Rate your worst headache.
Anxiety What was the SEVERITY of your ANXIETY at its WORST?1 Rate your worst anxiety (worrying).
Neuropathy What was the SEVERITY of your NUMBNESS OR TINGLING IN YOUR HANDS OR FEET at its WORST?1 Rate your worst numbness or tingling in your hands or feet.
Dyspnea What was the SEVERITY of your SHORTNESS OF BREATH?1 Rate your worst shortness of breath.
Cough What was the SEVERITY of your COUGH at its WORST?1 Rate your worst cough.
Trouble Concentrating What was the SEVERITY of your PROBLEMS WITH CONCENTRATION at their WORST?1 Rate your worst problems with concentration.
Diarrhea How OFTEN did you have LOOSE OR WATERY STOOLS (DIARRHEA)?1 How often did you have loose or watery stools (diarrhea).
Loss of control of urine How OFTEN did you have LOSS OF CONTROL OF URINE (LEAKAGE)? 1 How often did you have loss of control of urine (leakage).
Rash Did you have any RASH?1 Did you have a rash? (yes/no)
Other Symptoms Not Listed Did you have any other symptoms not listed?3 Did you have any other symptoms not listed?
Overall Health In general, would you say your HEALTH is:2 Excellent, Very Good, Good, Fair, Poor? In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?
Quality of Life In general, would you say your QUALITY OF LIFE is:2 Excellent, Very Good, Good, Fair, Poor? In general, would you say your quality of life is: Excellent, Very Good, Good, Fair, Poor?
Daily Activities To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?2 To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?

Notes:

1

PRO-CTCAE,

2

PROMIS Global Health Questionnaire,

3

Question Written by Authors.