Scribd Logo
Upload

Welcome to Scribd!

  • 21 views

    HN43 English

    Uploaded by

    Aayush Kapoor
    EORTC H&N 43 to assess Qol in head and neck cancer patients

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    HN43 English

    Uploaded by

    Aayush Kapoor
    21 views2 pages
    EORTC H&N 43 to assess Qol in head and neck cancer patients

    Original Title

    HN43 English (3)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    EORTC H&N 43 to assess Qol in head and neck cancer patients

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views2 pages

    HN43 English

    Uploaded by

    Aayush Kapoor
    EORTC H&N 43 to assess Qol in head and neck cancer patients

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ENGLISH

    EORTC QLQ – H&N43

    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 circling the number that best applies to you.

    During the past week: Not at A Quite Very


    All Little a Bit Much

    31. Have you had pain in your mouth? 1 2 3 4

    32. Have you had pain in your jaw? 1 2 3 4

    33. Have you had soreness in your mouth? 1 2 3 4

    34. Have you had pain in your throat? 1 2 3 4

    35. Have you had problems swallowing liquids? 1 2 3 4

    36. Have you had problems swallowing pureed food? 1 2 3 4

    37. Have you had problems swallowing solid food? 1 2 3 4

    38. Have you choked when swallowing? 1 2 3 4

    39. Have you had problems with your teeth? 1 2 3 4

    40. Have you had problems because of losing some teeth? 1 2 3 4

    41. Have you had problems opening your mouth wide? 1 2 3 4

    42. Have you had a dry mouth? 1 2 3 4

    43. Have you had sticky saliva? 1 2 3 4

    44. Have you had problems with your sense of smell? 1 2 3 4

    45. Have you had problems with your sense of taste? 1 2 3 4

    46. Have you had problems with coughing? 1 2 3 4

    47. Have you had problems with hoarseness? 1 2 3 4

    48. Have you had problems with your appearance? 1 2 3 4

    49. Have you felt less physically attractive as a result of your


    disease or treatment? 1 2 3 4

    Please go on to the next page


    ENGLISH

    During the past week: Not at A Quite Very


    All Little a Bit Much
    50. Have you felt dissatisfied with your body? 1 2 3 4

    51. Have you had problems eating? 1 2 3 4

    52. Have you had problems eating in front of your family? 1 2 3 4

    53. Have you had problems eating in front of other people? 1 2 3 4

    54. Have you had problems enjoying your meals? 1 2 3 4

    55. Have you had problems talking to other people? 1 2 3 4

    56. Have you had problems talking on the telephone? 1 2 3 4

    57. Have you had problems talking in a noisy environment? 1 2 3 4

    58. Have you had problems speaking clearly? 1 2 3 4

    59. Have you had problems going out in public? 1 2 3 4

    60. Have you felt less interest in sex? 1 2 3 4

    61. Have you felt less sexual enjoyment? 1 2 3 4

    62. Have you had problems raising your arm or moving it sideways? 1 2 3 4

    63. Have you had pain in your shoulder? 1 2 3 4

    64. Have you had swelling in your neck? 1 2 3 4

    65. Have you had skin problems (e.g. itchy, dry)? 1 2 3 4

    66. Have you had a rash? 1 2 3 4

    67. Has your skin changed colour? 1 2 3 4

    68. Have you worried that your weight is too low? 1 2 3 4

    69. Have you worried about the results of examinations and tests? 1 2 3 4

    70. Have you worried about your health in the future? 1 2 3 4

    71. Have you had problems with wounds healing? 1 2 3 4

    72. Have you had tingling or numbness in your hands or feet? 1 2 3 4

    73. Have you had problems chewing? 1 2 3 4

    © Copyright 2014 EORTC Quality of Life Group. All rights reserved. Phase IV module.

    You might also like