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Table 2 Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog, Version 3)

From: Cancer treatment regimens and their impact on the patient-reported outcome measures health-related quality of life and perceived cognitive function

Subscale FACT-Cog (version 3)
Item ID Item/question Response options
PCI CogA1 I have had trouble forming thoughts Frequency (never, about once a week, two to three times a week, nearly every day, several times a day)
CogA3 My thinking has been slow
CogC7 I have had trouble concentrating
CogM9 I have had trouble finding my way to a familiar place
CogM10 I have had trouble remembering where I put things, like my keys or my wallet
CogM12 I have had trouble remembering new information, like phone numbers or simple instructions
CogV13 I have had trouble recalling the name of an object while talking to someone
CogV15 I have had trouble finding the right word(s) to express myself
CogV16 I have used the wrong word when I referred to an object
CogV17b I have had trouble saying what I mean in conversations with others
CogF19 I have walked into a room and forgotten what I meant to get or do there
CogF23 I have had to work really hard to pay attention or I would make a mistake
CogF24 I have forgotten names of people soon after being introduced
CogF25 My reactions in everyday situations have been slow
CogC31 I have had to work harder than usual to keep track of what I was doing
CogC32 My thinking has been slower than usual
CogC33a I have had to work harder than usual to express myself clearly
CogC33c I have had to use written lists more often than usual so I would not forget things
OTH CogO1 Other people have told me I seemed to have trouble remembering information Frequency (never, about once a week, two to three times a week, nearly every day, several times a day)
CogO2 Other people have told me I seemed to have trouble speaking clearly
CogO3 Other people have told me I seemed to have trouble thinking clearly
CogO4 Other people have told me I seemed confused
PCA CogPC1 I have been able to concentrate Intensity (not at all, a little bit, somewhat quite a bit, very much)
CogPV1 I have been able to bring to mind words that I wanted to use while talking to someone
CogPM1 I have been able to remember things, like where I left my keys or wallet
CogPM2 I have been able to remember to do things, like take medicine or buy something I needed
CogPF1 I am able to pay attention and keep track of what I am doing without extra effort
CogPCh1 My mind is as sharp as it has always been
CogPCh2 My memory is as good as it has always been
Cog QoL CogQ35 I have been upset about these problems Intensity (not at all, a little bit, somewhat quite a bit, very much)
CogQ37 These problems have interfered with my ability to work
CogQ38 These problems have interfered with my ability to do things I enjoy
CogQ41 These problems have interfered with the quality of my life