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

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