Symptom nb | Symptom | Items | Alert threshold PRO-CTCAE grade | Alert wording | Number of questions | Grade threshold yellow/red |
---|---|---|---|---|---|---|
1 | Decreased appetite | Severity | 2 | 2:* | 1 | 2/ > 2 |
Interference with daily activities | 2 | 2:* | 2 | 2/ > 2 | ||
2 | Nausea | Frequency | 1 + 2 | 1: If you have been given anti-emetics that you haven’t applied, please take them now. If in doubt, please contact the department 2: * | 3 | 2/ > 2 |
Severity | 1 + 2 | 1: If you have been given anti-emetics that you haven’t applied, please take them now. If in doubt, please contact the department 2:* | 4 | 2/ > 2 | ||
3 | Vomiting | Frequency | 1 + 2 | 1: If you have been given anti-emetics that you haven’t applied, please take them now. If in doubt, please contact the department 2: * | 5 | 2/ > 2 |
Severity | 1 + 2 | 1: If you have been given anti-emetics that you haven’t applied, please take them now. If in doubt, please contact the department 2: * | 6 | 2/ > 2 | ||
4 | Constipation | Severity | 1 + 2 | 1: If you have laxative medications at home but are in doubt of how to apply them, please contact the department 2:* | 7 | 2/ > 2 |
5 | Diarrhea | Frequency | 1 | 1:* | 8 | 2/ > 2 |
6 | Shortness of breath | Severity | 2** | 2:* | 9 | 2/ > 2 |
Interference with daily activities | 2** | 2:* | 10 | 2/ > 2 | ||
7 | Swelling | Frequency | 2 | 2:* | 11 | 2/ > 2 |
Severity | 2 | 2:* | 12 | 2/ > 2 | ||
Interference with daily activities | 2 | 2:* | 13 | 2/ > 2 | ||
8 | Heart palpitations | Frequency | 2 | 2:* | 14 | 2/ > 2 |
Severity | 2 | 2:* | 15 | 2/ > 2 | ||
9 | Itching | Severity | 2 | 2:* | 16 | > 1 |
10 | Pain | Frequency | 1 + 2 | 1: If you have pain medication at home and have doubts of how to apply them, please call the department 2: * | 17 | 2/ > 2 |
Severity | 1 + 2 | 1: If you have pain medication at home and have doubts of how to apply them, please call the department 2: * | 18 | 2/ > 2 | ||
Interference with daily activities | 1 + 2 | 1: If you have pain medication at home and have doubts of how to apply them, please call the department 2: * | 19 | 2/ > 2 | ||
11 | Insomnia | Severity | 2 | 2:* | 20 | 2/ > 2 |
Interference with daily activities | 2 | 2:* | 21 | 2/ > 2 | ||
12 | Fatigue | Severity | 3 | 3:* | 22 | 2/ > 2 |
Interference with daily activities | 3 | 3:* | 23 | 2/ > 2 | ||
13 | Anxiety | Frequency | 2 | 2:* | 24 | 2/ > 2 |
Severity | 2 | 2:* | 25 | 2/ > 2 | ||
Interference with daily activities | 2 | 2:* | 26 | 2/ > 2 | ||
14 | Frequent urination | Frequency | 3 | 3:* | 27 | 3/ > 3 |
Interference with daily activities | 3 | 3:* | 28 | 3/ > 3 | ||
15 | Chills | Frequency | 1 | 1:* | 29 | 2/ > 2 |
Severity | 1 | 1:* | 30 | 2/ > 2 |