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Persons
Instruction: We are interested in certain things about you and your health. Please answer each question by checking the box in the indicated manner. If you are not sure how to answer a question, please give the answer that best applies to your situation. There are no wrong or right answers.
The following questions ask you about how you normally feel. You can choose from five response categories, from ‘never’ to ‘always’. Please choose the answer that is most applicable to you.
The following questions are about how you feel right now. Please choose the answer that best describes your current feeling. Do not think too long about your answer. These statements are about your personal impression. There are no wrong answers: it is opinion based.
We would like to know in which way cancer influences your life. Please answer the following questions. With every question, check the box that is most applicable to you. There are no right or wrong answers. Your personal impression is the only thing that counts.
Does your health limit you in these activities? If so, how much? Moderate activities, such as: moving a table, pushing a vacuum cleaner, bowling, or playing golf
During the past 4 weeks, have you had any of the following problems with your work or other regular activities as a result of your physical health?
During the past 4 weeks, were you limited in the kind of work you do or other regular activities as a result of any emotional problems? (such as feeling depressed or anxious)
During the past 4 weeks, how much did pain interfere with your normal work? (including both work outside the home and housework)
