Assessment of Quality of Life in Patients of Mastectomy With Chemotherapy

Questionnaire

Name:

Age:

Sex:

Believe:

Income:

Residence:

Registration Number.:

Stage of the disease:

Procedure performed:

Chemotherapy type: adjuvant/neoadjuvant:

Medicines used: CAF/AC/Paclitaxel or others:

Quality of life scale/breast cancer patient

Directions: We are interested in knowing how your experience of having cancer affects your quality of life. Please answer all of the following questions based on your life right now. Circle the number from 0 to 10 that best describes your experience:

• Physical changes

To what extent are the following problems for you:

1. Fatigue:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

2. Changes In Appetite:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

3. Pain or Pain:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

4. Sleep Changes:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

5. Weight Gain:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

6. Vaginal Dryness/Menopausal Symptoms:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

7. Menstrual Changes Or Fertility:

No problem, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, serious problem

8. Assess Your Overall Physical Health:

Extremely bad, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, excellent

• Psychological well-being items

9. How difficult is it for you to cope with your illness today?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

10. How hard is it for you to cope with your treatment today?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

11. How good is your quality of life?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

12. How much happiness do you feel?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

13. Do you feel like you have the situation in your life under control?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

14. How satisfying is your life?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, very difficult

15. What is your current ability to concentrate or remember?

Extremely bad, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, excellent

16. How useful do you feel?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

17. Has your illness or treatment changed your appearance?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

18. Has your illness or treatment caused changes in your self-image (how you see yourself)?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

• How troubling were the following aspects of your illness and treatment?

19. Initial Diagnosis:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

20. Chemotherapy In Cancer:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

21. Cancer Radiation:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

22. Cancer Surgery:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

23. Completion of Treatment:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

24. How Much Anxiety Do You Have?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

25. How Much Depression Do You Have?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

• To what extent are you afraid of:

26. Future Diagnostic Tests:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

27. Second Cancer:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

28. Cancer Recurrence:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

29. Metastasis (Metastasis) Of Your Cancer:

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

30. To what extent do you feel that your life has returned to normal?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

• Social concerns

31. How disturbing was your illness for your family?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

32. Is the amount of support you receive from others sufficient to meet your needs?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

33. Is your ongoing health care interfering with your personal relationships?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

34. Is your sexuality affected by your illness?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

35. To what extent have your illness and treatment interfered with your work?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

36. To what extent have your illness and treatment interfered with your activities at home?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

37. To what extent do you feel isolated by your illness?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

38. How concerned are you about breast cancer for your daughter(s) or other close female relatives?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

39. How much financial burden have you suffered as a result of your illness and treatment?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

• Spiritual well-being

40. How important is your participation in religious activities such as praying and going to church or temple?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

41. How important to you are other spiritual activities such as meditation or prayer?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

42. How much has your spiritual life changed as a result of your cancer diagnosis?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

43. How much uncertainty do you feel about your future?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

44. To what extent has your illness positively changed your life?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

45. Do you feel a purpose/mission for your life or a reason to live?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

46. ​​​​How hopeful do you feel?

Not at all, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, extremely

• Assessment of the treatment offered in the center and opinion on breast reconstruction surgery:

Are you satisfied with your mastectomy treatment?

Is treatment affordable for you or are you a government patient?

Would you like to undergo another surgery for breast reconstruction?

Can you have regular follow-up for a local recurrence?

Is the Cost of Reconstructive Surgery Affordable for You?

Leave a Comment