Download Childhood Cancer Survivor Study

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Expansion Baseline < 18: 5/08 – Present
Expansion Baseline: 5/08 – Present
Women's Health: 6/01 – 1/03
Teen: 12/01 – 2/03
Sleep Survey: 11/02 – 2/04
Project Vision: 1/03 – 12/05
Pregnancy - Male: 8/95 – 9/04
Pregnancy - Female: 8/95 – 9/04
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Men's Health Sibling: 02/08 – 11/09
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Men's Health: 02/08 – 11/09
Mammogram Sibling: 6/05 – 08/06
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Mammogram: 6/05 – 08/06
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Health Information Survey: 11/05 – 8/06
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Health Care Needs: 2/01 – 10/01
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Follow-Up 2005: 4/05 – 11/06
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SF-36TM Health Survey
SF-36v2TM Health Survey
Posttraumatic Growth Inventory (PTGI)
Cantril Ladder of Life
Posttraumatic Stress Disorder Symptom Scale (PSS)
Bone Health
LTFU Newsletter
Health Care Views
Health and Experiences with Family and Friends
Treatment Summary (patient indicates whether they have a
treatment summary)
Multidimensional Health Locus of Control (MHLC) Form A
Health Information
Pros and cons of mammography
Breast Cancer Risk
COPE
Short-Form Patient Satisfaction Questionnaire (PSQ-18)
Women's Health Questionnaire (WHQ)
Sexual Self-Schema Scale
Sexual Function/Intimacy
Puberty and Sexual Development
Fertility
Sperm Preservation
Perceptions-Infertility, low testosterone levels, sexual dysfunction
Testosterone Therapy
Erectile Dysfunction Therapy
Pittsburgh Sleep Quality Index (PSQI)
Epworth Sleepiness Scale
Fatigue/Sleeping
Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
(version 4)
Child Health and Illness Profile-Adolescent Edition (CHIP-AE)
Brief Index of Sexual Functioning for Women (BISF-W)
Quality of Life Scale/CANCER PATIENT/CANCER SURVIVOR
Toronto Extremity Salvage Score (TESS)
Reintegration to Normal Living Index (RNLI)
International Index of Erectile Function Questionnaire (IIEF)
Menstrual History
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Follow-Up 2007 Sibling: 7/08 – 12/09
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Follow-Up 2007: 7/07 – 11/09
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Follow-Up 2003 Sibling w/Psychosocial: 3/04 – 8/05
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Follow-Up 2003 Sibling: 3/04 – 10/06
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Follow-Up 2003: 11/02 – 04/05
Follow-Up 2000 Sibling: 8/01 – 3/04
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Follow-Up 2000: 2/00 – 12/02
Family History: 8/95 – 12/04
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Bone Tumors: 11/00 – 7/02
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Baseline Sibling < 18: 3/96 – 10/05
Baseline Sibling: 3/96 – 10/05
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Baseline < 18: 10/92 – 12/02
Question group
Demographics
Medical Care
Medications
Medical Conditions
Brief Symptom Inventory-18 (BSI-18)
Behavior Problems Index
Pain/Anxieties/Fears (as a result of your/your brother's/sister's
cancer, leukemia, tumor or similar illness, or its treatment)
Cancer, Leukemia or Tumors
Marital Status
Offspring/Pregnancy History
Smoking
Alcohol
Physical Activity
Health Practices/Medical Screening Tests
School History
Employment History
Family History Information (may include Genetic Conditions and
Conditions Present at Birth)
Genetic Conditions
Conditions Present at Birth
Insurance
Religion
Income
Other Issues
Future planning, updated address, and contact info
Childhood Cancer Survivor Study-Neurocognitive Questionnaire
(CCSS-NCQ)
Profile of Mood States (POMS)
Alternative Medicine or Complementary Healing Techniques
Dental Health
Sun Sensitivity
Radiation Treatment (2nd cancer)
Chemotherapy Treatment (2nd cancer)
Hospitalizations
Internet related question(s)
General Comments
Baseline: 10/92 – 12/02
Childhood Cancer Survivor Study - Survey Question Sets
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X: Question set is present on the survey
P: Question set is presented partially on the survey
E: Question set is present with additional related questions on the survey
01/06/2011