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Ovarian cancer cells


Stained ovarian cancer cells at high magnification.
Ovarian cancer
Please complete this questionnaire if you had Paclitaxel (Taxol) when your ovarian cancer returned.

Approximately how long ago did you have this chemotherapy?

Have you been treated with had any other chemotherapy drugs since your cancer came back?
If so please give the names and approximate dates of the treatments
Please also tell us, if you can, what chemotherapy drugs you had when your cancer was first diagnosed
Approximate date of first treatment
What age are you –  
20's 30's 40's 50's 60's 70's 80's 90's
It is not always easy to remember how you have felt in the past but please answer the following questions to the best of you ability.

Please click the answer that most reflects your memory of how you felt whilst receiving this drug; remember there are no right or wrong answers:

Feeling anxious or worried?
While you were being treated with Taxol did you experience any of the following.
   
Not
all all
A little
Quite a bit
Very
much
1. Nausea?
2. Vomiting?
3. Constipation?
4. Diarrhoea?
5. Weight gain?
6.

Problems with your mouth e.g. sore or dry mouth or throat, mouth ulcers?

7. Change in your appetite or taste?
8. Hair loss?
9.

Problems with your skin or nails e.g. dry, itchy or Inflamed, skin, sun sensitivity, Changes in nails or vein marking?

10.

Problems with your eyes e.g. sore, scratchy, dry or watery eyes?

11. Bleeding or bruising?
12. Shortness of breath?
13. Headaches?
14. Difficulty in sleeping?
15. Loss of appetite?
16.

Problems with infections? e.g. Infections that needed treatment

Did you feel any of the following while you were on treatment with Taxol
17.

Feeling unusually tired/ weak?

18. Feeling pain or discomfort?
  If so please state where
19. Feeling low or depressed?
20. Feeling anxious or worried?
Do you feel that your treatment affected any of the following areas of your life?
21.

Your intimate on sexual relationships e.g. decreased sexual interest?

22. Your ability to do your work or other daily activities?
23. Your ability to enjoy your hobbies orother leisure time activities?
24. Changes in your ability to concentrate or remember things?
25. Your ability to enjoy your family life?
26. Did you experience any financial difficultiesbecause of your medical treatment with Taxol

For the following questions please click the number between 1 and 7 that best applies to you.
27.

How would you rate your overall health during the treatment?

        
  1 2 3 4 5 6 7        
 
Very Poor
Excellent
       
  Do you think that your general health improved whilst you were on Taxol      
28. How would you rate your overall quality of life whilst you were on Taxol        
  1 2 3 4 5 6 7        
 
Very Poor
Excellent
       
  Do you think that your quality of life improved whilst you were on Taxol      
29. How successful in treating your cancer would you rate Taxol?        
  1 2 3 4 5 6 7        
 
Unsuccessful
Very successful
       
30. If offered, would you consider having this treatment again?        
  Yes No Don’t know        
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Thank You

 
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