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97202 Appendices

A Randomized Double-Blind Placebo-Controlled Study of
Oral Coenzyme Q10 to Relieve Self-Reported
Cancer Treatment Related Fatigue in Breast Cancer Patients

Appendices by Visit:

                       Screening and Baseline            ®         Weeks 8, 16 and 24

Appendices:
Combined Appendices

  1. Data Submission Checklist
  2. POMS-F
  3. FACT-B and FACIT-F
  4. Patient Self-Rating of Fatigue Scale (VAS)
  5. MOS Social Support
  6. Flow Sheet and Addenda
  7. CES-D Short Form
  8. Eligibility Checklist and Registration Form
  9. See below for individual patient medication calendars. 
  10. Protocol Chemotherapy and RT Summary
  11. Pharmacology Form
  12. Biomarkers Shipping for CCOPs/Non-CCOPs
  13. MedWatch Mandatory 

Patient Medication Diaries:
2006:
November  l  December
2007: 
January  l  February  l  March  l  April  l  May  l  June  l  July  l  August  l  September  l  October  l  November  l  December
2008: January
  l  February  l  March  l  April  l  May  l  June  l  July 
August  l  September  l  October  l  November  l  December
2009: January  l  February  l  March  l  April  l  May  l  June  l  July

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Winston-Salem, NC 27157

The information on this Website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified healthcare provider. If you have a medical problem or a health-related question, consult your physician or call Health On-Call at 336-716-2255 or 1-800-446-2255.

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Last Modified: 8/21/2008