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Example EORTC QLQ-C30 Survey Questionnaire

Cancer Quality of Life Questionnaire
Help us understand what we are doing right, what needs improving and anything else you would like to tell us

This is a fully functional survey e-questionnaire so you can try it out for completion. However, we do not analyse the results of this example survey
1.Do you have any trouble doing strenuous activities, like carrying a heavy shopping bag or a suitcase?
2.Do you have any trouble taking a long walk?
3.Do you have any trouble taking a short walk outside of the house?
4.Do you need to stay in bed or a chair during the day?
5.Do you need help with eating, dressing, washing yourself or using the toilet?
6.Were you limited in doing either your work or their daily activities?
7.Were you limited in pursuing your hobbies or other leisure time activities?
8.Were you short of breath?
9.Have you had pain?
10.Did you need to rest?
11.Have you had trouble sleeping?
12.Have you felt weak?
13.Have you lacked appetite?
14.Have you felt nauseated?
15.Have you vomited?
16.Have you been constipated?
17.Have you had diarrhoea?
18.Were you tired?
19.Did pain interfere with your daily activities?
20.Have you had difficulty in concentrating on things. like reading a newspaper or watching television?
21.Did you feel tense?
22.Did you worry?
23.Did you feel irritable?
24.Did you feel depressed?
25.Have you had difficulty remembering things?
26.Has your physical condition or medical treatment interfered with your family life?
27.Has your physical condition or medical treatment interfered with your social activities?
28.Has your physical condition or medical treatment caused you financial difficulties?
29.How would you rate your overall health during the past week?
30.How would you rate your overall quality of life during the past week?