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Table 1 Contents of questionnaires and data collection forms included in the head and neck 5000 clinical cohort study

From: Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000

Questionnaire

Question set

Research topic

Number of pages

Questionnaire pack

Data capture form

Diagnosis and treatment

Based on the UK National Head and neck Cancer Audit [8]

1

Baseline, 4-month, 12-month

 

Co-morbidity

Adult co-morbidity assessment 27 (ACE-27) [11]

1

 

Health and Lifestyle

About You

Demographic data, Education, occupation [12], Income [13], EQ5D initially then EQ-5D-5 L [14], Smoking [15, 16], Alcohol [15, 16]

4

Baseline, 4-month, 12-month

Quality of life

Your Outlook

Revised Life Orientation Test (LOT-R) [17]

1

Baseline, 4-month, 12-month

 

Your General Health

EORTC QLQ-C30 [18]

2.5

Baseline, 4-month, 12-month

 

Specific Aspects of Your Health

EORTC QLQ-H&N35 [19]

2

Baseline, 4-month, 12-month

 

Your Feelings

Hospital Anxiety and Depression Scale (HADS) [20]

2

Baseline, 4-month, 12-month

 

Your Diet

Three items (fruit, vegetables and deep fried food) modified from the semi-quantitative Food, Frequency Questionnaire [21]

1

Baseline, 4-month, 12-month

 

You and Cancer

Fears of Recurrence [22]

½

4-month, 12-month

 

Your Personal costs

Designed by the study team

2

4-month , 12-month

Sexual history

Sexual History

Sexual History [23]

1

Baseline

Quality of life

Your symptoms

Head and neck radiotherapy questionnaire (late toxicity) [24]

5

12-months (only people who receive radiotherapy)

Withdrawal form

Withdrawal from study

Questions designed by the study team completed by research nurse

1

As appropriate

Mortality form

Place and mode of death

Questions designed by the study team completed by research nurse

2

As appropriate

Quality of life additional questions used in Bristol participants

Your Quality of Life

The revised University of Washington (UW) QOL questionnaire [25, 26]

2

Baseline, 4-month, 12-month

 

Difficulties in Your Life

The Social Difficulties Inventory (SDI) [27]

2

Baseline, 4-month, 12-month

 

Your Appearance

The Derriford Appearance Scale (DAS 24) [28]

6

Baseline, 4-month, 12-month