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Table 2 Questionnaire documenting lower extremity symptoms of acute and chronic neuropathy experienced during or after oxaliplatin-based chemotherapy.

From: Survey of oxaliplatin-associated neurotoxicity using an interview-based questionnaire in patients with metastatic colorectal cancer

Lower Extremity Symptoms    If you had symptoms during the last cycle....
    How much of the symptoms did you have? Did the symptoms affect your daily activities?
Do you have....    Hardly any → Very much Hardly at all bothered → Extremely bothered
Tingling (pins and needles) Yes No 1 2 3 4 5 1 2 3 4 5
Numbness Yes No 1 2 3 4 5 1 2 3 4 5
Difficulty telling the difference between rough and smooth surfaces Yes No 1 2 3 4 5 1 2 3 4 5
Difficulty feeling hot things Yes No 1 2 3 4 5 1 2 3 4 5
Difficulty feeling cold things Yes No 1 2 3 4 5 1 2 3 4 5
A greater than normal sense of touch (i.e. discomfort with socks) Yes No 1 2 3 4 5 1 2 3 4 5
Burning pain or discomfort without cold Yes No 1 2 3 4 5 1 2 3 4 5
Burning pain or discomfort with cold Yes No 1 2 3 4 5 1 2 3 4 5
Legs feel heavy Yes No 1 2 3 4 5 1 2 3 4 5
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