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

Table 3 Questionnaire documenting oral or facial symptoms of acute and chronic neuropathy experienced during or after oxaliplatin-based chemotherapy.

Oral/Facial 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
Jaw pain	Yes	No	1	2	3	4	5	1	2	3	4	5
Eyelids drooping	Yes	No	1	2	3	4	5	1	2	3	4	5
Throat discomfort	Yes	No	1	2	3	4	5	1	2	3	4	5
Ear pain	Yes	No	1	2	3	4	5	1	2	3	4	5
Tingling in mouth	Yes	No	1	2	3	4	5	1	2	3	4	5
Difficulty with speech	Yes	No	1	2	3	4	5	1	2	3	4	5
Burning or discomfort of your eyes	Yes	No	1	2	3	4	5	1	2	3	4	5
Loss of any vision	Yes	No	1	2	3	4	5	1	2	3	4	5
Feeling shock/pain down back	Yes	No	1	2	3	4	5	1	2	3	4	5
Problems with breathing	Yes	No	1	2	3	4	5	1	2	3	4	5

ISSN: 1471-2407