1. 2. 3.

Pain Not at all Slightly Moderately Severely Overwhelmingly Shortness of breath Not at all Slightly Moderately Severely Overwhelmingly Weakness or lack of energy Not at all Slightly Moderately Severely Overwhemingly Nausea (feeling like you are going to be sick) Not at all Slightly Moderately Severely Overwhelmingly Vomiting (being sick) Not at all Slightly Moderately Severely Overwhelmingly Poor appetite Not at all Slightly Moderately Severely Overwhelmingly Constipation Not at all Slightly Moderately Severely Overwhelmingly Sore or dry mouth Not at all Slightly Moderately Severely Overwhelmingly Drowsiness Not at all Slightly Moderately Severely Overwhelmingly Poor Mobility Not at all Slightly Moderately Severely Overwhelmingly Itching Not at all Slightly Moderately Severely Overwhelmingly Difficultly Sleeping Not at all Slightly Moderately Severely Overwhelmingly Restless legs or difficulty keeping legs still Not at all Slightly Moderately Severely Overwhelmingly Changes in Skin Not at all Slightly Moderately Severely Overwhelmingly Diarrhoea Not at all Slightly Moderately Severely Overwhelmingly

1. 2. 3.

Q3. Have you been feeling anxious or worried about your illness or treatment? Not at all Occasionally Sometimes Most of the time Always Q4. Has any of your family or friends been anxious or worried about you? Not at all Occasionally Sometimes Most of the time Always Q5. Have you been feeling depressed? Not at all Occasionally Sometimes Most of the time Always Q6. Have you felt at peace? Always Most of the time Sometimes Occasionally Not at all Q7. Have you been able to share how you are feeling with your family or friends as much as you wanted? Always Occasionally Sometimes Occasionally Not at all Q8. Have you had as much information as you wanted? Always Most of the time Sometimes Occasionally Not at all Q9. Have any practical problems resulting from your illness been addressed? (such as financial or personal) Problems Addressed/ No Problems Problems Mostly Addressed Problems Partly Addressed Problems Hardly Addressed Problems Not Addressed Q10. How much time do you feel has been wasted on appointments relating to your healthcare, e.g.Waiting on transport or repeating tests None at all Up to half a day wasted More than half a day wasted Q11. How did you complete this Questionnaire? On my Own With help from a friend or relative With help from a member of staff