Skip to main content

Table 3 Self-report of adverse events 2

From: Study protocol of a single-arm phase 2 study evaluating the preventive effect of topical hydrocortisone for capecitabine-induced hand-foot syndrome in colorectal cancer patients receiving adjuvant chemotherapy with capecitabine plus oxaliplatin (T-CRACC study)

Side effect self-report 2         
Name         
Date         
  Grade / / / / / / /
Nausea         
Tolerable 1        
If I use anti-nausea drugs, I can manage to eat 2        
I can hardly eat because of nausea 3        
Anorexia         
I have a slight loss of appetite 1        
I can eat somehow 2        
I can hardly eat 3        
Malaise         
I am a little tired, but it does not interfere with my daily life 1        
I often lie down 2        
I lie down more often than I am awake 3        
Bedridden all day long 4        
Diarrhea         
Increased defecation frequency less than 4 times a day compared to usual 1        
Increased defecation frequency 4–6 times a day compared to usual 2        
Increased defecation frequency more than 7 times a day compared to usual 3        
If you have any other symptoms of concern, please write them down