Low-Dose Chemotherapy with Insulin (Insulin Potentiation Therapy) in Combination with Hormone Therapy for Treatment of Castration-Resistant Prostate Cancer
Table 4
Beretta Self-Compilation Questionnaire.
Self-Compilation Questionnaire for weekly determination of subjective status
The patient should cross the circle corresponding to the worst feeling in the week
Subjective factors
Coding definition
0
1
2
3
4
No
Little
Enough
Much
Very Much
Section A
(1) Feeling ill
○
○
○
○
○
(2) Feeling bad
○
○
○
○
○
(3) Feeling anxious
○
○
○
○
○
(4) Feeling depressed
○
○
○
○
○
(5) Presence of nausea
○
○
○
○
○
(6) Losing appetite
○
○
○
○
○
(7) Reduced working capacity (usual job)
○
○
○
○
○
(8) Reduced housework and concentration capacity
○
○
○
○
○
(9) Reduced social activities
○
○
○
○
○
(10) Reduced sexual activity
○
○
○
○
○
Section B
(11) Presence of fatigue
○
○
○
○
○
(12) Presence of respiratory distress
○
○
○
○
○
(13) Presence of pain
○
○
○
○
○
Section C
(14) Is treatment helping?
○
○
○
○
○
(15) Is doctor helping?
○
○
○
○
○
(16) Is nursing staff helping?
○
○
○
○
○
(17) Is hospital centre helping?
○
○
○
○
○
(18) Is family helping?
○
○
○
○
○
(19) Is social “milieu” helping?
○
○
○
○
○
(20) Is any other person/service/institution helping?
