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Title

Functional Assessment of Anorexia/Cachexia Treatment Version 4 (FAACT V4)

CDISC ReferenceQuestionnaire Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

FAACT V4

QRS Permission StatusApproveApproved
TeamPancreatic Cancer Standards Team and CDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date20022023-1102-1610
Notes
  • This supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.

...

Revision History

DateVersion
20222023-1102-16101.0 Draft

© 2022 2023 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

...

Although the United States Food and Drug Administration (US FDA) has provided input with regard to this supplement, this input does not constitute US FDA endorsement of any particular instrument.  

2 Copyright Status

David Cella, PhD. owns the copyright for the FAACT V4 instrument and has granted CDISC permission to include this supplement in the CDISC inventory of QRS data standards supplements. Hence, CDISC developed QSTESTCD and QSTEST for each item based on the actual text on the instrument.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with examples, and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

Info
titleInformation for Reviewers

The CRF is attached at the top of the Wiki. When you click the paperclip image, you will find the file for the annotated CRF.

Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at: https://www.cdisc.org/standards/terminology/controlled-terminology.

CDISC has developed this documentation at no cost to the copyright holder or any additional cost to users of the instrument beyond the normal license fees charged by the copyright holder.

CDISC acknowledges Dr. David Cella and FACIT.org, for the approval to include the FAACT V4 in the CDISC data standards.

Reference for the FAACT V4:

These materials discuss and/or include FACIT Measurement System, which is owned exclusively by Dr. David Cella. No part of the FACIT Measurement System may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of Dr. David Cella and payment of any applicable fees. Copyright Dr. David Cella. All rights reserved. Copyright 1987, 1997 David Cella, Ph.D.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with examples, and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

Info
titleInformation for Reviewers

The CRF is attached at the top of the Wiki. When you click the paperclip image, you will find the file for the annotated CRF.

Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at: https://www.cdisc.org/standards/terminology/controlled-terminology.

CDISC has developed this documentation at no cost to the copyright holder or any additional cost to users of the instrument beyond the normal license fees charged by the copyright holder.

CDISC acknowledges Dr. David Cella and FACIT.org, for the approval to include the FAACT V4 in the CDISC data standards.

Reference for the FAACT V4:

  • FACIT.org for more information as well as the scoring guide
  • Copyright 1987, 1997 David Cella, Ph.D.
  • These materials discuss and/or include FACIT Measurement System, which is owned exclusively by Dr. David Cella. No part of the FACIT Measurement System may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of Dr. David Cella and payment of any applicable fees. Copyright Dr. David Cella. All rights reserved.



3 The QS Domain Model

3.1 Assumptions for the QS Domain Model

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Dataset wrap
Nameqs
Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSSCATQSORRESQSSTRESCQSSTRESNQSSTATQSREASNDQSLOBXFLVISITNUMQSDTCQSEVLINT
1STUDYXQS2324-P00011FAC06501FAC065-I Have a Lack of EnergyFAACT V4PHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
2STUDYXQS2324-P00012FAC06502FAC065-I Have NauseaFAACT V4PHYSICAL WELL-BEINGNot at all00

Y12015-05-15-P7D
3STUDYXQS2324-P00013FAC06503FAC065-Trouble Meeting Needs of FamilyFAACT V4PHYSICAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
4STUDYXQS2324-P00014FAC06504FAC065-I Have PainFAACT V4PHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
5STUDYXQS2324-P00015FAC06505FAC065-Botheredby Treatment Side EffectFAACT V4PHYSICAL WELL-BEINGNot at all00

Y12015-05-15-P7D
6STUDYXQS2324-P00016FAC06506FAC065-I Feel IllFAACT V4PHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
7STUDYXQS2324-P00017FAC06507FAC065-I Am Forced to Spend Time in BedFAACT V4PHYSICAL WELL-BEINGA little bit11

Y12015-05-15-P7D
8STUDYXQS2324-P00018FAC06508FAC065-I Feel Close to My FriendsFAACT V4SOCIAL/FAMILY WELL-BEINGQuite a bit33

Y12015-05-15-P7D
9STUDYXQS2324-P00019FAC06509FAC065-Get Emotional Support From FamilyFAACT V4SOCIAL/FAMILY WELL-BEINGQuite a bit33

Y12015-05-15-P7D
10STUDYXQS2324-P000110FAC06510FAC065-I Get Support From FriendsFAACT V4SOCIAL/FAMILY WELL-BEINGSomewhat22

Y12015-05-15-P7D
11STUDYXQS2324-P000111FAC06511FAC065-My Family Has Accepted My IllnessFAACT V4SOCIAL/FAMILY WELL-BEINGQuite a bit33

Y12015-05-15-P7D
12STUDYXQS2324-P000112FAC06512FAC065-Satisfied Communication IllnessFAACT V4SOCIAL/FAMILY WELL-BEINGVery much44

Y12015-05-15-P7D
13STUDYXQS2324-P000113FAC06513FAC065-I Feel Close to My PartnerFAACT V4SOCIAL/FAMILY WELL-BEINGVery much44

Y12015-05-15-P7D
14STUDYXQS2324-P000114FAC06514FAC065-I Am Satisfied With My Sex LifeFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONEPREFER NOT TO ANSWERY12015-05-15-P7D
15STUDYXQS2324-P000115FAC06515FAC065-I Feel SadFAACT V4EMOTIONAL WELL-BEINGA little bit11

Y12015-05-15-P7D
16STUDYXQS2324-P000116FAC06516FAC065-Satisfied With How I Am CopingFAACT V4EMOTIONAL WELL-BEINGQuite a bit33

Y12015-05-15-P7D
17STUDYXQS2324-P000117FAC06517FAC065-Losing Hope Against IllnessFAACT V4EMOTIONAL WELL-BEINGA little bit11

Y12015-05-15-P7D
18STUDYXQS2324-P000118FAC06518FAC065-I Feel NervousFAACT V4EMOTIONAL WELL-BEINGA little bit11

Y12015-05-15-P7D
19STUDYXQS2324-P000119FAC06519FAC065-I Worry About DyingFAACT V4EMOTIONAL WELL-BEINGA little bit11

Y12015-05-15-P7D
20STUDYXQS2324-P000120FAC06520FAC065-Worry My Condition Will Get WorseFAACT V4EMOTIONAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
21STUDYXQS2324-P000121FAC06521FAC065-I Am Able to WorkFAACT V4FUNCTIONAL WELL-BEINGA little bit11

Y12015-05-15-P7D
22STUDYXQS2324-P000122FAC06522FAC065-My Work Is FulfillingFAACT V4FUNCTIONAL WELL-BEINGQuite a bit33

Y12015-05-15-P7D
23STUDYXQS2324-P000123FAC06523FAC065-I Am Able to Enjoy LifeFAACT V4FUNCTIONAL WELL-BEINGQuite a bit33

Y12015-05-15-P7D
24STUDYXQS2324-P000124FAC06524FAC065-I Have Accepted My IllnessFAACT V4FUNCTIONAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
25STUDYXQS2324-P000125FAC06525FAC065-I Am Sleeping WellFAACT V4FUNCTIONAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
26STUDYXQS2324-P000126FAC06526FAC065-Enjoy Things I Usually Do for FunFAACT V4FUNCTIONAL WELL-BEINGSomewhat22

Y12015-05-15-P7D
27STUDYXQS2324-P000127FAC06527FAC065-Content With Quality of My LifeFAACT V4FUNCTIONAL WELL-BEINGQuite a bit33

Y12015-05-15-P7D
28STUDYXQS2324-P000128FAC06528FAC065-I Have a Good AppetiteFAACT V4ADDITIONAL CONCERNSSomewhat22

Y12015-05-15-P7D
29STUDYXQS2324-P000129FAC06529FAC065-Amount I Eat Is SufficientFAACT V4ADDITIONAL CONCERNSNot at all00

Y12015-05-15-P7D
30STUDYXQS2324-P000130FAC06530FAC065-I Am Worried About My WeightFAACT V4ADDITIONAL CONCERNSQuite a bit33

Y12015-05-15-P7D
31STUDYXQS2324-P000131FAC06531FAC065-Most Food Tastes Unpleasant to MeFAACT V4ADDITIONAL CONCERNSQuite a bit33

Y12015-05-15-P7D
32STUDYXQS2324-P000132FAC06532FAC065-I Am Concerned How Thin I LookFAACT V4ADDITIONAL CONCERNSA little bit11

Y12015-05-15-P7D
33STUDYXQS2324-P000133FAC06533FAC065-Interest in Food Drops Try to EatFAACT V4ADDITIONAL CONCERNSQuite a bit33

Y12015-05-15-P7D
34STUDYXQS2324-P000134FAC06534FAC065-Have Difficulty Eating Rich FoodsFAACT V4ADDITIONAL CONCERNSNot at all00

Y12015-05-15-P7D
35STUDYXQS2324-P000135FAC06535FAC065-My Family Pressuring Me to EatFAACT V4ADDITIONAL CONCERNSA little bit11

Y12015-05-15-P7D
36STUDYXQS2324-P000136FAC06536FAC065-I Have Been VomitingFAACT V4ADDITIONAL CONCERNSA little bit11

Y12015-05-15-P7D
37STUDYXQS2324-P000137FAC06537FAC065-I Seem to Get Full QuicklyFAACT V4ADDITIONAL CONCERNSSomewhat22

Y12015-05-15-P7D
38STUDYXQS2324-P000138FAC06538FAC065-I Have Pain in My Stomach AreaFAACT V4ADDITIONAL CONCERNSA  little bit11

Y12015-05-15-P7D
39STUDYXQS2324-P000139FAC06539FAC065-My General Health Is ImprovingFAACT V4ADDITIONAL CONCERNSA little bit11

Y12015-05-15-P7D
40STUDYXQS2324-P000140FAC06540FAC065-Physical Subscale ScoreFAACT V4
222222

Y12015-05-15-P7D
41STUDYXQS2324-P000141FAC06541FAC065-Social/Family Subscale ScoreFAACT V4
222222

Y12015-05-15-P7D
42STUDYXQS2324-P000142FAC06542FAC065-Emotional Subscale ScoreFAACT V4
171717

Y12015-05-15-P7D
43STUDYXQS2324-P000143FAC06543FAC065-Functional Subscale ScoreFAACT V4
161616

Y12015-05-15-P7D
44STUDYXQS2324-P000144FAC06544FAC065-Additional Concern Subscale ScoreFAACT V4
242424

Y12015-05-15-P7D
45STUDYXQS2324-P000145FAC06545FAC065-Trial Outcome Index ScoreFAACT V4
626262

Y12015-05-15-P7D
46STUDYXQS2324-P000146FAC06546FAC065-FACT-G Total ScoreFAACT V4
777777

Y12015-05-15-P7D
47STUDYXQS2324-P000147FAC06547FAC065-Total ScoreFAACT V4
101101101

Y12015-05-15-P7D
48STUDYXQS2324-P000148FAC06501FAC065-I Have a Lack of EnergyFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

49STUDYXQS2324-P000149FAC06502FAC065-I Have NauseaFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

50STUDYXQS2324-P000150FAC06503FAC065-Trouble Meeting Needs of FamilyFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

51STUDYXQS2324-P000151FAC06504FAC065-I Have PainFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

52STUDYXQS2324-P000152FAC06505FAC065-Botheredby Treatment Side EffectFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

53STUDYXQS2324-P000153FAC06506FAC065-I Feel IllFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

54STUDYXQS2324-P000154FAC06507FAC065-I Am Forced to Spend Time in BedFAACT V4PHYSICAL WELL-BEING


NOT DONE

2

55STUDYXQS2324-P000155FAC06508FAC065-I Feel Close to My FriendsFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

56STUDYXQS2324-P000156FAC06509FAC065-Get Emotional Support From FamilyFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

57STUDYXQS2324-P000157FAC06510FAC065-I Get Support From FriendsFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

58STUDYXQS2324-P000158FAC06511FAC065-My Family Has Accepted My IllnessFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

59STUDYXQS2324-P000159FAC06512FAC065-Satisfied Communication IllnessFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

60STUDYXQS2324-P000160FAC06513FAC065-I Feel Close to My PartnerFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

61STUDYXQS2324-P000161FAC06514FAC065-I Am Satisfied With My Sex LifeFAACT V4SOCIAL/FAMILY WELL-BEING


NOT DONE

2

62STUDYXQS2324-P000162FAC06515FAC065-I Feel SadFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

63STUDYXQS2324-P000163FAC06516FAC065-Satisfied With How I Am CopingFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

64STUDYXQS2324-P000164FAC06517FAC065-Losing Hope Against IllnessFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

65STUDYXQS2324-P000165FAC06518FAC065-I Feel NervousFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

66STUDYXQS2324-P000166FAC06519FAC065-I Worry About DyingFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

67STUDYXQS2324-P000167FAC06520FAC065-Worry My Condition Will Get WorseFAACT V4EMOTIONAL WELL-BEING


NOT DONE

2

68STUDYXQS2324-P000168FAC06521FAC065-I Am Able to WorkFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

69STUDYXQS2324-P000169FAC06522FAC065-My Work Is FulfillingFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

70STUDYXQS2324-P000170FAC06523FAC065-I Am Able to Enjoy LifeFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

71STUDYXQS2324-P000171FAC06524FAC065-I Have Accepted My IllnessFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

72STUDYXQS2324-P000172FAC06525FAC065-I Am Sleeping WellFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

73STUDYXQS2324-P000173FAC06526FAC065-Enjoy Things I Usually Do for FunFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

74STUDYXQS2324-P000174FAC06527FAC065-Content With Quality of My LifeFAACT V4FUNCTIONAL WELL-BEING


NOT DONE

2

75STUDYXQS2324-P000175FAC06528FAC065-I Have a Good AppetiteFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

76STUDYXQS2324-P000176FAC06529FAC065-Amount I Eat Is SufficientFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

77STUDYXQS2324-P000177FAC06530FAC065-I Am Worried About My WeightFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

78STUDYXQS2324-P000178FAC06531FAC065-Most Food Tastes Unpleasant to MeFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

79STUDYXQS2324-P000179FAC06532FAC065-I Am Concerned How Thin I LookFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

80STUDYXQS2324-P000180FAC06533FAC065-Interest in Food Drops Try to EatFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

81STUDYXQS2324-P000181FAC06534FAC065-Have Difficulty Eating Rich FoodsFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

82STUDYXQS2324-P000182FAC06535FAC065-My Family Pressuring Me to EatFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

83STUDYXQS2324-P000183FAC06536FAC065-I Have Been VomitingFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

84STUDYXQS2324-P000184FAC06537FAC065-I Seem to Get Full QuicklyFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

85STUDYXQS2324-P000185FAC06538FAC065-I Have Pain in My Stomach AreaFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

86STUDYXQS2324-P000186FAC06539FAC065-My General Health Is ImprovingFAACT V4ADDITIONAL CONCERNS


NOT DONE

2

87STUDYXQS2324-P000187FAC06540FAC065-Physical Subscale ScoreFAACT V4



NOT DONE

2

88STUDYXQS2324-P000188FAC06541FAC065-Social/Family Subscale ScoreFAACT V4



NOT DONE

2

89STUDYXQS2324-P000189FAC06542FAC065-Emotional Subscale ScoreFAACT V4



NOT DONE

2

90STUDYXQS2324-P000190FAC06543FAC065-Functional Subscale ScoreFAACT V4



NOT DONE

2

91STUDYXQS2324-P000191FAC06544FAC065-Additional Concern Subscale ScoreFAACT V4



NOT DONE

2

92STUDYXQS2324-P000192FAC06545FAC065-Trial Outcome Index ScoreFAACT V4



NOT DONE

2

93STUDYXQS2324-P000193FAC06546FAC065-FACT-G Total ScoreFAACT V4



NOT DONE

2

94STUDYXQS2324-P000194FAC06547FAC065-Total ScoreFAACT V4



NOT DONE

2


4 SDTM Mapping Strategy

This section is used for reference regarding the CRF data capture and to understand the alignment of the instrument to the SDTM QS domain. It also provides guidance on how the result variables (QSORRES, QSSTRESC, and QSSTRESN) should be populated.

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