Select the language
Number of Chemotherapy Agents
How is your hearing (with a hearing aid, if needed)?
Number of falls in the past 6 months
Can you take your own medicines?
Does your health limit you in walking one block?
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
Select Serum Creatinine
* Dose delivered with first dose for chemotherapy