APPENDIX C INDEX OF CO-MORBIDITY Patient's Name: Physician: I. Please indicate the extent to which conditions of these systems may have contributed to or hastened the patient's death. Very Much A Little Not At All Central Nervous Cardiovascular Pulmonary Hemotopoietic Kidneys Gastrointestinal Endocrine Musculo-skeletal Genital II. Please indicate the extent to which conditions of these systems may have negatively influenced the effectiveness of treatment for the cancer. Very Much A Little Not At All Central Nervous Cardiovascular Pulmonary Hemotopoietic Kidneys Gastrointestinal Endocrine Musculo-skeletal Genital