ID
10616
Beschrijving
CALGB: 49903 ADVANCED FOLLOW-UP FORM NCT00053339 Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D2007-5070-476F-E034-0003BA0B1A09
Link
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Versies (3)
- 26-08-12 26-08-12 -
- 22-05-15 22-05-15 -
- 03-06-15 03-06-15 -
Geüploaded op
3 juni 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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CALGB: 49903 ADVANCED FOLLOW-UP FORM NCT00053339
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschrijving
Patient clinical trial data
Beschrijving
Patient'sName
Datatype
text
Beschrijving
ParticipatingGroup
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
PatientHospitalNumber
Datatype
text
Beschrijving
ParticipatingGroupProtocolNo.
Datatype
text
Beschrijving
AffiliateName
Datatype
text
Beschrijving
ParticipatingGroupPatientID
Datatype
text
Beschrijving
Cancer follow up
Beschrijving
Patient'sVitalStatus
Datatype
text
Beschrijving
DeathReason
Datatype
text
Beschrijving
DeathDate/LastContactDate
Datatype
date
Beschrijving
CancerFollow-upStatusInd
Datatype
text
Beschrijving
CancerFollow-upStatusDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
OverallTumorResponse
Datatype
text
Beschrijving
ResponseDurationBeginDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS 2011AA ObjectClass
- C0871261
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
Beschrijving
ProgressionInd
Datatype
text
Beschrijving
ProgressionDate
Datatype
date
Beschrijving
Non-protocol Therapy
Beschrijving
Non-ProtocolTherapyInd
Datatype
text
Beschrijving
Non-ProtocolHormonalTherapyInd
Datatype
text
Beschrijving
OtherNon-ProtocolTherapyName
Datatype
text
Beschrijving
Non-ProtocolTherapyDate,First
Datatype
date
Beschrijving
AgentEndDate
Datatype
date
Beschrijving
Comments
Datatype
text
Beschrijving
PersonCompletingForm,FirstName
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
FormCompletionDate,Original
Datatype
date
Beschrijving
Ccrr Module For Calgb: 49903 Advanced Follow-up Form
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0677946 (UMLS 2011AA)
C0871261 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)