ID

10623

Descrizione

CALGB: 49808 RADIOTHERAPY REPORT FORM NCT00016276 Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8724-227A-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8724-227A-E034-080020C9C0E0

Keywords

versioni (3)
  1. 26/08/12 26/08/12 -
  2. 22/05/15 22/05/15 -
  3. 03/06/15 03/06/15 -
Caricato su

3 giugno 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
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CALGB: 49808 RADIOTHERAPY REPORT FORM NCT00016276

Inglese

No Instruction available.

1 moduli  
  1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
    1. No Instruction available.
CALGB clinical trial administrative data
Descrizione

CALGB clinical trial administrative data

CALGB Form
Descrizione

CALGBForm

Tipo di dati

text

CALGB Study No
Descrizione

CALGBProtocolNumber

Tipo di dati

text

CALGB Patient ID
Descrizione

CALGBPatientID

Tipo di dati

text

From
Descrizione

From

Tipo di dati

text

To (Date of last contact or death)
Descrizione

To

Tipo di dati

text

Amended data?
Descrizione

AmendedDataInd

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Patient clinical trial data
Descrizione

Patient clinical trial data

Patient's Name
Descrizione

Patient'sName

Tipo di dati

text

Participating Group
Descrizione

ParticipatingGroup

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Descrizione

PatientHospitalNumber

Tipo di dati

text

Participating Group Protocol No.
Descrizione

ParticipatingGroupProtocolNo.

Tipo di dati

text

Main Member Institution/Adjunct
Descrizione

MainMemberInstitution/Adjunct

Tipo di dati

text

Participating Group Patient No.
Descrizione

ParticipatingGroupPatientNo.

Tipo di dati

text

Radiation Treatment
Descrizione

Radiation Treatment

Has the patient received radiation therapy?
Descrizione

Hasthepatientreceivedradiationtherapy?

Tipo di dati

text

If No, reason
Descrizione

IfNo,reason

Tipo di dati

text

Date radiation therapy ended
Descrizione

Dateradiationtherapyended

Tipo di dati

text

What was the total number of days the patient was treated with radiation?
Descrizione

Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?

Tipo di dati

text

Was there a break in radiation treatment due to toxicity?
Descrizione

Wasthereabreakinradiationtreatmentduetotoxicity?

Tipo di dati

text

If Yes, reason
Descrizione

IfYes,reason

Tipo di dati

text

Date of last radiation therapy prior to break
Descrizione

Dateoflastradiationtherapypriortobreak

Tipo di dati

text

Date of first radiation therapy after break
Descrizione

Dateoffirstradiationtherapyafterbreak

Tipo di dati

text

Fields of radiation therapy (mark all that apply with an X)
Descrizione

Fieldsofradiationtherapy

Tipo di dati

text

Fields of radiation therapy Other, specify
Descrizione

FieldsofradiationtherapyOther,specify

Tipo di dati

text

Did patient begin taking tamoxifen during this reporting period?
Descrizione

Didpatientbegintakingtamoxifenduringthisreportingperiod?

Tipo di dati

text

If Yes, date tamoxifen started
Descrizione

IfYes,datetamoxifenstarted

Tipo di dati

text

Comments
Descrizione

Comments

Comments
Descrizione

Comments

Tipo di dati

text

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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
CALGB clinical trial administrative data
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
From
Item
From
text
To
Item
To (Date of last contact or death)
text
Item
Amended data?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Patient clinical trial data
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
Item Group
Radiation Treatment
Item
Has the patient received radiation therapy?
text
CL.2
Code List
Has the patient received radiation therapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
IfNo,reason
Item
If No, reason
text
Dateradiationtherapyended
Item
Date radiation therapy ended
text
Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?
Item
What was the total number of days the patient was treated with radiation?
text
Item
Was there a break in radiation treatment due to toxicity?
text
CL.3
Code List
Was there a break in radiation treatment due to toxicity?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
IfYes,reason
Item
If Yes, reason
text
Dateoflastradiationtherapypriortobreak
Item
Date of last radiation therapy prior to break
text
Dateoffirstradiationtherapyafterbreak
Item
Date of first radiation therapy after break
text
Item
Fields of radiation therapy (mark all that apply with an X)
text
CL.4
Code List
Fields of radiation therapy (mark all that apply with an X)
CL Item
Ipsilateral Breast (Ipsilateral breast)
CL Item
Supraclavicular Field (Supraclavicular field)
CL Item
Axillary Fields (Axillary fields)
CL Item
Internal Mammary Fields (Internal mammary fields)
CL Item
Ipsilateral Chest Wall (Ipsilateral chest wall)
CL Item
Other, Specify: (Other, specify)
FieldsofradiationtherapyOther,specify
Item
Fields of radiation therapy Other, specify
text
Item
Did patient begin taking tamoxifen during this reporting period?
text
CL.5
Code List
Did patient begin taking tamoxifen during this reporting period?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
IfYes,datetamoxifenstarted
Item
If Yes, date tamoxifen started
text
Item Group
Comments
Comments
Item
Comments
text
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