ID

10623

Beschrijving

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

Link

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

Trefwoorden

Versies (3)
  1. 26-08-12 26-08-12 -
  2. 22-05-15 22-05-15 -
  3. 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: 49808 RADIOTHERAPY REPORT FORM NCT00016276

Engels

No Instruction available.

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

CALGB clinical trial administrative data

CALGB Form
Beschrijving

CALGBForm

Datatype

text

CALGB Study No
Beschrijving

CALGBProtocolNumber

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

From
Beschrijving

From

Datatype

text

To (Date of last contact or death)
Beschrijving

To

Datatype

text

Amended data?
Beschrijving

AmendedDataInd

Datatype

text

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

Patient clinical trial data

Patient's Name
Beschrijving

Patient'sName

Datatype

text

Participating Group
Beschrijving

ParticipatingGroup

Datatype

text

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

PatientHospitalNumber

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Main Member Institution/Adjunct
Beschrijving

MainMemberInstitution/Adjunct

Datatype

text

Participating Group Patient No.
Beschrijving

ParticipatingGroupPatientNo.

Datatype

text

Radiation Treatment
Beschrijving

Radiation Treatment

Has the patient received radiation therapy?
Beschrijving

Hasthepatientreceivedradiationtherapy?

Datatype

text

If No, reason
Beschrijving

IfNo,reason

Datatype

text

Date radiation therapy ended
Beschrijving

Dateradiationtherapyended

Datatype

text

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

Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?

Datatype

text

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

Wasthereabreakinradiationtreatmentduetotoxicity?

Datatype

text

If Yes, reason
Beschrijving

IfYes,reason

Datatype

text

Date of last radiation therapy prior to break
Beschrijving

Dateoflastradiationtherapypriortobreak

Datatype

text

Date of first radiation therapy after break
Beschrijving

Dateoffirstradiationtherapyafterbreak

Datatype

text

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

Fieldsofradiationtherapy

Datatype

text

Fields of radiation therapy Other, specify
Beschrijving

FieldsofradiationtherapyOther,specify

Datatype

text

Did patient begin taking tamoxifen during this reporting period?
Beschrijving

Didpatientbegintakingtamoxifenduringthisreportingperiod?

Datatype

text

If Yes, date tamoxifen started
Beschrijving

IfYes,datetamoxifenstarted

Datatype

text

Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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