Description:

NSABP PROTOCOL B-36 Treatment Form for Celecoxib/Placebo NCT00087178 Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C87B7926-0F4F-5A9C-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C87B7926-0F4F-5A9C-E034-0003BA12F5E7

Keywords:

Breast Neoplasms

Uploaded on:

June 3, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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NSABP PROTOCOL B-36 Treatment Form for Celecoxib/Placebo NCT00087178

No Instruction available.

StudyEvent: NSABP PROTOCOL B-36 Treatment Form for Celecoxib/Placebo
1. No Instruction available.

Header

Patient Initials (Last, First Middle)

NSABP Patient ID

Institution Name

Affiliate Name

Person Completing Form (Phone)

Are data amended?

Yes

No

Summary Of Celecoxib/placebo

Treatment Begin Date (0=not begun)

Treatment End Date (0=not begun)

Reason Treatment Ended (Select the reason that best explains why celecoxib/placebo has ended, or why the patient did not begin celecoxib/placebo.)

Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)

Adverse Event/side Effects/complications (Toxicity/Side effects/Complications)

Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)

Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal)

5 more items in the detailed view.

Other (specify)

Ccrr Module For Nsabp Protocol B-36 Treatment Form For Celecoxib/placebo

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