ID

11485

Descripción

SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE NCT00070564 Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Palabras clave

Versiones (3)
  1. 26/8/12 26/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 5/7/15 5/7/15 -
Subido en

5 de julio de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE NCT00070564

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Header
Descripción

Header

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Patient Initials (L, F M)
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution / Affiliate
Descripción

MainMemberInstitution/AffiliateNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Physician (Groups other than SWOG)
Descripción

RegisteredInvestigator

Tipo de datos

text

Group Name (Groups other than SWOG)
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No. (Groups other than SWOG)
Descripción

Particip.GroupProtocolNumber

Tipo de datos

float

Pt. ID (Groups other than SWOG)
Descripción

PatientStudyID,ParticipatingGroup

Tipo de datos

text

Treatment period
Descripción

Treatment period

Treatment Start Date
Descripción

TreatmentStartDate

Tipo de datos

date

Treatment End Date
Descripción

TreatmentEndDate

Tipo de datos

date

Regimen or Procedure or Site(s)
Descripción

RegimenorProcedureorSite(s)

Tipo de datos

text

Off-protocol treatment
Descripción

Off-protocol treatment

Off Treatment Reason (select one)
Descripción

OffTreatmentReason

Tipo de datos

text

Patient refused, due to toxicity, specify
Descripción

OffTreatmentReason,Toxicity

Tipo de datos

text

Patient refused, due to toxicity, specify
Descripción

OffTreatmentReason,Toxicity

Tipo de datos

text

Progression or relapse. Sites
Descripción

ProgressionSite

Tipo de datos

text

Other, specify (Off Treatment Date)
Descripción

OffTreatmentReason,Other

Tipo de datos

text

Other, specify (Off Treatment Date)
Descripción

OffTreatmentReason,Other

Tipo de datos

text

Date of completion, progression, death or decision to discontinue therapy
Descripción

OffTreatmentDate

Tipo de datos

date

Further treatment
Descripción

Further treatment

Will patient receive further treatment?
Descripción

FurtherTreatmentInd

Tipo de datos

text

Yes, specify
Descripción

TreatmentType,Specify

Tipo de datos

text

Vital status
Descripción

Vital status

Date of Last Contact (or death)
Descripción

DeathDate/LastContactDate

Tipo de datos

date

Vital Status
Descripción

Patient'sVitalStatus

Tipo de datos

text

COMMENTS
Descripción

COMMENTS

Comments
Descripción

Comments

Tipo de datos

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice
Descripción

Ccrr Module For Southwest Oncology Group Off Treatment Notice

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
MainMemberInstitution/AffiliateNumber
Item
Institution / Affiliate
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name (Groups other than SWOG)
text
Particip.GroupProtocolNumber
Item
Study No. (Groups other than SWOG)
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Groups other than SWOG)
text
Item Group
Treatment period
TreatmentStartDate
Item
Treatment Start Date
date
TreatmentEndDate
Item
Treatment End Date
date
RegimenorProcedureorSite(s)
Item
Regimen or Procedure or Site(s)
text
Item Group
Off-protocol treatment
Item
Off Treatment Reason (select one)
text
CL.1
Code List
Off Treatment Reason (select one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Medically required, due to toxicity, specify (Medically required, due to toxicity, specify)
CL Item
Patient refused, due to toxicity, specify (Patient refused, due to toxicity, specify)
CL Item
Patient refused, other than toxicity, specify (Patient refused, other than toxicity, specify)
CL Item
Progression or relapse. Sites (Progression or relapse. Sites)
CL Item
Death (Death)
CL Item
Other, Specify (Other, specify)
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
ProgressionSite
Item
Progression or relapse. Sites
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentDate
Item
Date of completion, progression, death or decision to discontinue therapy
date
Item Group
Further treatment
Item
Will patient receive further treatment?
text
CL.2
Code List
Will patient receive further treatment?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TreatmentType,Specify
Item
Yes, specify
text
Item Group
Vital status
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
CL.3
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
COMMENTS
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Off Treatment Notice
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