ID

11485

Beskrivning

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

Länk

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

Nyckelord

Versioner (3)
  1. 2012-08-26 2012-08-26 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-07-05 2015-07-05 -
Uppladdad den

5 juli 2015

DOI

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Licens

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

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Header
Beskrivning

Header

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Patient Initials (L, F M)
Beskrivning

Patient Initials

Datatyp

text

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

MainMemberInstitution/AffiliateNumber

Datatyp

text

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

RegisteredInvestigator

Datatyp

text

Group Name (Groups other than SWOG)
Beskrivning

ParticipatingGroupName

Datatyp

text

Study No. (Groups other than SWOG)
Beskrivning

Particip.GroupProtocolNumber

Datatyp

float

Pt. ID (Groups other than SWOG)
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Treatment period
Beskrivning

Treatment period

Treatment Start Date
Beskrivning

TreatmentStartDate

Datatyp

date

Treatment End Date
Beskrivning

TreatmentEndDate

Datatyp

date

Regimen or Procedure or Site(s)
Beskrivning

RegimenorProcedureorSite(s)

Datatyp

text

Off-protocol treatment
Beskrivning

Off-protocol treatment

Off Treatment Reason (select one)
Beskrivning

OffTreatmentReason

Datatyp

text

Patient refused, due to toxicity, specify
Beskrivning

OffTreatmentReason,Toxicity

Datatyp

text

Patient refused, due to toxicity, specify
Beskrivning

OffTreatmentReason,Toxicity

Datatyp

text

Progression or relapse. Sites
Beskrivning

ProgressionSite

Datatyp

text

Other, specify (Off Treatment Date)
Beskrivning

OffTreatmentReason,Other

Datatyp

text

Other, specify (Off Treatment Date)
Beskrivning

OffTreatmentReason,Other

Datatyp

text

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

OffTreatmentDate

Datatyp

date

Further treatment
Beskrivning

Further treatment

Will patient receive further treatment?
Beskrivning

FurtherTreatmentInd

Datatyp

text

Yes, specify
Beskrivning

TreatmentType,Specify

Datatyp

text

Vital status
Beskrivning

Vital status

Date of Last Contact (or death)
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Vital Status
Beskrivning

Patient'sVitalStatus

Datatyp

text

COMMENTS
Beskrivning

COMMENTS

Comments
Beskrivning

Comments

Datatyp

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice
Beskrivning

Ccrr Module For Southwest Oncology Group Off Treatment Notice

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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