ID

11960

Description

SOUTHWEST ONCOLOGY GROUP S0307 PRESTUDY FORM Zoledronate, Clodronate, or Ibandronate in Treating Women Who Have Undergone Surgery for Stage I, Stage II, or Stage III Breast SOUTHWEST ONCOLOGY GROUP S0307 PRESTUDY FORM Zoledronate, Clodronate, or Ibandronate in Treating Women Who Have Undergone Surgery for Stage I, Stage II, or Stage III Breast Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DEA0B902-CDD3-54E6-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DEA0B902-CDD3-54E6-E034-0003BA12F5E7

Keywords

  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 8/26/15 8/26/15 - Martin Dugas
Uploaded on

August 26, 2015

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0 Legacy

Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Pre-Study Breast Cancer SWOG S0307 NCT00127205

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0307 PRESTUDY FORM
    1. No Instruction available.
Administrative documentation
Disease Description
Performance Status
Histologically confirmed primary invasive adenocarcinoma of the breast
Laboratory Values
mg/dL
mg/dL
Previous bisphosphonate
Bone Pain
Bone Metastasis
Consent For Submission And Banking
Consent for submission and banking
Patient Characteristics
Menopausal status (select one:)
cm
kg
Disease Description
Tumor Laterality (select one:)
cm
ER Status
PgR Status
Was HER-2/neu status determined?
If Yes, HER2/neu final diagnosis
Treatment With Statins
Is the patient currently taking a statin (atorvastatin Lipitor, pravastatin Pravachol, simvastatin Zocor, lovastatin Mevacor, fluvastatin Lescol, rosuvastatin Crestor?)
Length of time on statin
Patient Preference
If oral and intravenous bisphosphonates are equally effective in preventing breast cancer recurrence in the bone, which would the patient prefer to receive? (Note that the answer to this question will not in any way affect which treatment the patient is randomly assigned to on this study.)
Prior Treatment Related To This Cancer
Most Extensive Primary Surgery (select one:)
Was sentinel node sampling performed?
Sentinel Node Biopsy Results
Was axillary dissection performed?
Systemic Treatment For This Cancer
Chemotherapy (select one:)
Hormone therapy (select one:)
If currently receiving

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial