ID

43187

Beskrivning

SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM 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=BACD42B3-A5E1-6833-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BACD42B3-A5E1-6833-E034-0003BA12F5E7

Nyckelord

Versioner (3)
  1. 2012-08-26 2012-08-26 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2021-09-20 2021-09-20 -
Uppladdad den

20 september 2021

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00070564 Follow-Up - SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM - 2101304v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM
    1. No Instruction available.
Header
Beskrivning

Header

SWOG Patient ID
Beskrivning

Trial subject ID SWOG

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
SWOG Study No.
Beskrivning

Protocol ID SWOG

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
Registration Step
Beskrivning

Registration Number

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Institution/Affiliate
Beskrivning

Institution Name

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Physician
Beskrivning

Investigator Name

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2826892
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus ObjectClass-2
C25644
Participating Group Name
Beskrivning

ParticipatingGroupName

Datatyp

text

Participating Group Protocol Number
Beskrivning

ParticipatingGroupProtocolNumber

Datatyp

float

Participating Group Patient ID
Beskrivning

Trial subject ID Participating Group

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Header
Beskrivning

Header

Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
Beskrivning

HasthepatientbeendiagnosedwithcontralateralinsitubreastcancersincethesubmissionofthelastFollow-upForm?

Datatyp

boolean

Date of diagnosis
Beskrivning

NewCancerDiagnosisDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Has the patient been diagnosed with first local-regional recurrence since submission of last follow-up form?
Beskrivning

Neoplasm Recurrence, locoregional

Datatyp

boolean

Alias
NCI Thesaurus ObjectClass
C19987
UMLS CUI-1
C0027643
NCI Thesaurus Property
C25388
NCI Thesaurus Property-2
C25509
NCI Thesaurus Property-3
C15220
NCI Thesaurus ValueDomain
C38148
Date of First Local-Regional Progression
Beskrivning

ProgressionDate,FirstLocal-Regional

Datatyp

date

Site(s) of First Local-Regional Progression (select all that apply)
Beskrivning

ProgressionSite(s),FirstLocal-Regional

Datatyp

text

How was this progression information obtained?
Beskrivning

ProgressionAssessmentSource

Datatyp

text

How was this progression information obtained?
Beskrivning

ProgressionAssessmentSource

Datatyp

text

Has the patient been diagnosed with first distant recurrence/progression since submission of last follow-up form?
Beskrivning

FirstProgressionDistantPresentInd-3

Datatyp

boolean

Alias
NCI Thesaurus ObjectClass
C19987
UMLS 2011AA ObjectClass
C0242656
NCI Thesaurus Property
C25321
UMLS 2011AA Property
C0443203
NCI Thesaurus Property-2
C25509
UMLS 2011AA Property-2
C1279901
NCI Thesaurus Property-3
C15220
UMLS 2011AA Property-3
C0011900
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Date of First Distant Progression
Beskrivning

ProgressionDate,FirstDistant

Datatyp

date

Site(s) of First Distant Progression
Beskrivning

ProgressionSite,FirstDistant

Datatyp

text

Other, NOS (site of first distant progression
Beskrivning

Other,NOS(siteoffirstdistantprogression

Datatyp

text

Comments
Beskrivning

Comments

Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Header
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Investigator Name
Item
Physician
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
ParticipatingGroupName
Item
Participating Group Name
text
ParticipatingGroupProtocolNumber
Item
Participating Group Protocol Number
float
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
HasthepatientbeendiagnosedwithcontralateralinsitubreastcancersincethesubmissionofthelastFollow-upForm?
Item
Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
boolean
NewCancerDiagnosisDate
Item
Date of diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Neoplasm Recurrence, locoregional
Item
Has the patient been diagnosed with first local-regional recurrence since submission of last follow-up form?
boolean
C19987 (NCI Thesaurus ObjectClass)
C0027643 (UMLS CUI-1)
C25388 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C15220 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
ProgressionDate,FirstLocal-Regional
Item
Date of First Local-Regional Progression
date
Item
Site(s) of First Local-Regional Progression (select all that apply)
text
CL.3
Code List
Site(s) of First Local-Regional Progression (select all that apply)
CL Item
Ipsilateral Breast (Ipsilateral Breast)
CL Item
Axillary Breast (Axillary Breast)
CL Item
Supraclavicular nodes (Supraclavicular nodes)
CL Item
Chest wall (Chest wall)
CL Item
Internal mammary nodes (Internal mammary nodes)
CL Item
Infraclavicular nodes (Infraclavicular nodes)
CL Item
Axilla (Axilla)
Item
How was this progression information obtained?
text
CL.7
Code List
How was this progression information obtained?
CL Item
Clinical Assessment (Clinical assessment)
CL Item
Patient Self Report Only (Patient self-report only)
Item
How was this progression information obtained?
text
CL.7
Code List
How was this progression information obtained?
CL Item
Clinical Assessment (Clinical assessment)
CL Item
Patient Self Report Only (Patient self-report only)
FirstProgressionDistantPresentInd-3
Item
Has the patient been diagnosed with first distant recurrence/progression since submission of last follow-up form?
boolean
C19987 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
C25321 (NCI Thesaurus Property)
C0443203 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property-2)
C15220 (NCI Thesaurus Property-3)
C0011900 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
ProgressionDate,FirstDistant
Item
Date of First Distant Progression
date
Item
Site(s) of First Distant Progression
text
CL.6
Code List
Site(s) of First Distant Progression
CL Item
Bone (bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Central Nervous System (braine)
C12438 (NCI Thesaurus)
C3714787 (UMLS 2011AA)
CL Item
Central Nervous System (other CNS)
C12438 (NCI Thesaurus)
C3714787 (UMLS 2011AA)
CL Item
Liver (liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Lymph Nodes (distant) (nodes)
CL Item
Specify Other Location Not Described (other soft tissue)
CL Item
Lung (lung/pleura)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Skin (skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Specify Other Location Not Described (other visceral)
CL Item
Other, Generalized, Nos, Carcinomatosis (other, NOS)
Other,NOS(siteoffirstdistantprogression
Item
Other, NOS (site of first distant progression
text
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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