ID

43195

Descrizione

CALGB COOPERATIVE GROUP ADJUVANT BREAST CANCER RANDOMIZATION NCT00016276 Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8542-227A-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8542-227A-E034-080020C9C0E0

Keywords

  1. 26/08/12 26/08/12 -
  2. 22/05/15 22/05/15 -
  3. 03/06/15 03/06/15 -
  4. 20/09/21 20/09/21 -
Caricato su

20 settembre 2021

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy

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CALGB COOPERATIVE GROUP ADJUVANT BREAST CANCER RANDOMIZATION NCT00016276

No Instruction available.

  1. StudyEvent: CALGB COOPERATIVE GROUP ADJUVANT BREAST CANCER RANDOMIZATION
    1. No Instruction available.
CALGB Information
Descrizione

CALGB Information

CALGB Patient Number
Descrizione

CALGBPatientNumber

Tipo di dati

text

Participating Group Code Patient No.
Descrizione

ParticipatingGroupCodePatientNo.

Tipo di dati

text

Patient Medical Record No.
Descrizione

PatientMedicalRecordNo.

Tipo di dati

text

Participating Group Code
Descrizione

ParticipatingGroupCode

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Main Member Institution/Affiliate
Descrizione

MainMemberInstitution/Affiliate

Tipo di dati

text

Physician of Record
Descrizione

RegisteredInvestigator

Tipo di dati

text

FAX
Descrizione

FAX

Tipo di dati

text

Phone
Descrizione

Phone

Tipo di dati

text

Protocol Administration
Descrizione

Protocol Administration

IRB/REB Approval Date
Descrizione

IRB/REBApprovalDate

Tipo di dati

text

Person Completing Form, Last Name
Descrizione

PersonCompletingForm,LastName

Tipo di dati

text

Consent Form Date
Descrizione

ConsentFormDate

Tipo di dati

text

Person Completing Form, first Name
Descrizione

PersonCompletingForm,FirstName

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Projected Start Date
Descrizione

ProjectedStartDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25431
UMLS 2011AA ValueDomain
C0439659
NCI Thesaurus ValueDomain
C25631
Person Phone
Descrizione

PersonPhone

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25395
UMLS 2011AA Property
C0039457
Person Fax
Descrizione

PersonFax

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25210
UMLS 2011AA Property
C0085205
Date of Registration
Descrizione

RegistrationDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Registrar
Descrizione

Registrar

Tipo di dati

text

Patient Demographics / Pre U Treatment Characteristics
Descrizione

Patient Demographics / Pre U Treatment Characteristics

Patient Name (l,f,m.i.)
Descrizione

PatientName

Tipo di dati

text

Social Security Number (USA Only)
Descrizione

PatientSocialSecurityNumber

Tipo di dati

double

Patient Race/ Ethnicity
Descrizione

PatientRace/Ethnicity

Tipo di dati

text

Sex
Descrizione

Sex

Tipo di dati

text

Birthdate
Descrizione

Birthdate

Tipo di dati

text

Method of Payment
Descrizione

MethodofPayment

Tipo di dati

text

Zip Code
Descrizione

ZipCode

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Performance Status
Descrizione

PerformanceStatus

Tipo di dati

text

Pt Height (cm)
Descrizione

PtHeight

Tipo di dati

text

Pt Weight (kg)
Descrizione

PtWeight

Tipo di dati

text

BSA (m2)
Descrizione

BSA

Tipo di dati

text

Patient Eligible?
Descrizione

PatientEligible?

Tipo di dati

text

Name of medical oncologist
Descrizione

Nameofmedicaloncologist

Tipo di dati

text

Name of RT oncologist
Descrizione

NameofRToncologist

Tipo di dati

text

RN Coordinator
Descrizione

RNCoordinator

Tipo di dati

text

Surgeon
Descrizione

Surgeon

Tipo di dati

text

Stratification Factors
Descrizione

Stratification Factors

Disease Type
Descrizione

DiseaseType

Tipo di dati

text

ASSIGNED TREATMENT ARM
Descrizione

ProtocolTreatmentArmAssignmentText

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass
C42651
UMLS 2011AA ObjectClass
C0442711
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C25426
UMLS 2011AA Property
C1516050
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Patient?s initial consent given for specimen use for research on the patient?s cancer?
Descrizione

Patient?sinitialconsentgivenforspecimenuseforresearchonthepatient?scancer?

Tipo di dati

text

Patient?s initial consent given for specimen use for research unrelated to the patient?s cancer?
Descrizione

Patient?sinitialconsentgivenforspecimenuseforresearchunrelatedtothepatient?scancer?

Tipo di dati

text

Patient?s initial consent given for further contact regarding specimen?
Descrizione

Patient'sinitialconsentgivenforfurthercontactregardingspecimen?

Tipo di dati

text

Similar models

No Instruction available.

  1. StudyEvent: CALGB COOPERATIVE GROUP ADJUVANT BREAST CANCER RANDOMIZATION
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
CALGB Information
CALGBPatientNumber
Item
CALGB Patient Number
text
ParticipatingGroupCodePatientNo.
Item
Participating Group Code Patient No.
text
PatientMedicalRecordNo.
Item
Patient Medical Record No.
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
MainMemberInstitution/Affiliate
Item
Main Member Institution/Affiliate
text
RegisteredInvestigator
Item
Physician of Record
text
FAX
Item
FAX
text
Phone
Item
Phone
text
Item Group
Protocol Administration
IRB/REBApprovalDate
Item
IRB/REB Approval Date
text
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
ConsentFormDate
Item
Consent Form Date
text
PersonCompletingForm,FirstName
Item
Person Completing Form, first Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProjectedStartDate
Item
Projected Start Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
C25631 (NCI Thesaurus ValueDomain)
PersonPhone
Item
Person Phone
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
PersonFax
Item
Person Fax
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)
RegistrationDate
Item
Date of Registration
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Registrar
Item
Registrar
text
Item Group
Patient Demographics / Pre U Treatment Characteristics
PatientName
Item
Patient Name (l,f,m.i.)
text
PatientSocialSecurityNumber
Item
Social Security Number (USA Only)
double
Item
Patient Race/ Ethnicity
text
Code List
Patient Race/ Ethnicity
CL Item
White (White)
CL Item
Hispanic (Hispanic)
CL Item
Black (Black)
CL Item
Oriental (Oriental)
CL Item
Native Hawaiian (Native Hawaiian)
CL Item
Native American (Native American)
CL Item
Indian (Indian)
CL Item
Filipino (Filipino)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Patient Refusal (Patient refusal)
CL Item
Institution Refusal (Institution refusal)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Sex
text
Code List
Sex
CL Item
Male (M)
C20197 (NCI Thesaurus)
C0086582 (UMLS 2011AA)
CL Item
Female (F)
C16576 (NCI Thesaurus)
C0086287 (UMLS 2011AA)
Birthdate
Item
Birthdate
text
Item
Method of Payment
text
Code List
Method of Payment
CL Item
Private Insurance (Private Insurance)
CL Item
Medicare And Private Insurance (Medicare and Private Insurance)
CL Item
Medicaid (Medicaid)
C0025071 (NCI Metathesaurus)
CL Item
Medicaid And Medicare (Medicaid and Medicare)
CL Item
Millitary Or Veterans Administration (Millitary or Veterans Administration)
CL Item
Self Pay (Self Pay)
CL Item
No Means Of Payment (No means of payment)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Zip Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Code List
Zip Code
CL Item
(usa Only) ((USA Only))
Item
Performance Status
text
Code List
Performance Status
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction, (Fully active, able to carry on all pre-disease performance without restriction,)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory, (Restricted in physically strenuous activity but ambulatory,)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities, (Ambulatory and capable of all selfcare but unable to carry out any work activities,)
CL Item
Capable Of Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours, (Capable of limited selfcare, confined to bed or chair more than 50% of waking hours,)
CL Item
Completely Disabled (Completely disabled)
PtHeight
Item
Pt Height (cm)
text
PtWeight
Item
Pt Weight (kg)
text
BSA
Item
BSA (m2)
text
Item
Patient Eligible?
text
Code List
Patient Eligible?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, All Requirements Confirmed (Yes, all requirements confirmed)
Nameofmedicaloncologist
Item
Name of medical oncologist
text
NameofRToncologist
Item
Name of RT oncologist
text
RNCoordinator
Item
RN Coordinator
text
Surgeon
Item
Surgeon
text
Item Group
Stratification Factors
Item
Disease Type
text
Code List
Disease Type
CL Item
Inflammatory (Inflammatory)
C25535 (NCI Thesaurus)
C0333348 (UMLS 2011AA)
CL Item
Noninflammatory, Inoperable Stage Iii/regional Stage Iv (Noninflammatory, inoperable Stage III/regional Stage IV)
CL Item
Operable Stage Iii (Operable Stage III)
ProtocolTreatmentArmAssignmentText
Item
ASSIGNED TREATMENT ARM
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C25426 (NCI Thesaurus Property)
C1516050 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
Patient?s initial consent given for specimen use for research on the patient?s cancer?
text
Code List
Patient?s initial consent given for specimen use for research on the patient?s cancer?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Patient?s initial consent given for specimen use for research unrelated to the patient?s cancer?
text
Code List
Patient?s initial consent given for specimen use for research unrelated to the patient?s cancer?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Patient?s initial consent given for further contact regarding specimen?
text
Code List
Patient?s initial consent given for further contact regarding specimen?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

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