Brain and Central Nervous System Tumors NCT00890747 Off Treatment - AMC-061 Off Protocol Treatment Summary Form (F05) - 2934968v1.0 - Portale di modelli di dati medici (MDM-Portal)

ID

730

Descrizione

AMC-061 Off Protocol Treatment Summary Form (F05) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F855-68F0-E040-BB89AD4358A1

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F855-68F0-E040-BB89AD4358A1

Keywords

C71.9

D016543

26/08/12 26/08/12 -
08/01/15 08/01/15 - Martin Dugas

Caricato su

26 agosto 2012

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy

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Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

1 moduli

StudyEvent: AMC-061 Off Protocol Treatment Summary Form (F05)
1. Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

Name

genere

Description | Question | Decode (Coded Value)

Tipo di dati

Alias

Off-Protocol Treatment Summary

Item Group

Ccrr Module For Off Protocol Treatment Summary - Rf05b

TreatmentEndDate

Item

Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property)
C2746065 (UMLS 2011AA Property)

Off-treatmentReason

Item

Reason Treatment Ended (select the primary reason)

text

C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.1

Code List

Reason Treatment Ended (select the primary reason)

CL Item

Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)

CL Item

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

CL Item

Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)

CL Item

Death On Study (Death on study)

CL Item

Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal/refusal after beginning protocol therapy)

CL Item

Patient Withdrawal Or Refusal Before Beginning Protocol Therapy (Patient withdrawal/refusal prior to beginning protocol therapy)

CL Item

Alternative Therapy (Alternative therapy)

CL Item

Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)

CL Item

Lost To Follow-up (Lost to follow-up)

CL310949 (NCI Metathesaurus)

CL Item

Cytogenetic Resistance (Cytogenetic Resistance)

CL Item

Disease Progression Before Active Treatment (Disease Progression before active treatment)

CL Item

No Treatment, Per Protocol Criteria (No treatment, per protocol criteria)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

Off-treatmentReasonSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

ResearchCommentsText

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

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Brain and Central Nervous System Tumors NCT00890747 Off Treatment - AMC-061 Off Protocol Treatment Summary Form (F05) - 2934968v1.0

Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

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Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

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