Description:

CALGB: 40101 ON-STUDY FORM Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E097B4-CDDD-18B4-E034-080020C9C0E0

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https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E097B4-CDDD-18B4-E034-080020C9C0E0
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  1. 8/26/12 8/26/12 -
  2. 3/23/15 3/23/15 - Martin Dugas
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August 26, 2012

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License :
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00041119 On-Study - CALGB: 40101 ON-STUDY FORM - 2040995v3.0

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  1. StudyEvent: CALGB: 40101 ON-STUDY FORM
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Unnamed1
Amended data?
Unnamed2
Unnamed3
Menopausal Status (mark one with an X)
Tumor Laterality (mark one with an X)
Receptor Status, ER (If measured in fmols/mg cytosol protein >= 10 is positive. If other measures are used apply institutional standards; borderline results should be reported as positive)
Receptor Status, PgR (mark one with an X)
Histologic Grade (combined histologic grade is used according to SBR/ELSTON classification.)
HER-2 neu Status (mark one with an X)
Unnamed4
Unnamed5
Prior hormonal therapy? (do not include steroids given with chemotherapy)
Tamoxifen
Raloxifene
Prior adjuvant chemotherapy for this malignancy? (include pre-op chemotherapy at diagnosis)
Unnamed6
Type of biopsy (mark one with an X)
Most extensive primary surgery (mark one with an X)
Sentinel node biopsy
If done, sentinel node biopsy results (per protocol)
Was axillary dissection performed?
Ccrr Module For Calgb: 40101 On-study Form

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