Description:

PACCT-1 TAILORx Pre-Registration Form Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0A2EF9D6-F0E2-1C86-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0A2EF9D6-F0E2-1C86-E044-0003BA3F9857

Keywords:

Breast Neoplasms

8/26/12 8/26/12 -
1/9/15 1/9/15 - Martin Dugas

Uploaded on:

January 9, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00310180 Registration - PACCT-1 TAILORx Pre-Registration Form - 2442999v1.0

No Instruction available.

StudyEvent: PACCT-1 TAILORx Pre-Registration Form
1. No Instruction available.

Header

ECOG Protocol Number

ECOG Patient ID

DCI Name

Registration Step Number

Reporting Period

Preregistration (Pre-registration)

Header

Reason patient not registered

Patient_ineligible (Patient ineligible)

Disease Progression, Relapse Prior To Beginning Protocol Therapy (Disease progression, relapse before protocol treatment)

Adverse Event/side Effects/complications (Adverse events/side effects/complications)

Death Before Beginning Protocol Therapy (Death before beginning protocol therapy)

3 more items in the detailed view.

Other specify

Oncotype DX Recurrence Score

Mark an 'X' if unknown

Footer Module

Investigator Signature

Investigator Signature Date

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