Description:

CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1) PET Scan Imaging in Assessing Response in Patients With Esophageal Cancer Receiving Combination Chemotherapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE28FF1D-7C5B-BC14-E040-BB89AD43491A

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE28FF1D-7C5B-BC14-E040-BB89AD43491A

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

DOI:
To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Adenocarcinoma of the Gastroesophageal Junction NCT01333033 Registration - CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1) - 3287859v1.0

Randomized Phase II Trial of PET-Scan Directed Combined Modality Therapy in Esophageal Cancer

  1. StudyEvent: CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1)
    1. Randomized Phase II Trial of PET-Scan Directed Combined Modality Therapy in Esophageal Cancer
Protocol Administration
Pre-treatment Characteristics
Performance Status
cm
Kg
Certification Of Eligibility
In the opinion of the investigator, is the patient eligible
Protocol Design (stratification Factors)
Initial Patient Consent For Specimen Use
I agree that my blood and tissue may be used for the research described in the protocol (consent question #1 - must be Yes for participation in 151007)
My specimens may be kept for future unknown use in research to learn about, prevent, treat, or cure cancer (consent question #2)
My specimens may be kept for use in research about other health problems (for example: diabetes, Alzheimer's disease, or heart disease). (consent question #3)
My doctor or someone from CALGB may contact me in the future to ask me to take part in more research (consent question #4)
In the opinion of the investigator, is the patient eligible
Companion Study Calgb - 150714
I choose to take part in the Quality of Life study and agree to complete the QOL assessments
In the opinion of the investigator, is the patient eligible

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial