ID

9296

Beschreibung

SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678C302-20D3-50A8-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678C302-20D3-50A8-E034-0003BA0B1A09

Stichworte

Versionen (3)
  1. 26.08.12 26.08.12 -
  2. 20.03.14 20.03.14 - Martin Dugas
  3. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00070564 Follow-Up - SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM - 2050216v3.0

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM
    1. No Instruction available.
Administrative documentation
Beschreibung

Administrative documentation

Alias
UMLS CUI
C1320722
SWOG Patient ID
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

text

Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution / Affiliate
Beschreibung

InstitutionName

Datentyp

text

Physician
Beschreibung

RegisteredInvestigator

Datentyp

text

Participating Group Name
Beschreibung

ParticipatingGroupName

Datentyp

text

Participating Group Study No.
Beschreibung

ParticipatingGroupProtocolNumber

Datentyp

float

Participating Group Patient ID
Beschreibung

Trial subject ID Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Vital Status
Beschreibung

Vital Status

Vital Status
Beschreibung

Vital Status

Datentyp

integer

Alias
UMLS CUI
C1148433
Date of last contact or death
Beschreibung

Last Contact Date

Datentyp

date

Alias
UMLS CUI
C0585085
Disease Follow Up Status
Beschreibung

Disease Follow Up Status

Has the patient had a documented clinical assessment for this cancer since submission of the previous follow-up form?
Beschreibung

CancerFollow-upStatusInd

Datentyp

boolean

Date of Last Clinical Assessment
Beschreibung

CancerFollow-upStatusDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Notice Of Progression - Adjuvant
Beschreibung

Notice Of Progression - Adjuvant

Has the patient developed a first relapse or progression that has not been previously reported
Beschreibung

DiseaseRelapseProgressionInd-3

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C38155
UMLS 2011AA Property
C0277556
NCI Thesaurus Property-2
C15220
UMLS 2011AA Property-2
C0011900
NCI Thesaurus Property-3
C19987
UMLS 2011AA Property-3
C0242656
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
If Yes, Date of Relapse or Progression:
Beschreibung

IfYes,DateofRelapseorProgression:

Datentyp

text

Site(s) of relapse or progression
Beschreibung

DiseaseProgressionRelapseSiteText

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C18265
NCI Thesaurus ObjectClass
C17747
UMLS 2011AA ObjectClass
C0242656
Notice Of New Primary
Beschreibung

Notice Of New Primary

Has a new primary cancer, opposite breast cancer, or myelodysplastic syndrome (MDS) been diagnosed that has not been previously reported?
Beschreibung

NewPrimaryCancerInd

Datentyp

boolean

Date of Diagnosis
Beschreibung

NewPrimaryCancerDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
New Primary Site
Beschreibung

NewPrimarySite

Datentyp

text

Non-protocol Treatment
Beschreibung

Non-protocol Treatment

Alias
UMLS CUI
C1518384
Has the patient received any non-protocol cancer therapy (prior to progression/relapse) not previously reported?
Beschreibung

Non-Protocol Therapy

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25590
NCI Thesaurus Property
C25629
NCI Thesaurus Property-2
C19987
NCI Thesaurus Property-3
C25409
NCI Thesaurus ValueDomain
C38148
UMLS CUI
C1518384
Date of First Non-Protocol Therapy (If Yes,)
Beschreibung

Non-ProtocolTherapyFirstAdministeredDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25590
UMLS 2011AA ObjectClass
C1518384
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Agent
Beschreibung

Agent Name

Datentyp

string

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
UMLS CUI
C0729502
Long Term Toxicity
Beschreibung

Long Term Toxicity

Has the patient experienced any severe long term toxicity that has not been previously reported?
Beschreibung

LateAdverseEventInd

Datentyp

boolean

Toxicities and Grades
Beschreibung

CTCAdverseEventTerm

Datentyp

text

Comments
Beschreibung

Comments

Alias
UMLS CUI
C0947611
Comments
Beschreibung

Comments

Datentyp

string

Alias
UMLS CUI
C0947611
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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative documentation
C1320722 (UMLS CUI)
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician
text
ParticipatingGroupName
Item
Participating Group Name
text
ParticipatingGroupProtocolNumber
Item
Participating Group Study No.
float
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Vital Status
Item
Vital Status
integer
C1148433 (UMLS CUI)
CL.1
Code List
Vital Status
CL Item
Alive (1)
CL Item
Dead (0)
Last Contact Date
Item
Date of last contact or death
date
C0585085 (UMLS CUI)
Item Group
Disease Follow Up Status
CancerFollow-upStatusInd
Item
Has the patient had a documented clinical assessment for this cancer since submission of the previous follow-up form?
boolean
CancerFollow-upStatusDate
Item
Date of Last Clinical Assessment
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Notice Of Progression - Adjuvant
DiseaseRelapseProgressionInd-3
Item
Has the patient developed a first relapse or progression that has not been previously reported
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C19987 (NCI Thesaurus Property-3)
C0242656 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
IfYes,DateofRelapseorProgression:
Item
If Yes, Date of Relapse or Progression:
text
DiseaseProgressionRelapseSiteText
Item
Site(s) of relapse or progression
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18265 (NCI Thesaurus Property-2)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
Item Group
Notice Of New Primary
NewPrimaryCancerInd
Item
Has a new primary cancer, opposite breast cancer, or myelodysplastic syndrome (MDS) been diagnosed that has not been previously reported?
boolean
NewPrimaryCancerDate
Item
Date of Diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
New Primary Site
text
Item Group
Non-protocol Treatment
C1518384 (UMLS CUI)
Non-Protocol Therapy
Item
Has the patient received any non-protocol cancer therapy (prior to progression/relapse) not previously reported?
boolean
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25629 (NCI Thesaurus Property)
C19987 (NCI Thesaurus Property-2)
C25409 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1518384 (UMLS CUI)
Non-ProtocolTherapyFirstAdministeredDate
Item
Date of First Non-Protocol Therapy (If Yes,)
date
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Agent Name
Item
Agent
string
C25364 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C0729502 (UMLS CUI)
Item Group
Long Term Toxicity
LateAdverseEventInd
Item
Has the patient experienced any severe long term toxicity that has not been previously reported?
boolean
CTCAdverseEventTerm
Item
Toxicities and Grades
text
Item Group
Comments
C0947611 (UMLS CUI)
Comments
Item
Comments
string
C0947611 (UMLS CUI)
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