ID
934
Beskrivning
PACCT-1 TAILORx FACT - Fatique Scale 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=84B81FA9-D91A-473F-E040-BB89AD4317EF
Länk
Nyckelord
Versioner (3)
- 2012-08-26 2012-08-26 -
- 2015-01-08 2015-01-08 - Martin Dugas
- 2015-06-08 2015-06-08 -
Uppladdad den
26 augusti 2012
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :
Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.
Itemgroup-kommentar för :
Item-kommentar för :
Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.
Breast Cancer NCT00310180 Quality of Life - PACCT-1 TAILORx FACT - Fatique Scale Form - 3072107v1.0
INSTRUCTIONS: Please complete this form according to the forms submission schedule. Submit original to the ECOG Coordinating Center. Keep a copy for your files
- StudyEvent: PACCT-1 TAILORx FACT - Fatique Scale Form
Beskrivning
On Treatment
Beskrivning
TreatmentEvaluationPeriodType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus ObjectClass
- C15368
Beskrivning
Unnamed2
Beskrivning
DataAmendedInd-3
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Beskrivning
DataAmendedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
- NCI Thesaurus ValueDomain
- C25367
Beskrivning
DataAmendedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
- NCI Thesaurus ValueDomain
- C25367
Beskrivning
Unnamed1
Beskrivning
Additional Concerns
Beskrivning
Quality-of-LifeAssessmentPatientFatigueScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
NeurotoxicityPatientMuscleWeaknessAssessmentQualityofLifeScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C27961
- UMLS 2011AA ObjectClass
- C0235032
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0151786
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientLethargicScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C50412
- UMLS 2011AA Property
- C0023380
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientSmallFatigueScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus Property
- C25376
- UMLS 2011AA Property
- C0700321
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientBeginFatigueScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus Property
- C25431
- UMLS 2011AA Property
- C0439659
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientEndFatigueScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus Property
- C25496
- UMLS 2011AA Property
- C2746065
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientEnergyScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C48058
- UMLS 2011AA Property
- C0542479
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientActivityType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C43431
- UMLS 2011AA Property
- C0441655
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
Beskrivning
Quality-of-LifeAssessmentPatientDayRestingScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C25301
- UMLS 2011AA Property
- C0439228
- NCI Thesaurus Property
- C28185
- UMLS 2011AA Property
- C0035253
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientIngestionFatigueScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus Property
- C28229
- UMLS 2011AA Property
- C0232478
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientSupportActivityScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C43431
- UMLS 2011AA Property
- C0441655
- NCI Thesaurus Property
- C37902
- UMLS 2011AA Property
- C1521721
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientFrustrationScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C61483
- UMLS 2011AA Property
- C0016770
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Beskrivning
Quality-of-LifeAssessmentPatientFatigueActivityScale
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15584
- UMLS 2011AA ObjectClass
- C0281588
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C43431
- UMLS 2011AA Property
- C0441655
- NCI Thesaurus Property
- C3036
- UMLS 2011AA Property
- C0015672
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C17047
- UMLS 2011AA ValueDomain
- C0518214
Similar models
INSTRUCTIONS: Please complete this form according to the forms submission schedule. Submit original to the ECOG Coordinating Center. Keep a copy for your files
- StudyEvent: PACCT-1 TAILORx FACT - Fatique Scale Form
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus ObjectClass)
C0332307 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C15368 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0030705 (UMLS 2011AA ObjectClass)
C27961 (NCI Thesaurus ObjectClass)
C0235032 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0151786 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C50412 (NCI Thesaurus Property)
C0023380 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C25376 (NCI Thesaurus Property)
C0700321 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property)
C2746065 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C48058 (NCI Thesaurus Property)
C0542479 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C15584 (NCI Thesaurus ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C28185 (NCI Thesaurus Property)
C0035253 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C28229 (NCI Thesaurus Property)
C0232478 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C37902 (NCI Thesaurus Property)
C1521721 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C61483 (NCI Thesaurus Property)
C0016770 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)
C0281588 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ValueDomain)
C0518214 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus)
C70543 (NCI Thesaurus)
C2003901 (UMLS 2011AA)
C91216 (NCI Thesaurus)
C91217 (NCI Thesaurus)