ID

9404

Description

NSABP PROTOCOL B-39: Chemotherapy Report Radiation Therapy in Treating Women Who Have Undergone Surgery For Ductal Carcinoma In Situ or Stage I or Stage II Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6F98A67-4163-1881-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6F98A67-4163-1881-E034-0003BA3F9857

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00103181 Treatment - NSABP PROTOCOL B-39: Chemotherapy Report - 2295346v3.0

English
Details

This form is to be submitted for all patients, including those who do not receive adjuvant chemotherapy.

1 forms  
Part 1. Patient Treatment Plan Based On Information Provided At Patient Registration
Intention to Administer Chemotherapy
Assigned Treatment
Treatment Plan
Part 2. To Be Completed By Institution
Did patient receive adjuvant chemotherapy? (If no, remaining questions do not apply.)
Adjuvant Chemotherapy (mark all types of chemotherapy patient received)
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