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Description:

TAILORx Second Primary 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=A3BB68BA-CCE2-8DF9-E040-BB89AD43631B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A3BB68BA-CCE2-8DF9-E040-BB89AD43631B

Keywords:

Follow-Up Studies

Breast Neoplasms

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

Uploaded on:

August 26, 2012

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00310180 Follow-Up - TAILORx Second Primary Form - 3236572v1.0

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StudyEvent: TAILORx Second Primary Form
1. No Instruction available.

Unnamed1

ECOG Protocol Number

ECOG Patient ID

DCI Name

Registration Step

Reporting Period

Second Primary Cancer (Second primary)

Completed By Central Lab

Date of Diagnosis of Second Primary Cancer (mm/dd/yyyy)

Site of Second Primary Cancer

Acute Lymphocytic Leukemia (Acute Lymphocytic Leukemia (ALL))

Acute Myelogenous Leukemia (Acute Myelogenous Leukemia (AML))

Adrenal (Adrenal)

Aids-related Lymphoma (AIDS-related Lymphoma)

50 more items in the detailed view.

Include information on histologic subtype (s Please attach copies of any corroborating pathology reports.)

Comments

Investigator Signature

Investigator Signature Date

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