ID

9994

Beschrijving

Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer NCT00016276 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8C3D-227A-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8C3D-227A-E034-080020C9C0E0

Trefwoorden

  1. 26-08-12 26-08-12 -
  2. 12-03-15 12-03-15 - Martin Dugas
Geüploaded op

12 maart 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00016276 Treatment - CALGB: 49808 TREATMENT SUMMARY FORM HERCEPTIN VS OBSERVATION - 2032660v3.0

No Instruction available.

  1. StudyEvent: CALGB: 49808 TREATMENT SUMMARY FORM HERCEPTIN VS OBSERVATION
    1. No Instruction available.
Header
Beschrijving

Header

CALGB Form
Beschrijving

CALGBForm

Datatype

text

CALGB Study No
Beschrijving

CALGBProtocolNumber

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

Amended data?
Beschrijving

Amended data?

Datatype

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Patient's Name
Beschrijving

Patient's Name

Datatype

text

Alias
UMLS CUI-1
C1299487
Participating Group
Beschrijving

ParticipatingGroup

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Beschrijving

PatientHospitalNumber

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Main Member Institution/Adjunct
Beschrijving

MainMemberInstitution/Adjunct

Datatype

text

Participating Group Patient No.
Beschrijving

ParticipatingGroupPatientNo.

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Treatment Plan
Beschrijving

Treatment Plan

Is patient taking Herceptin?
Beschrijving

Is patient taking Herceptin?

Datatype

boolean

Alias
UMLS CUI-1
C0338204
Initial dose this reporting period (Total dose in mg Herceptin if randomized)
Beschrijving

Initialdosethisreportingperiod

Datatype

text

Last date protocol therapy was given
Beschrijving

ProtocolTreatmentAdministeredEndDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C42651
NCI Thesaurus Property
C25382
UMLS CUI-1
C1531784
Number of completed weeks during this reporting period
Beschrijving

Numberofcompletedweeksduringthisreportingperiod

Datatype

integer

Reason Treatment Ended (mark one with an X)
Beschrijving

ReasonTreatmentEnded

Datatype

text

Reason Treatment Ended Other, specify
Beschrijving

ReasonTreatmentEndedOther,specify

Datatype

text

Treatment Schedule - Systemic Therapy
Beschrijving

Treatment Schedule - Systemic Therapy

Were there any dose modifications or additions/ omissions to protocol treatment? (mark one with an X)
Beschrijving

Werethereanydosemodificationsoradditions/omissionstoprotocoltreatment?

Datatype

text

Alias
UMLS CUI-1
C1705236
Were any optional protocol therapies given?
Beschrijving

Wereanyoptionalprotocoltherapiesgiven?

Datatype

boolean

Optional Protocol Therapy Name
Beschrijving

OptionalProtocolTherapyName

Datatype

text

Were any non-protocol therapies given during protocol treatment?
Beschrijving

Wereanynon-protocoltherapiesgivenduringprotocoltreatment?

Datatype

boolean

Alias
UMLS CUI-1
C1518384
UMLS CUI-2
C0087111
Concurrent Non-Protocol Chemotherapy?
Beschrijving

ConcurrentNon-ProtocolChemotherapyInd

Datatype

boolean

Concurrent Non-Protocol Hormonal Therapy?
Beschrijving

ConcurrentNon-ProtocolHormonalTherapyInd

Datatype

boolean

Concurrent Non-Protocol Biologic Response Modifier Therapy?
Beschrijving

ConcurrentNon-ProtocolBRMInd

Datatype

boolean

Concurrent Non-Protocol Radiation Therapy?
Beschrijving

ConcurrentNon-ProtocolRTInd

Datatype

boolean

Concurrent Non-Protocol High Dose Chemotherapy/Autologous Stem Cell Transplant?
Beschrijving

ConcurrentNon-ProtocolHDC/ASCTInd

Datatype

boolean

Did this patient receive any tamoxifen?
Beschrijving

PastTamoxifenInd

Datatype

boolean

Did patient begin taking tamoxifen during this reporting period? (If Yes)
Beschrijving

Didpatientbegintakingtamoxifenduringthisreportingperiod?

Datatype

boolean

Alias
UMLS CUI-1
C0039286
If Yes, date tamoxifen started
Beschrijving

IfYes,datetamoxifenstarted

Datatype

date

Is the patient still receiving tamoxifen?
Beschrijving

CurrentTamoxifenInd

Datatype

boolean

If patient discontinued tamoxifen since last follow-up, give date.
Beschrijving

Ifpatientdiscontinuedtamoxifensincelastfollow-up,givedate.

Datatype

date

Similar models

No Instruction available.

  1. StudyEvent: CALGB: 49808 TREATMENT SUMMARY FORM HERCEPTIN VS OBSERVATION
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
Data amended
Item
Amended data?
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
Patient Name
Item
Patient's Name
text
C1299487 (UMLS CUI-1)
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
Comments
Item
Comments
text
Item Group
Treatment Plan
Herceptin
Item
Is patient taking Herceptin?
boolean
C0338204 (UMLS CUI-1)
Initialdosethisreportingperiod
Item
Initial dose this reporting period (Total dose in mg Herceptin if randomized)
text
Therapy end date
Item
Last date protocol therapy was given
date
C25164 (NCI Thesaurus ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1531784 (UMLS CUI-1)
Number of completed weeks
Item
Number of completed weeks during this reporting period
integer
Item
Reason Treatment Ended (mark one with an X)
text
Code List
Reason Treatment Ended (mark one with an X)
CL Item
Not applicable (Not applicable)
CL Item
Treatment completed per protocol criteria (Treatment completed per protocol criteria)
CL Item
Disease progression/relapse during active treatment (Disease progression/relapse during active treatment)
CL Item
Toxicity/side effects/complications (Toxicity/side effects/complications)
CL Item
Death on study (Death on study)
CL Item
Patient withdrawal or refusal after beginning protocol therapy (Patient withdrawal or refusal after beginning protocol therapy)
CL Item
Patient withdrawal or refusal prior to beginning protocol therapy (Patient withdrawal or refusal prior to beginning protocol therapy)
CL Item
Alternative therapy (Alternative therapy)
CL Item
Other complicating disease (Other complicating disease)
CL Item
Other, specify (Other, specify)
ReasonTreatmentEndedOther,specify
Item
Reason Treatment Ended Other, specify
text
Item Group
Treatment Schedule - Systemic Therapy
Item
Were there any dose modifications or additions/ omissions to protocol treatment? (mark one with an X)
text
C1705236 (UMLS CUI-1)
Code List
Were there any dose modifications or additions/ omissions to protocol treatment? (mark one with an X)
CL Item
No (0)
C1298908 (UMLS CUI-1)
CL Item
Yes, planned (1)
C1705108 (UMLS CUI-1)
C1301732 (UMLS CUI-2)
CL Item
Yes, Unplanned (2)
Optional protocol therapies
Item
Were any optional protocol therapies given?
boolean
OptionalProtocolTherapyName
Item
Optional Protocol Therapy Name
text
Non-protocol Therapy
Item
Were any non-protocol therapies given during protocol treatment?
boolean
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
ConcurrentNon-ProtocolChemotherapyInd
Item
Concurrent Non-Protocol Chemotherapy?
boolean
ConcurrentNon-ProtocolHormonalTherapyInd
Item
Concurrent Non-Protocol Hormonal Therapy?
boolean
ConcurrentNon-ProtocolBRMInd
Item
Concurrent Non-Protocol Biologic Response Modifier Therapy?
boolean
ConcurrentNon-ProtocolRTInd
Item
Concurrent Non-Protocol Radiation Therapy?
boolean
ConcurrentNon-ProtocolHDC/ASCTInd
Item
Concurrent Non-Protocol High Dose Chemotherapy/Autologous Stem Cell Transplant?
boolean
PastTamoxifenInd
Item
Did this patient receive any tamoxifen?
boolean
Tamoxifen
Item
Did patient begin taking tamoxifen during this reporting period? (If Yes)
boolean
C0039286 (UMLS CUI-1)
Tamoxifen start date
Item
If Yes, date tamoxifen started
date
CurrentTamoxifenInd
Item
Is the patient still receiving tamoxifen?
boolean
Tamoxifen discontinuation date
Item
If patient discontinued tamoxifen since last follow-up, give date.
date

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