ID

9994

Descripción

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

Palabras clave

Versiones (2)
  1. 26/8/12 26/8/12 -
  2. 12/3/15 12/3/15 - Martin Dugas
Subido en

12 de marzo de 2015

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

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

Inglés

No Instruction available.

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

Header

CALGB Form
Descripción

CALGBForm

Tipo de datos

text

CALGB Study No
Descripción

CALGBProtocolNumber

Tipo de datos

text

CALGB Patient ID
Descripción

CALGBPatientID

Tipo de datos

text

Amended data?
Descripción

Amended data?

Tipo de datos

boolean

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

Patient's Name

Tipo de datos

text

Alias
UMLS CUI-1
C1299487
Participating Group
Descripción

ParticipatingGroup

Tipo de datos

text

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

PatientHospitalNumber

Tipo de datos

text

Participating Group Protocol No.
Descripción

ParticipatingGroupProtocolNo.

Tipo de datos

text

Main Member Institution/Adjunct
Descripción

MainMemberInstitution/Adjunct

Tipo de datos

text

Participating Group Patient No.
Descripción

ParticipatingGroupPatientNo.

Tipo de datos

text

Comments
Descripción

Comments

Tipo de datos

text

Treatment Plan
Descripción

Treatment Plan

Is patient taking Herceptin?
Descripción

Is patient taking Herceptin?

Tipo de datos

boolean

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

Initialdosethisreportingperiod

Tipo de datos

text

Last date protocol therapy was given
Descripción

ProtocolTreatmentAdministeredEndDate

Tipo de datos

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
Descripción

Numberofcompletedweeksduringthisreportingperiod

Tipo de datos

integer

Reason Treatment Ended (mark one with an X)
Descripción

ReasonTreatmentEnded

Tipo de datos

text

Reason Treatment Ended Other, specify
Descripción

ReasonTreatmentEndedOther,specify

Tipo de datos

text

Treatment Schedule - Systemic Therapy
Descripción

Treatment Schedule - Systemic Therapy

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

Werethereanydosemodificationsoradditions/omissionstoprotocoltreatment?

Tipo de datos

text

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

Wereanyoptionalprotocoltherapiesgiven?

Tipo de datos

boolean

Optional Protocol Therapy Name
Descripción

OptionalProtocolTherapyName

Tipo de datos

text

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

Wereanynon-protocoltherapiesgivenduringprotocoltreatment?

Tipo de datos

boolean

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

ConcurrentNon-ProtocolChemotherapyInd

Tipo de datos

boolean

Concurrent Non-Protocol Hormonal Therapy?
Descripción

ConcurrentNon-ProtocolHormonalTherapyInd

Tipo de datos

boolean

Concurrent Non-Protocol Biologic Response Modifier Therapy?
Descripción

ConcurrentNon-ProtocolBRMInd

Tipo de datos

boolean

Concurrent Non-Protocol Radiation Therapy?
Descripción

ConcurrentNon-ProtocolRTInd

Tipo de datos

boolean

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

ConcurrentNon-ProtocolHDC/ASCTInd

Tipo de datos

boolean

Did this patient receive any tamoxifen?
Descripción

PastTamoxifenInd

Tipo de datos

boolean

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

Didpatientbegintakingtamoxifenduringthisreportingperiod?

Tipo de datos

boolean

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

IfYes,datetamoxifenstarted

Tipo de datos

date

Is the patient still receiving tamoxifen?
Descripción

CurrentTamoxifenInd

Tipo de datos

boolean

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

Ifpatientdiscontinuedtamoxifensincelastfollow-up,givedate.

Tipo de datos

date

Volver a la parte superior de la página

Similar models

No Instruction available.

1 formularios
  1. StudyEvent: CALGB: 49808 TREATMENT SUMMARY FORM HERCEPTIN VS OBSERVATION
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
CL.3
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)
CL.4
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
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial