Anal Cancer NCT00550589 On-Study - AMC-046 HPV On-Study Form (ONS) - 2989612v1.0

Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus NCT00550589 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2FE1-08A5-E040-BB89AD434A3B

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  1. StudyEvent: AMC-046 HPV On-Study Form (ONS)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
HospitalAdmissionOrdinalNumber
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Item Group
Date of HIV+ diagnosis
Item
Date of HIV+ diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C14219 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C0019682 (UMLS CUI-1)
C2316983 (UMLS CUI-2)
Item
CDC HIV Risk Group
text
C16960 (NCI Thesaurus ObjectClass)
C14219 (NCI Thesaurus Property)
C17102 (NCI Thesaurus Property-2)
C25161 (NCI Thesaurus Property-3)
C25372 (NCI Thesaurus ValueDomain)
C0019682 (UMLS CUI-1)
C0035647 (UMLS CUI-2)
C0683312 (UMLS CUI-3)
Code List
CDC HIV Risk Group
CL Item
Homosexual Or Bisexual Contact (Homosexual or bisexual contact)
CL Item
Heterosexual Contact (Heterosexual contact)
CL Item
Iv Drug User (IV drug user)
CL Item
Transfusion Recipient (Transfusion recipient)
CL Item
Hemophilia (Hemophiliac)
C3093 (NCI Thesaurus)
C0684275 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
HIV risk category, other
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C14219 (NCI Thesaurus Property)
C17102 (NCI Thesaurus Property-2)
C25161 (NCI Thesaurus Property-3)
C25685 (NCI Thesaurus ValueDomain)
C0019682 (UMLS CUI-1)
C0035647 (UMLS CUI-2)
C1521902 (UMLS CUI-3)
HSIL confirmation date
Item
Perianal high-grade squamous intraepithelial lesions (HSIL) biopsy confirmed date
date
C2991 (NCI Thesaurus ObjectClass)
C28048 (NCI Thesaurus ObjectClass-2)
C8336 (NCI Thesaurus ObjectClass-3)
C25458 (NCI Thesaurus Property)
C15189 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0333875 (UMLS CUI-1)
C0750484 (UMLS CUI-2)
C0011008 (UMLS CUI-3)
Prior systemic chemotherapy or radiation therapy
Item
Prior systemic chemotherapy or radiation therapy
boolean
C38147 (NCI Thesaurus ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C49236 (NCI Thesaurus Property)
C0006826 (UMLS CUI-1)
C0332152 (UMLS CUI-2)
HPV dysplasia anal canal
Item
Anal canal
boolean
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12375 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0150312 (UMLS CUI-4)
C0227411 (UMLS CUI-5)
C1522602 (UMLS CUI-6)
HPV dysplasia perianal
Item
Perianal
boolean
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12375 (NCI Thesaurus Property-2)
C52247 (NCI Thesaurus Property-3)
C25180 (NCI Thesaurus ValueDomain)
Item
Penile
text
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12409 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0030851 (UMLS CUI-4)
Code List
Penile
CL Item
Not Available (N/A)
C0686905 (UMLS CUI-1)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS CUI-1)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS CUI-1)
Item
Scrotal
text
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12785 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0036471 (UMLS CUI-4)
Code List
Scrotal
CL Item
Not Available (N/A)
C0686905 (UMLS CUI-1)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS CUI-1)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS CUI-1)
Item
Vulvar
text
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12408 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0042993 (UMLS CUI-4)
Code List
Vulvar
CL Item
Not Available (N/A)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Cervical
text
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C12844 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0205064 (UMLS CUI-4)
Code List
Cervical
CL Item
Not Available (N/A)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Vaginal
text
C14226 (NCI Thesaurus ObjectClass)
C4086 (NCI Thesaurus ObjectClass-2)
C14158 (NCI Thesaurus ObjectClass-3)
C25626 (NCI Thesaurus Property)
C13309 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0021344 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
C0205082 (UMLS CUI-3)
C0042232 (UMLS CUI-4)
Code List
Vaginal
CL Item
Not Available (N/A)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
C1514463 (UMLS CUI-1)
Prior treatment
Item
Prior Treatment? (If "Yes", Check below)
boolean
C38148 (NCI Thesaurus ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus Property)
C15368 (NCI Thesaurus Property-2)
C1514463 (UMLS CUI-1)
Prior Cautery
Item
Prior Cautery
boolean
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15199 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0007471 (UMLS CUI-1)
C0332152 (UMLS CUI-2)
Prior TCA
Item
Prior trichloroacetic acid (TCA)
boolean
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C13344 (NCI Thesaurus Property)
C20985 (NCI Thesaurus Property-2)
C25382 (NCI Thesaurus Property-3)
C48807 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0332152 (UMLS CUI-1)
C0332237 (UMLS CUI-2)
C0547070 (UMLS CUI-3)
C1521801 (UMLS CUI-4)
C0220806 (UMLS CUI-5)
Treatment Date
Item
Treatment Date
date
C25164 (NCI Thesaurus ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C0011008 (UMLS CUI-1)
C1521801 (UMLS CUI-2)
Prior biological therapy
Item
Specify (If "Yes")
text
C25704 (NCI Thesaurus ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0005527 (NCI Metathesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C0005527 (UMLS CUI-1)
C1521801 (UMLS CUI-2)
Prior Surgery
Item
Prior Surgery
boolean
C38148 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0744961 (UMLS CUI-1)
Prior cryotherapy
Item
Prior cryotherapy
boolean
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C40030 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0010412 (UMLS CUI-1)
C0332152 (UMLS CUI-2)
Prior topical/intralesional therapy
Item
Prior topical/intralesional therapy
boolean
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C13344 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C28040 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C0332237 (UMLS CUI-1)
C1512954 (UMLS CUI-2)
C0332152 (UMLS CUI-3)
Other Prior Therapy
Item
Other Prior Therapy (e.g. Hyperthermia, etc.)
boolean
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
Other Prior Therapy, specify
Item
Specify (If "Yes")
text
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
Name of other prior therapies
Item
Name of other prior therapies (If "Yes")
text
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C42614 (NCI Thesaurus ValueDomain)

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