Bladder Cancer NCT00014534 Treatment - NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 - 2056083v3.0

NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C01F91-F376-264F-E034-0003BA12F5E7

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  1. StudyEvent: NCI Cooperative Group Treatment by Cycle Form-CALGB-90104
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Mskcc 00-138; Calgb-90104; Ecog
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
C1507394 (UMLS CUI-1)
C1705823 (UMLS CUI-2)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Institution Name
Item
Institution Name
text
C0565990 (UMLS CUI-1)
AffiliateName
Item
Affiliate
text
Patient Last Name
Item
Patient Last Name (initials acceptable)
text
C1301584 (UMLS CUI-1)
Patient First Name
Item
Patient First Name (initials acceptable)
text
C1443235 (UMLS CUI-1)
Patient middle name
Item
Patient Middle Name (initials acceptable)
text
C1320720 (UMLS CUI-1)
Item Group
Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
AmendedDataInd
Item
Are data amended?
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI-1)
C1691222 (UMLS CUI-2)
Item Group
Treatment Cycles
CourseIdentification
Item
Current Cycle Number
text
CourseBeginDate
Item
Cycle Start Date
date
ChemotherapyAgentName
Item
Chemotherapy Agent Name
text
AgentBeginDate
Item
Agent Start Date
date
AgentEndDate
Item
Agent End Date
date
AgentAdminRoute
Item
Agent Admin Route
text
AgentTotalDose
Item
Agent Total Dose (per day)
double
AgentDoseLevelValue
Item
Agent Dose Level
text
C25488 (NCI Thesaurus Property)
C0178602 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25554 (NCI Thesaurus Property)
C0441889 (UMLS 2011AA Property)
AgentDoseUnits
Item
Agent Dose Units
text
Item Group
Ccrr Module For Nci Cooperative Group Treatment By Cycle Form-calgb-90104

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