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

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

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  1. StudyEvent: TAILORx Second Primary Form
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Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Unnamed1
ProtocolECOGIdentifierNumber
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
PatientECOGIdentifierNumber
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
CollectedDataFormName
Item
DCI Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus ObjectClass)
RegistrationStepNumber
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25646 (NCI Thesaurus ObjectClass)
C1514821 (UMLS 2011AA ObjectClass)
C16154 (NCI Thesaurus Property)
C1704379 (UMLS 2011AA Property)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
Item
Reporting Period
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25651 (NCI Thesaurus ObjectClass)
C0700287 (UMLS 2011AA ObjectClass)
Code List
Reporting Period
CL Item
Second Primary Cancer (Second primary)
Item Group
Completed By Central Lab
SecondPrimaryNeoplasmDiagnosisDate
Item
Date of Diagnosis of Second Primary Cancer (mm/dd/yyyy)
date
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus ObjectClass)
C0205436 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
Site of Second Primary Cancer
text
C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus ObjectClass)
C0205436 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Site of Second Primary Cancer
CL Item
Acute Lymphocytic Leukemia (Acute Lymphocytic Leukemia (ALL))
CL Item
Acute Myelogenous Leukemia (Acute Myelogenous Leukemia (AML))
CL Item
Adrenal (Adrenal)
CL Item
Aids-related Lymphoma (AIDS-related Lymphoma)
CL Item
Anal Canal (Anal Canal)
C12375 (NCI Thesaurus)
C0227411 (UMLS 2011AA)
CL Item
Basal Cell Carcinoma (Basal Cell Carcinoma)
CL066969 (NCI Metathesaurus)
CL Item
Bladder, Urinary Tract (Bladder, Urinary Tract)
CL Item
Brain Tumor (Brain Tumor)
CL Item
Breast (Breast)
C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)
CL Item
Breast, In Situ (Breast, in situ)
CL Item
Carcinoid (Carcinoid)
CL Item
Cervix (Cervix)
C12311 (NCI Thesaurus)
C0007874 (UMLS 2011AA)
CL Item
Chronic Lymphocytic Leukemia (Chronic Lymphocytic Leukemia (CLL))
CL Item
Chronic Myelogenous Leukemia, Bcr-abl1 Positive (Chronic Myelogenous Leukemia (CML))
C3174 (NCI Thesaurus)
C0023473 (UMLS 2011AA)
CL Item
Colon (Colon)
C12382 (NCI Thesaurus)
C0009368 (UMLS 2011AA)
CL Item
Endometrium, Uterine Corpus (Endometrium, Uterine Corpus)
CL Item
Esophagus (Esophagus)
C12389 (NCI Thesaurus)
C0014876 (UMLS 2011AA)
CL Item
Gastric Cancer (Gastric Cancer)
CL Item
Hairy Cell Leukemia (Hairy Cell Leukemia)
C7402 (NCI Thesaurus)
C0023443 (UMLS 2011AA)
CL Item
Head And Neck (Head and Neck)
C12418 (NCI Thesaurus)
C0460004 (UMLS 2011AA)
CL Item
Hodgkin's Lymphoma (Hodgkin's Disease)
C9357 (NCI Thesaurus)
C0019829 (UMLS 2011AA)
CL Item
Islet Cell/carcinoid (Islet Cell/Carcinoid)
CL Item
Kaposi Sarcoma (Kaposi sarcoma)
C9087 (NCI Thesaurus)
C0036220 (UMLS 2011AA)
CL Item
Leukemia (Leukemia)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
CL Item
Liver, Gall Bladder, Bile Duct (Liver, Gall Bladder, Bile Duct)
CL Item
Lung Cancer (Lung cancer)
CL Item
Lymphoma (Lymphoma)
C3208 (NCI Thesaurus)
C0024299 (UMLS 2011AA)
CL Item
Lymphosarcoma (Lymphosarcoma)
CL Item
Melanoma (Melanoma)
C3224 (NCI Thesaurus)
C0025202 (UMLS 2011AA)
CL Item
Mesothelioma (Mesothelioma)
CL Item
Myelodysplastic Syndrome (Myelodysplastic Syndrome)
CL Item
Myeloma (Myeloma)
CL Item
Non-hodgkin Lymphoma (Non-Hodgkin's Lymphoma)
C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)
CL Item
Non-small Cell Lung Cancer (Non-Small Cell Lung Cancer)
CL Item
Osteosarcoma (Osteosarcoma)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Other Gyn (Other GYN)
CL Item
Other Non-melanoma Skin Cancer (Other non-melanoma skin cancer)
CL Item
Ovarian (Ovarian)
CL Item
Pancreas (Pancreas)
C12393 (NCI Thesaurus)
C0030274 (UMLS 2011AA)
CL Item
Penile (Penile)
CL Item
Pleural Effusion (Pleural effusion)
C3331 (NCI Thesaurus)
C0021071 (UMLS 2011AA)
CL Item
Promyelocytic Leukemia (Promyelocytic Leukemia (APL))
CL Item
Prostate (Prostate)
C12410 (NCI Thesaurus)
C0033572 (UMLS 2011AA)
CL Item
Rectum (Rectum)
C12390 (NCI Thesaurus)
C0034896 (UMLS 2011AA)
CL Item
Renal Cell (Renal Cell)
CL Item
Sarcoma (Sarcoma)
C9118 (NCI Thesaurus)
C1261473 (UMLS 2011AA)
CL Item
Small Intestine (Small Intestine)
C12386 (NCI Thesaurus)
C0021852 (UMLS 2011AA)
CL Item
Small-cell Lung Cancer (Small-Cell Lung Cancer)
CL Item
Spinal Cord (Spinal Cord)
C12464 (NCI Thesaurus)
C0037925 (UMLS 2011AA)
CL Item
Testis, Germ Cell, Seminoma (Testis, Germ Cell, Seminoma)
CL Item
Thymoma (Thymoma)
CL Item
Thyroid (Thyroid)
CL Item
Waldenstrom's Macroglobulinemia (Waldenstrom's Macroglobulinemia)
SecondTumorHistologicSubtypeSpecify
Item
Include information on histologic subtype (s Please attach copies of any corroborating pathology reports.)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus ObjectClass)
C0205436 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25696 (NCI Thesaurus Property)
C0449560 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Comments
InvestigatorSignatureText
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
InvestigatorSignatureDate
Item
Investigator Signature Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)

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