ID

11398

Beschreibung

S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A93556CA-1C7B-6F30-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A93556CA-1C7B-6F30-E034-0003BA12F5E7

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 03.07.15 03.07.15 -
Hochgeladen am

3. Juli 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice
    1. No Instruction available.
SWOG clinical trial administrative data
Beschreibung

SWOG clinical trial administrative data

SWOG Patient No.
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

text

Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution/Member
Beschreibung

MainMemberInstitution/Affiliate

Datentyp

text

Physician (Groups other than SWOG)
Beschreibung

TreatingPhysician

Datentyp

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
Group Name
Beschreibung

ParticipatingGroupName

Datentyp

text

Study No.
Beschreibung

StudyNo.

Datentyp

text

Pt. No.
Beschreibung

Pt.ID

Datentyp

text

Off-protocol treatment
Beschreibung

Off-protocol treatment

Reason off Treatment (select one)
Beschreibung

OffTreatmentReason

Datentyp

text

Off Treatment due to the following toxicities
Beschreibung

OffTreatmentReason,Toxicity

Datentyp

text

Sites (progression or relapse)
Beschreibung

Sites(progressionorrelapse)

Datentyp

text

Other, specify (off treatment reason) (Date off treatment date of completion, death, or decision to discontinue therapy)
Beschreibung

OffTreatmentReason,Other

Datentyp

text

Will patient receive further treatment?
Beschreibung

FurtherTreatmentInd

Datentyp

text

Yes, specify (further treatment)
Beschreibung

FurtherTreatmentSpecify

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25519
UMLS 2011AA ObjectClass
C1517331
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Date of Last Contact (or death)
Beschreibung

DeathDate/LastContactDate

Datentyp

date

Vital Status
Beschreibung

Patient'sVitalStatus

Datentyp

text

Comments
Beschreibung

Comments

Comments
Beschreibung

Comments

Datentyp

text

By
Beschreibung

PersonCompletingForm,FirstName

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Date
Beschreibung

FormCompletionDate,Original

Datentyp

date

Ccrr Module For S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice
Beschreibung

Ccrr Module For S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice

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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient No.
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
MainMemberInstitution/Affiliate
Item
Institution/Member
text
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
ParticipatingGroupName
Item
Group Name
text
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. No.
text
Item Group
Off-protocol treatment
Item
Reason off Treatment (select one)
text
CL.1
Code List
Reason off Treatment (select one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment/observation completed per protocol)
CL Item
Toxicity/side Effects/complications (Toxicity, medically required, specify)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient refused, due to toxicity, specify)
CL Item
Patient Off-treatment For Other Complicating Disease (Patient refused, other than toxicity, specify)
CL Item
Disease Progression, Relapse During Active Treatment (Progression or relapse)
CL Item
Death Of Patient Occurred After The Patient Began Protocol Therapy (Death)
CL Item
Other, Specify (Other, specify)
Item
Off Treatment due to the following toxicities
text
CL.2
Code List
Off Treatment due to the following toxicities
CL Item
granuloma (granuloma)
CL Item
local injection site reaction/pain (local injection site reaction/pain)
CL Item
flu-like symptoms (flu-like symptoms)
CL Item
other, specify in Comments (other, specify in Comments)
Item
Sites (progression or relapse)
text
CL.3
Code List
Sites (progression or relapse)
CL Item
Local Recurrence (local recurrence)
CL Item
In-transit Recurrence (in-transit recurrence)
CL Item
Regional Recurrence (regional recurrence)
CL Item
Distant Metastasis (distant metastasis)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
OffTreatmentReason,Other
Item
Other, specify (off treatment reason) (Date off treatment date of completion, death, or decision to discontinue therapy)
text
Item
Will patient receive further treatment?
text
CL.4
Code List
Will patient receive further treatment?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
FurtherTreatmentSpecify
Item
Yes, specify (further treatment)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25519 (NCI Thesaurus ObjectClass-2)
C1517331 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
CL.5
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Comments
Comments
Item
Comments
text
PersonCompletingForm,FirstName
Item
By
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormCompletionDate,Original
Item
Date
date
Item Group
Ccrr Module For S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice
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