ID

11398

Descripción

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

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 3/7/15 3/7/15 -
Subido en

3 de julio de 2015

DOI

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Licencia

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

Inglés

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient No.
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Patient Initials (L, F M)
Descripción

Patient Initials

Tipo de datos

text

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

MainMemberInstitution/Affiliate

Tipo de datos

text

Physician (Groups other than SWOG)
Descripción

TreatingPhysician

Tipo de datos

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
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No.
Descripción

StudyNo.

Tipo de datos

text

Pt. No.
Descripción

Pt.ID

Tipo de datos

text

Off-protocol treatment
Descripción

Off-protocol treatment

Reason off Treatment (select one)
Descripción

OffTreatmentReason

Tipo de datos

text

Off Treatment due to the following toxicities
Descripción

OffTreatmentReason,Toxicity

Tipo de datos

text

Sites (progression or relapse)
Descripción

Sites(progressionorrelapse)

Tipo de datos

text

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

OffTreatmentReason,Other

Tipo de datos

text

Will patient receive further treatment?
Descripción

FurtherTreatmentInd

Tipo de datos

text

Yes, specify (further treatment)
Descripción

FurtherTreatmentSpecify

Tipo de datos

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)
Descripción

DeathDate/LastContactDate

Tipo de datos

date

Vital Status
Descripción

Patient'sVitalStatus

Tipo de datos

text

Comments
Descripción

Comments

Comments
Descripción

Comments

Tipo de datos

text

By
Descripción

PersonCompletingForm,FirstName

Tipo de datos

text

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

FormCompletionDate,Original

Tipo de datos

date

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

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

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: S0201 Southwest Oncology Group Adjuvant Melanoma Off Treatment Notice
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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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