ID

11666

Description

Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8B98176-F2DC-123A-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8B98176-F2DC-123A-E034-0003BA12F5E7

Keywords

Versions (4)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/5/15 7/5/15 -
  4. 7/25/15 7/25/15 - Martin Dugas
Uploaded on

July 25, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Prestudy Form Adjuvant Melanoma SWOG S0201

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
    1. No Instruction available.
SWOG clinical trial administrative data
Description

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Data type

text

Patient Initials (L, F M)
Description

Patient Initials

Data type

text

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

MainMemberInstitution/Affiliate

Data type

text

Physician (Groups other than SWOG)
Description

TreatingPhysician

Data type

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
Description

ParticipatingGroupName

Data type

text

Study No.
Description

StudyNo.

Data type

text

Pt. ID
Description

Pt.ID

Data type

text

Patient Characteristics
Description

Patient Characteristics

Alias
UMLS CUI-1
C0815172
Height
Description

Height

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI-1
C0005890
cm
Body weight
Description

Body weight

Data type

float

Measurement units
  • kg
Alias
UMLS CUI-1
C0005910
kg
Body surface area
Description

Body surface area

Data type

float

Measurement units
  • m²
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25157
UMLS CUI-1
C0005902
m²
Performance Status
Description

Performance Status

Data type

text

Alias
UMLS CUI-1
C1520224
Hla Status
Description

Hla Status

HLA Type
Description

HLAType

Data type

text

Date of HLA typing
Description

DateofHLAtyping

Data type

text

Specify HLA tissue typing kit used
Description

SpecifyHLAtissuetypingkitused

Data type

text

Primary Tumor
Description

Primary Tumor

Alias
UMLS CUI-1
C0677930
Date of initial pathologic diagnosis
Description

InitialDiagnosisDate,Pathologic

Data type

date

Site
Description

Site

Data type

text

Alias
UMLS CUI-1
C0475447
Ulceration present?
Description

UlcerationInd

Data type

text

Breslow thickness
Description

BreslowDepth

Data type

float

Clark level of invasion
Description

ClarkLevel

Data type

text

Regional Lymph Node Metastases
Description

RegionalLymphNodeMetastases

Data type

text

If yes, date of first diagnosis
Description

InitialDiagnosisDate,Metastatic

Data type

date

Total number of nodes examined
Description

LymphNode(s)ExaminedNumber

Data type

float

Alias
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
Number of positive nodes
Description

LymphNode(s)PositiveNumber

Data type

float

Alias
NCI Thesaurus Property
C25246
UMLS 2011AA Property
C1446409
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
Comments
Description

Comments

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient ID
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/Affiliate
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. ID
text
Item Group
Patient Characteristics
C0815172 (UMLS CUI-1)
Height
Item
Height
float
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005890 (UMLS CUI-1)
Weight
Item
Body weight
float
C0005910 (UMLS CUI-1)
BSA
Item
Body surface area
float
C16960 (NCI Thesaurus ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI-1)
Performance Status
Item
Performance Status
text
C1520224 (UMLS CUI-1)
Item Group
Hla Status
Item
HLA Type
text
CL.1
Code List
HLA Type
CL Item
A2+ Only (A2+ only)
CL Item
C3+ Only (C3+ only)
CL Item
Both A2+ And C3+ (both A2+ and C3+)
DateofHLAtyping
Item
Date of HLA typing
text
SpecifyHLAtissuetypingkitused
Item
Specify HLA tissue typing kit used
text
Item Group
Primary Tumor
C0677930 (UMLS CUI-1)
InitialDiagnosisDate,Pathologic
Item
Date of initial pathologic diagnosis
date
Item
Site
text
C0475447 (UMLS CUI-1)
CL.2
Code List
Site
CL Item
Head (head or neck)
C12419 (NCI Thesaurus)
C0018670 (UMLS 2011AA)
CL Item
Upper Extremity (upper limb)
C12671 (NCI Thesaurus)
C1140618 (UMLS 2011AA)
CL Item
Trunk (trunk)
C33816 (NCI Thesaurus)
C0460005 (UMLS 2011AA)
CL Item
Ocular (eye)
C0521414 (NCI Metathesaurus)
CL Item
Lower Extremity (lower limb)
C12742 (NCI Thesaurus)
C0023216 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Ulceration present?
text
CL.3
Code List
Ulceration present?
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
BreslowDepth
Item
Breslow thickness
float
Item
Clark level of invasion
text
CL.4
Code List
Clark level of invasion
CL Item
I-above Basal Lamina (in Situ) (I)
CL Item
Ii- Extension Into Papillary Dermis (II)
CL Item
Iii-interface Papillary-reticular Dermis (III)
CL Item
Iv-reticular Dermis (IV)
CL Item
V-subcutaneous Fat (V)
CL Item
Unknown (Unknown)
Item
Regional Lymph Node Metastases
text
CL.5
Code List
Regional Lymph Node Metastases
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
InitialDiagnosisDate,Metastatic
Item
If yes, date of first diagnosis
date
LymphNode(s)ExaminedNumber
Item
Total number of nodes examined
float
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
LymphNode(s)PositiveNumber
Item
Number of positive nodes
float
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
Comments
Item
Comments
text
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