ID

10009

Description

Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer NCT00324415 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 3/14/15 3/14/15 - Martin Dugas
Uploaded on

March 14, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00324415 On-Study - AMC-045 History of AIDS Defining Disease Form (F03) - 2937261v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Header Module
Description

Header Module

Visit number
Description

Visit number

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI-1
C1549755
History of AIDS Defining Disease
Description

History of AIDS Defining Disease

Date of Evaluation
Description

Date of Evaluation

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C3824
NCI Thesaurus Property
C20989
NCI Thesaurus ValueDomain-2
C25367
UMLS CUI-1
C0221198
UMLS CUI-2
C0031809
mm/dd/yyyy
History of opportunistic diseases and predisposing disease
Description

OpportunisticInfectionSusceptibilityDiseasePersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C3289
NCI Thesaurus ObjectClass-3
C16505
NCI Metathesaurus Property
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS CUI-1
C0029118
Disease Type
Description

AcquiredImmunodeficiencySyndromeAssociatedDiseaseDiagnosisType

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C2851
NCI Thesaurus ObjectClass-3
C25281
NCI Thesaurus Property
C15220
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0001175
UMLS CUI-2
C0683312
Disease status (Please select the disease status of the diseases listed)
Description

DiseaseResponseSiteStatus

Data type

text

Alias
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus Property-2
C25341
UMLS 2011AA Property-2
C0450429
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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No Instruction available.

1 forms
  1. StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
HospitalAdmissionOrdinalNumber
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
LesionAssessmentDate
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C0221198 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
History of opportunistic diseases
Item
History of opportunistic diseases and predisposing disease
boolean
C2991 (NCI Thesaurus ObjectClass)
C3289 (NCI Thesaurus ObjectClass-2)
C16505 (NCI Thesaurus ObjectClass-3)
C0262926 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C0029118 (UMLS CUI-1)
Item
Disease Type
text
C2991 (NCI Thesaurus ObjectClass)
C2851 (NCI Thesaurus ObjectClass-2)
C25281 (NCI Thesaurus ObjectClass-3)
C15220 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0001175 (UMLS CUI-1)
C0683312 (UMLS CUI-2)
CL.2
Code List
Disease Type
CL Item
Candidiasis Of Bronchi, Trachea Or Lungs (Candidiasis of bronchi, trachea or lungs)
CL Item
Candidiasis, Esophageal (Candidiasis, esophageal)
CL Item
Cervical Cancer (Cervical cancer, invasive)
C0007847 (NCI Metathesaurus)
CL Item
Coccidioidomycosis, Disseminated Or Extrapulmonary (Coccidioidomycosis, disseminated or extrapulmonary)
CL Item
Cryptococcosis (Cryptococcosis, extrapulmonary)
C2967 (NCI Thesaurus)
C0010414 (UMLS 2011AA)
CL Item
Cryptosporidiosis, Chronic Intestinal (Cryptosporidiosis, chronic intestinal)
CL Item
Cmv Other Than Liver, Spleen Or Nodes, Onset At Age >1month (CMV other than liver, spleen or nodes, onset at age >1month)
CL Item
Cmv Retinitis (CMV retinitis)
CL Item
Encephalopathy (Encephalopathy, HIV-related)
C26920 (NCI Thesaurus)
C0085584 (UMLS 2011AA)
CL Item
Herpes Simplex: Chronic Ulcers (> 1 Month's Duration) Or Bronchitis, Pneumonitis Or Esophagitis (onset At Age > 1 Month) (Herpes simplex: chronic ulcers (> 1 month's duration) or bronchitis, pneumonitis or esophagitis (onset at age > 1 month))
CL Item
Histoplasmosis, Disseminated Or Extrapulmonary (Histoplasmosis, disseminated or extrapulmonary)
CL Item
Isosporiasis, Chronic Intestinal (> 1 Mon) (Isosporiasis, chronic intestinal (> 1 mon))
CL Item
Kaposi's Sarcoma Aids Related (Kaposi's sarcoma)
CL Item
Non-hodgkin's Lymphoma (Lymphoma, systemic non-Hodgkin's)
C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)
CL Item
Lymphoma, Primary, Of Brain (Lymphoma, primary, of brain)
CL Item
Mycobacterium Avium Complex Or Mycobacterium Kansasii Disseminated Or Extrapulmonary (Mycobacterium avium complex or Mycobacterium kansasii disseminated or extrapulmonary)
CL Item
Mycobacterium Tuberculosis Of Any Site, Pulmonary, Disseminated Or Extrapulmonary (Mycobacterium tuberculosis of any site, pulmonary, disseminated or extrapulmonary)
CL Item
Mycobacterium, Other Species Or Unidentified Species, Disseminated Or Extrapulmonary (Mycobacterium, other species or unidentified species, disseminated or extrapulmonary)
CL Item
Pneumocystis Jirovecii Pneumonia (Pneumocystis jirovecii pneumonia)
CL Item
Pneumonia (Pneumonia, recurrent)
C3333 (NCI Thesaurus)
C0032285 (UMLS 2011AA)
CL Item
Progressive Multifocal Leukoencephalopathy (pml) (Progressive multifocal leukoencephalopathy)
CL Item
Salmonella Septicemia, Recurrent (Salmonella septicemia, recurrent)
CL Item
Toxoplasmosis Of The Brain, Onset At Age >1month (Toxoplasmosis of the brain, onset at age >1month)
CL Item
Wasting Syndrome, Due To Hiv (Wasting syndrome, due to HIV)
Item
Disease status (Please select the disease status of the diseases listed)
text
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25341 (NCI Thesaurus Property-2)
C0450429 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Disease status (Please select the disease status of the diseases listed)
CL Item
Active (Currently active)
C45329 (NCI Thesaurus)
C0205177 (UMLS 2011AA)
CL Item
Present (Ever present)
C25626 (NCI Thesaurus)
C0150312 (UMLS 2011AA)
CL Item
Never Present (Never present)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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