ID
10026
Beschrijving
FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CE883A-971B-476A-E044-0003BA3F9857
Link
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 18-03-15 18-03-15 - Martin Dugas
Geüploaded op
18 maart 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Prostate cancer (FS RTOG) Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO
INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
Beschrijving
Patient data
Beschrijving
Patient'sVitalStatus
Datatype
text
Beschrijving
DeathDate/LastContactDate
Datatype
date
Beschrijving
Causeofdeath
Datatype
text
Beschrijving
PrimaryCauseDeathOtherReasonSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ObjectClass-2
- C25251
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- NCI Thesaurus Property-2
- C25365
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
Beschrijving
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beschrijving
CancerFollow-upStatusDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
PERFORMANCE STATUS (ZUBROD 0-4)
Datatype
integer
Beschrijving
Follow-upPSAValue(s)
Datatype
text
Beschrijving
DateofPSAAssessment(s)
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0194804
Beschrijving
Biopsy Date
Datatype
date
Alias
- UMLS CUI-1
- C0005558
- UMLS CUI-2
- C0011008
Beschrijving
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0242656
Beschrijving
ProgressionInd,Biochemical
Datatype
boolean
Beschrijving
ProgressionDate,FirstBiochemical
Datatype
date
Beschrijving
ProgressionPSAValue
Datatype
float
Beschrijving
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beschrijving
ProgressionDate,FirstLocal-Regional
Datatype
date
Beschrijving
SITE(S)OFLOCAL/REGIONALPROGRESSION
Datatype
text
Beschrijving
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Datatype
text
Beschrijving
Other,specify(methodusedtodeterminelocal/regionalprogression)
Datatype
text
Beschrijving
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1269798
Beschrijving
ProgressionDate,FirstDistant
Datatype
date
Beschrijving
Site(s)ofFirstDistantProgression
Datatype
text
Beschrijving
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Datatype
text
Beschrijving
Other,specify(methodusedtodeterminedistantprogression)
Datatype
text
Beschrijving
Radiation therapy
Alias
- UMLS CUI-1
- C1522449
Beschrijving
TOTAL DOSE TO PROSTATE (Gy)
Datatype
float
Maateenheden
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
Beschrijving
TOTALDOSETOPELVIS
Datatype
float
Maateenheden
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0242485
Beschrijving
RTBeginDate
Datatype
date
Beschrijving
RTEndDate
Datatype
date
Beschrijving
RTInterruptionsInd
Datatype
text
Beschrijving
RadiationTherapyUnscheduledInterruptionSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C15313
- NCI Thesaurus Property
- C25594
- NCI Thesaurus Property-2
- C25211
- NCI Thesaurus Property-3
- C25542
Beschrijving
REASONRADIATIONTHERAPYTREATMENTENDED
Datatype
text
Beschrijving
Alternativetherapy,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
Other,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
PROTOCOLHORMONESCONTINUING
Datatype
text
Beschrijving
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1518384
Beschrijving
Non-ProtocolTherapyAdministeredType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
Non-ProtocolTherapyDate,First
Datatype
date
Beschrijving
Specify(non-protocolprostatecancertherapy)
Datatype
text
Beschrijving
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beschrijving
URINARYINCONTINENCE,SeverityGrade
Datatype
text
Beschrijving
URINARYINCONTINENCE,Attribution
Datatype
text
Beschrijving
Specifyifothercause(urinaryincontinence,attribution)
Datatype
text
Beschrijving
URINARYINCONTINENCE,AERBeginDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
URINARYFREQUENCY/URGENCY,SeverityGrade
Datatype
text
Beschrijving
URINARYFREQUENCY/URGENCY,Attribution
Datatype
text
Beschrijving
Specifyifothercause(urinaryfrequency/urgency,attribution)
Datatype
text
Beschrijving
URINARYFREQUENCY/URGENCY,AERBeginDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
ERECTILEIMPOTENCE,SeverityGrade
Datatype
text
Beschrijving
ERECTILEIMPOTENCE,Attribution
Datatype
text
Beschrijving
Specifyifothercause(erectileimpotence,attribution)
Datatype
text
Beschrijving
ERECTILEIMPOTENCE,AERBeginDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beschrijving
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beschrijving
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatype
text
Beschrijving
CTCAdverseEventTerm
Datatype
text
Beschrijving
COMMONTOXICITYGENERALCATEGORY
Datatype
text
Beschrijving
CTCADVERSEEVENTGRADE
Datatype
text
Alias
- UMLS CUI-1
- C2985911
Beschrijving
CTCADVERSEEVENTONSETDATE
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
CTCADVERSEEVENTATTRIBUTIONCODE
Datatype
text
Beschrijving
Othercause,specify(adverseeventattribution)
Datatype
text
Beschrijving
Specify(adverseevent)
Datatype
text
Beschrijving
HQUse
Datatype
text
Beschrijving
New cancer
Alias
- UMLS CUI-1
- C0205314
- UMLS CUI-2
- C0006826
Beschrijving
NewCancerDiagnosisAnatomicSite
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C9305
- UMLS 2011AA ObjectClass-2
- C0006826
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
Beschrijving
NewPrimaryCancerDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
Specify(newprimarysite)
Datatype
text
Similar models
INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
C0237753 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0439673 (UMLS 2011AA)
C25251 (NCI Thesaurus ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0007465 (UMLS CUI-1)
C25180 (NCI Thesaurus ValueDomain-2)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0205448 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0194804 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C25180 (NCI Thesaurus ValueDomain-2)
C0242656 (UMLS CUI-1)
C25180 (NCI Thesaurus ValueDomain-2)
C1521733 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C1269798 (UMLS CUI-1)
C1521733 (UMLS 2011AA)
C0242485 (UMLS CUI-1)
C1298908 (UMLS 2011AA)
C15313 (NCI Thesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C25211 (NCI Thesaurus Property-2)
C25542 (NCI Thesaurus Property-3)
C25180 (NCI Thesaurus ValueDomain-2)
C1518384 (UMLS CUI-1)
C0332307 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0005778 (UMLS 2011AA)
C0521362 (UMLS 2011AA)
C0019080 (UMLS 2011AA)
C0205054 (UMLS 2011AA)
C0497254 (UMLS 2011AA)
C0027855 (UMLS 2011AA)
C0030193 (UMLS 2011AA)
C2709248 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0439673 (UMLS 2011AA)
C1515974 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C0005682 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C0555952 (UMLS 2011AA)
C1522619 (UMLS 2011AA)
C1704242 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0025202 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)