ID
10026
Beskrivning
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
Länk
Nyckelord
Versioner (2)
- 2012-09-19 2012-09-19 -
- 2015-03-18 2015-03-18 - Martin Dugas
Uppladdad den
18 mars 2015
DOI
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Licens
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
Beskrivning
Patient data
Beskrivning
Patient'sVitalStatus
Datatyp
text
Beskrivning
DeathDate/LastContactDate
Datatyp
date
Beskrivning
Causeofdeath
Datatyp
text
Beskrivning
PrimaryCauseDeathOtherReasonSpecify
Datatyp
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
Beskrivning
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
CancerFollow-upStatusDate
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beskrivning
PERFORMANCE STATUS (ZUBROD 0-4)
Datatyp
integer
Beskrivning
Follow-upPSAValue(s)
Datatyp
text
Beskrivning
DateofPSAAssessment(s)
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0194804
Beskrivning
Biopsy Date
Datatyp
date
Alias
- UMLS CUI-1
- C0005558
- UMLS CUI-2
- C0011008
Beskrivning
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0242656
Beskrivning
ProgressionInd,Biochemical
Datatyp
boolean
Beskrivning
ProgressionDate,FirstBiochemical
Datatyp
date
Beskrivning
ProgressionPSAValue
Datatyp
float
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
ProgressionDate,FirstLocal-Regional
Datatyp
date
Beskrivning
SITE(S)OFLOCAL/REGIONALPROGRESSION
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminelocal/regionalprogression)
Datatyp
text
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1269798
Beskrivning
ProgressionDate,FirstDistant
Datatyp
date
Beskrivning
Site(s)ofFirstDistantProgression
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminedistantprogression)
Datatyp
text
Beskrivning
Radiation therapy
Alias
- UMLS CUI-1
- C1522449
Beskrivning
TOTAL DOSE TO PROSTATE (Gy)
Datatyp
float
Måttenheter
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
Beskrivning
TOTALDOSETOPELVIS
Datatyp
float
Måttenheter
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0242485
Beskrivning
RTBeginDate
Datatyp
date
Beskrivning
RTEndDate
Datatyp
date
Beskrivning
RTInterruptionsInd
Datatyp
text
Beskrivning
RadiationTherapyUnscheduledInterruptionSpecify
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C15313
- NCI Thesaurus Property
- C25594
- NCI Thesaurus Property-2
- C25211
- NCI Thesaurus Property-3
- C25542
Beskrivning
REASONRADIATIONTHERAPYTREATMENTENDED
Datatyp
text
Beskrivning
Alternativetherapy,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Other,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
PROTOCOLHORMONESCONTINUING
Datatyp
text
Beskrivning
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1518384
Beskrivning
Non-ProtocolTherapyAdministeredType
Datatyp
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
Beskrivning
Non-ProtocolTherapyDate,First
Datatyp
date
Beskrivning
Specify(non-protocolprostatecancertherapy)
Datatyp
text
Beskrivning
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
URINARYINCONTINENCE,SeverityGrade
Datatyp
text
Beskrivning
URINARYINCONTINENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryincontinence,attribution)
Datatyp
text
Beskrivning
URINARYINCONTINENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
URINARYFREQUENCY/URGENCY,SeverityGrade
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryfrequency/urgency,attribution)
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
ERECTILEIMPOTENCE,SeverityGrade
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(erectileimpotence,attribution)
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beskrivning
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatyp
text
Beskrivning
CTCAdverseEventTerm
Datatyp
text
Beskrivning
COMMONTOXICITYGENERALCATEGORY
Datatyp
text
Beskrivning
CTCADVERSEEVENTGRADE
Datatyp
text
Alias
- UMLS CUI-1
- C2985911
Beskrivning
CTCADVERSEEVENTONSETDATE
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
CTCADVERSEEVENTATTRIBUTIONCODE
Datatyp
text
Beskrivning
Othercause,specify(adverseeventattribution)
Datatyp
text
Beskrivning
Specify(adverseevent)
Datatyp
text
Beskrivning
HQUse
Datatyp
text
Beskrivning
New cancer
Alias
- UMLS CUI-1
- C0205314
- UMLS CUI-2
- C0006826
Beskrivning
NewCancerDiagnosisAnatomicSite
Datatyp
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
Beskrivning
NewPrimaryCancerDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Specify(newprimarysite)
Datatyp
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)