ID
10027
Descripción
CALGB: 40101 FOLLOW-UP FORM Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer NCT00041119 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A46CA742-FE60-27F9-E034-080020C9C0E0
Link
Palabras clave
Versiones (2)
- 26/8/12 26/8/12 -
- 19/3/15 19/3/15 - Martin Dugas
Subido en
19 de marzo de 2015
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0 Legacy
Comentarios del modelo :
Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.
Comentarios de grupo de elementos para :
Comentarios del elemento para :
Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.
Breast Cancer adjuvant therapy (CALGB 40101 NCT00041119)
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Descripción
Patient status
Descripción
Patient's Vital Status (mark one with an X)
Tipo de datos
text
Descripción
Cause of death (if dead)
Tipo de datos
text
Alias
- UMLS CUI-1
- C0007465
Descripción
DeathReason,Specify
Tipo de datos
text
Descripción
CurrentMenopausalStatus
Tipo de datos
text
Descripción
Resumptiondate
Tipo de datos
text
Descripción
Cessationdate
Tipo de datos
text
Descripción
Haspatienthadadocumentedclinicalassessmentforthiscancersincesubmissionofthepreviousfollow-upform?
Tipo de datos
boolean
Descripción
CancerFollow-upStatusDate
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Descripción
Hasthepatientbeendiagnosedwithafirstlocal-regionalrecurrence/progressionsincesubmissionofthelastfollow-upform?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
Descripción
ProgressionDate,FirstLocal-Regional
Tipo de datos
date
Descripción
ProgressionSite(s),FirstLocal-Regional
Tipo de datos
text
Descripción
ProgressionAssessmentSource
Tipo de datos
text
Descripción
Hasthepatientbeendiagnosedwithafirstdistantrecurrence/progressionsincesubmissionofthelastfollow-upform?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1269798
Descripción
ProgressionDate,FirstDistant
Tipo de datos
date
Descripción
ProgressionSite,FirstDistant
Tipo de datos
text
Descripción
Hasanewprimarycancerormyelodysplasticsyndrome(MDS)beendiagnosedthathasnotbeenpreviouslyreported?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
Descripción
Date of diagnosis (M)
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
Descripción
NewPrimarySite
Tipo de datos
text
Descripción
Adverse event
Alias
- UMLS CUI-1
- C0877248
Descripción
Hasthepatientexperienced(priortodiagnosisofrecurrenceorsecondprimary)anysevere(Grade>=3),longtermtreatmentrelatedtoxicitythathasnotbeenpreviouslyreported?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Descripción
IMTCode
Tipo de datos
text
Descripción
CTCAdverseEventTerm
Tipo de datos
text
Descripción
Grade
Tipo de datos
float
Descripción
DateofOnset
Tipo de datos
text
Descripción
Therapy
Descripción
PastTamoxifenInd
Tipo de datos
boolean
Descripción
CurrentTamoxifenInd
Tipo de datos
boolean
Alias
- UMLS CUI-1
- C0039286
Descripción
Datetamoxifenstarted
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Descripción
TamoxifenDiscontinuedDate
Tipo de datos
date
Descripción
Didthepatientreceiveanyaromataseinhibitors?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Descripción
Whicharomataseinhibitor?
Tipo de datos
text
Descripción
Other,specify(aromataseinhibitor)
Tipo de datos
text
Descripción
Isthepatientstillreceivingaromataseinhibitor?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Descripción
Datearomataseinhibitorstarted
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus ObjectClass-2
- C1740
- UMLS 2011AA ObjectClass-2
- C0593802
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Descripción
Ifpatientdiscontinuedaromataseinhibitorsincelastfollow-up,givedate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0011008
Descripción
Didpatientreceivenon-protocolcancertherapypriortofirstrecurrenceandnotpreviouslyreported?
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Descripción
Non-ProtocolTherapy
Tipo de datos
text
Descripción
Non-ProtocolChemotherapyAdministeredSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15632
- UMLS 2011AA ObjectClass
- C0392920
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Descripción
Non-ProtocolHormoneTherapyAdministeredSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Descripción
Non-protocolbiologicresponsemodifiertherapy,specify
Tipo de datos
text
Descripción
Non-ProtocolRadiationTherapyAdministeredSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0439673 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C1269798 (UMLS CUI-1)
C1519275 (UMLS CUI-1)
C3537125 (UMLS CUI-2)
C0011008 (UMLS 2011AA ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C0290882 (UMLS 2011AA)
C0246421 (UMLS 2011AA)
C1522602 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C1740 (NCI Thesaurus ObjectClass-2)
C0593802 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0011008 (UMLS CUI-1)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C1521902 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)