ID
10042
Beschrijving
FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer NCT00023829 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A56DC7B3-8145-10C4-E034-080020C9C0E0
Link
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 21-03-15 21-03-15 - Martin Dugas
Geüploaded op
21 maart 2015
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0 Legacy
Model Commentaren :
Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.
Itemgroep Commentaren voor :
Item Commentaren voor :
U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.
Prostate Cancer adjuvant therapy (FS RTOG Phase III Study NCT00023829)
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 characteristics
Alias
- UMLS CUI-1
- C0815172
Beschrijving
Patient'sVitalStatus
Datatype
text
Beschrijving
DeathDate/LastContactDate
Datatype
date
Beschrijving
Causeofdeath
Datatype
text
Beschrijving
PrimaryCauseDeathOtherReasonSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25251
- UMLS 2011AA ObjectClass-2
- C0205225
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
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
PERFORMANCESTATUS
Datatype
text
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
BiopsyDate
Datatype
date
Beschrijving
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0242656
Beschrijving
ProgressionInd,Biochemical
Datatype
text
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
- UMLS CUI-1
- C0027643
Beschrijving
ProgressionDate,FirstLocal-Regional
Datatype
date
Alias
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0027643
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
Beschrijving
ProgressionDate,FirstDistant
Datatype
date
Beschrijving
Site(s)ofFirstDistantProgression
Datatype
text
Beschrijving
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Datatype
text
Beschrijving
Other,specify(methodusedtodeterminedistantprogression)
Datatype
text
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
Beschrijving
HQUse
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
- UMLS CUI-2
- C0087111
Beschrijving
Non-ProtocolTherapyAdministeredType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- NCI Thesaurus Property
- C25382
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Beschrijving
Non-ProtocolTherapyDate,First
Datatype
date
Beschrijving
Specify(non-protocolprostatecancertherapy)
Datatype
text
Beschrijving
Radiation therapy
Alias
- UMLS CUI-1
- C1522449
Beschrijving
TOTALDOSETOPROSTATE
Datatype
float
Maateenheden
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0033572
Beschrijving
TOTALDOSETOPELVIS
Datatype
float
Maateenheden
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0030797
Beschrijving
RTBeginDate
Datatype
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0808070
Beschrijving
RTEndDate
Datatype
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0806020
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
- UMLS CUI-1
- C0392360
- UMLS CUI-2
- C1522449
- UMLS CUI-3
- C1512900
Beschrijving
REASONRADIATIONTHERAPYTREATMENTENDED
Datatype
text
Alias
- UMLS CUI-1
- C3166257
- UMLS CUI-2
- C1522449
Beschrijving
Alternativetherapy,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
Other,specify(reasonradiationtherapyended)
Datatype
text
Beschrijving
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beschrijving
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Beschrijving
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatype
text
Beschrijving
CTC ADVERSE EVENT TERM
Datatype
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Beschrijving
COMMONTOXICITYGENERALCATEGORY
Datatype
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C0683312
Beschrijving
CTC ADVERSE EVENT GRADE
Datatype
integer
Alias
- UMLS CUI-1
- C2985911
Beschrijving
CTC ADVERSE EVENT ONSET DATE (GRADE >=3)
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0332162
Beschrijving
CTCADVERSEEVENTATTRIBUTIONCODE
Datatype
text
Alias
- UMLS CUI-1
- C1706735
Beschrijving
Othercause,specify(adverseeventattribution)
Datatype
text
Beschrijving
Specify(adverseevent)
Datatype
text
Beschrijving
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1527021
- UMLS CUI-2
- C1522602
Beschrijving
URINARYINCONTINENCE,SeverityGrade
Datatype
text
Alias
- UMLS CUI-1
- C0042024
- UMLS CUI-2
- C0392364
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
ERECTILE IMPOTENCE, Severity Grade (0-3)
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
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)
C0030705 (UMLS 2011AA ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C0205225 (UMLS 2011AA ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
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)
C25180 (NCI Thesaurus ValueDomain-2)
C0242656 (UMLS CUI-1)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C0027643 (UMLS CUI-1)
C0027643 (UMLS CUI-2)
C1521733 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C1521733 (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)
C25180 (NCI Thesaurus ValueDomain-2)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C0549184 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C2169193 (UMLS CUI-1)
C0033572 (UMLS CUI-2)
C2169193 (UMLS CUI-1)
C0030797 (UMLS CUI-2)
C0808070 (UMLS CUI-2)
C0806020 (UMLS CUI-2)
C1298908 (UMLS 2011AA)
C15313 (NCI Thesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C25211 (NCI Thesaurus Property-2)
C25542 (NCI Thesaurus Property-3)
C0392360 (UMLS CUI-1)
C1522449 (UMLS CUI-2)
C1512900 (UMLS CUI-3)
C1522449 (UMLS CUI-2)
C25180 (NCI Thesaurus ValueDomain-2)
C1519275 (UMLS CUI-1)
C3537125 (UMLS CUI-2)
C2826934 (UMLS CUI-2)
C0683312 (UMLS CUI-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 CUI-1)
C0877248 (UMLS CUI-2)
C0332162 (UMLS CUI-3)
C0439673 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS CUI-1)
C1522602 (UMLS CUI-2)
C0392364 (UMLS CUI-2)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
Geen commentaren