Description:

S1011 Pre-Randomization Off-Study Form (#52060) Standard or Extended Pelvic Lymphadenectomy in Treating Patients Undergoing Surgery for Invasive Bladder Cancer NCT01224665 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9399F2B7-7E68-06C0-E040-BB89AD436952

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9399F2B7-7E68-06C0-E040-BB89AD436952

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/8/15
  3. 3/24/15
Uploaded on:

March 24, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT01224665

Details

Instructions: For registration step 1, submit this form within 2 weeks after going off study, if patient is off study without randomization to extended vs. standard LND. List treatments that the patient received. Systemic Therapy: List regimens, start and end dates. For multidrug regimens, do not list individual drugs separately; end date would be the date all drugs in the regimen were discontinued. Surgery: List type of surgery, and in the "end date" column, the date of surgery. Radiation: List sites, start and end dates (inclusive of boosts and implants)

Header
Treatment Information
Did the patient receive any treatment (on this registration step)
Off Treatment Reason
Off Study Reason (select one)
Additional Treatment
Will patient receive further treatment?
Vital Status
Vital Status
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