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:
No DOI assigned. To request one pleaselog in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Bladder Cancer NCT01224665

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