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10090

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SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226) S0226 Anastrozole With or Without Fulvestrant as First-Line Therapy in Postmenopausal Women With Metastatic Breast Cancer NCT00075764 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C322202A-32BF-25B7-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C322202A-32BF-25B7-E034-0003BA12F5E7

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Versies (3)
  1. 26-08-12 26-08-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 25-03-15 25-03-15 - Martin Dugas
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25 maart 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Breast Cancer SWOG baseline tumor assessment NCT00075764

    Engels

    No Instruction available.

    1 Formulieren  
    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226)
      1. No Instruction available.
    Header
    Beschrijving

    Header

    SWOG Patient ID
    Beschrijving

    Trial subject ID SWOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    SWOG Study No.
    Beschrijving

    Protocol ID SWOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Registration Step
    Beschrijving

    Registration Number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Patient Initials (L, F M)
    Beschrijving

    Patient Initials

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution/Affiliate
    Beschrijving

    Institution Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Physician (Groups Other than SWOG)
    Beschrijving

    Investigator Name

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Group Name
    Beschrijving

    Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Study No.
    Beschrijving

    Study Number Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Please refer to section 10.0 of the protocol for definitions. Choose all measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total to follow as target lesions. Record any remaining measurable lesions and all non-measurable lesions as non-terget lesions.)
    Beschrijving

    Trial subject ID Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Comments
    Beschrijving

    Comments

    Datatype

    text

    Target Lesions
    Beschrijving

    Target Lesions

    Alias
    UMLS CUI-1
    C2986546
    Lesion Number
    Beschrijving

    LesionSiteNumber

    Datatype

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C3824
    NCI Thesaurus Property
    C25341
    UMLS CUI-1
    C0449791
    Target Lesion Site
    Beschrijving

    LesionTargetSite

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    NCI Thesaurus ObjectClass
    C3824
    NCI Thesaurus Property
    C25341
    NCI Thesaurus Property-2
    C25702
    UMLS CUI-1
    C1521840
    UMLS CUI-2
    C1515974
    Longest Diameter
    Beschrijving

    Longest Diameter

    Datatype

    float

    Maateenheden
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C3824
    NCI Thesaurus Property
    C25285
    NCI Thesaurus Property-2
    C25558
    NCI Thesaurus ValueDomain
    C25209
    NCI Thesaurus ValueDomain-2
    C25285
    UMLS CUI-1
    C0221198
    UMLS CUI-2
    C1301886
    UMLS CUI-3
    C1522425
    cm
    Assessment Type
    Beschrijving

    Assessment Type

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus ObjectClass
    C20989
    NCI Thesaurus Property
    C16847
    UMLS CUI-1
    C2911685
    Assessment Date
    Beschrijving

    AssessmentDate

    Datatype

    date

    Non-target Disease
    Beschrijving

    Non-target Disease

    Alias
    UMLS CUI-1
    C2986547
    Lesion Number
    Beschrijving

    Lesion,ReferenceNumber

    Datatype

    integer

    Alias
    UMLS CUI-1
    C0449791
    Lesion site
    Beschrijving

    Lesion site

    Datatype

    text

    Extent
    Beschrijving

    Extent

    Datatype

    text

    Assessment Type
    Beschrijving

    Assessment Type

    Datatype

    text

    Alias
    UMLS CUI-1
    C2911685
    Other tests
    Beschrijving

    Other tests

    Tests/studies
    Beschrijving

    Tests/studies

    Datatype

    text

    Terug naar het begin van de pagina

    Similar models

    No Instruction available.

    1 Formulieren
    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Patient Initials
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Investigator Name
    Item
    Physician (Groups Other than SWOG)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Participating Group
    Item
    Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Please refer to section 10.0 of the protocol for definitions. Choose all measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total to follow as target lesions. Record any remaining measurable lesions and all non-measurable lesions as non-terget lesions.)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Comments
    Item
    Comments
    text
    Item Group
    Target Lesions
    C2986546 (UMLS CUI-1)
    Lesion Number
    Item
    Lesion Number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C25341 (NCI Thesaurus Property)
    C0449791 (UMLS CUI-1)
    LesionTargetSite
    Item
    Target Lesion Site
    text
    C13717 (NCI Thesaurus ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C25341 (NCI Thesaurus Property)
    C25702 (NCI Thesaurus Property-2)
    C1521840 (UMLS CUI-1)
    C1515974 (UMLS CUI-2)
    Longest Diameter of Lesion
    Item
    Longest Diameter
    float
    C3824 (NCI Thesaurus ObjectClass)
    C25285 (NCI Thesaurus Property)
    C25558 (NCI Thesaurus Property-2)
    C25209 (NCI Thesaurus ValueDomain)
    C25285 (NCI Thesaurus ValueDomain-2)
    C0221198 (UMLS CUI-1)
    C1301886 (UMLS CUI-2)
    C1522425 (UMLS CUI-3)
    Item
    Assessment Type
    text
    C25284 (NCI Thesaurus ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C16847 (NCI Thesaurus Property)
    C2911685 (UMLS CUI-1)
    CL.1
    Code List
    Assessment Type
    CL Item
    Palpation (Palpation)
    C0030247 (UMLS CUI-1)
    CL Item
    Visualization (Visualization)
    C0178707 (UMLS CUI-1)
    CL Item
    Colposcopy (Colposcopy)
    C0009417 (UMLS CUI-1)
    CL Item
    Endoscopy (Endoscopy)
    C0014245 (UMLS CUI-1)
    CL Item
    Plain film/X-ray without contrast (Plain film/X-ray without contrast)
    C1306645 (UMLS CUI-1)
    CL Item
    Plain film/X-ray with contrast (Plain film/X-ray with contrast)
    C3267101 (UMLS CUI-1)
    CL Item
    CT Scan (CT scan)
    C0040405 (UMLS CUI-1)
    CL Item
    MRI (MRI scan)
    C0024485 (UMLS CUI-1)
    CL Item
    Radioisotope scan (Radioisotope scan)
    C0034606 (UMLS CUI-1)
    CL Item
    Ultrasound (Ultrasound)
    C64384 (NCI Thesaurus)
    C1456803 (UMLS CUI-1)
    CL Item
    PET scan (PET scan)
    C0032743 (UMLS CUI-1)
    CL Item
    Spiral CT Scan (Spiral CT scan)
    C0860888 (UMLS CUI-1)
    CL Item
    Cystoscopy (Cystoscopy)
    C16482 (NCI Thesaurus)
    C0010702 (UMLS CUI-1)
    CL Item
    Histology (Histologic confirmation)
    C16681 (NCI Thesaurus)
    C0019638 (UMLS CUI-1)
    CL Item
    Cytology (Cytologic confirmation)
    C16491 (NCI Thesaurus)
    C0010819 (UMLS CUI-1)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS CUI-1)
    AssessmentDate
    Item
    Assessment Date
    date
    Item Group
    Non-target Disease
    C2986547 (UMLS CUI-1)
    Lesion Number
    Item
    Lesion Number
    integer
    C0449791 (UMLS CUI-1)
    Lesion site
    Item
    Lesion site
    text
    Extent
    Item
    Extent
    text
    Item
    Assessment Type
    text
    C2911685 (UMLS CUI-1)
    CL.1
    Code List
    Assessment Type
    CL Item
    Palpation (Palpation)
    C0030247 (UMLS CUI-1)
    CL Item
    Visualization (Visualization)
    C0178707 (UMLS CUI-1)
    CL Item
    Colposcopy (Colposcopy)
    C0009417 (UMLS CUI-1)
    CL Item
    Endoscopy (Endoscopy)
    C0014245 (UMLS CUI-1)
    CL Item
    Plain film/X-ray without contrast (Plain film/X-ray without contrast)
    C1306645 (UMLS CUI-1)
    CL Item
    Plain film/X-ray with contrast (Plain film/X-ray with contrast)
    C3267101 (UMLS CUI-1)
    CL Item
    CT Scan (CT scan)
    C0040405 (UMLS CUI-1)
    CL Item
    MRI (MRI scan)
    C0024485 (UMLS CUI-1)
    CL Item
    Radioisotope scan (Radioisotope scan)
    C0034606 (UMLS CUI-1)
    CL Item
    Ultrasound (Ultrasound)
    C64384 (NCI Thesaurus)
    C1456803 (UMLS CUI-1)
    CL Item
    PET scan (PET scan)
    C0032743 (UMLS CUI-1)
    CL Item
    Spiral CT Scan (Spiral CT scan)
    C0860888 (UMLS CUI-1)
    CL Item
    Cystoscopy (Cystoscopy)
    C16482 (NCI Thesaurus)
    C0010702 (UMLS CUI-1)
    CL Item
    Histology (Histologic confirmation)
    C16681 (NCI Thesaurus)
    C0019638 (UMLS CUI-1)
    CL Item
    Cytology (Cytologic confirmation)
    C16491 (NCI Thesaurus)
    C0010819 (UMLS CUI-1)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS CUI-1)
    Item Group
    Other tests
    Tests/studies
    Item
    Tests/studies
    text
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