ID
10096
Description
E1505 Hematology/Chemistry Form Chemotherapy With or Without Bevacizumab in Treating Patients With Stage IB, Stage II, or Stage IIIA Non-Small Lung Cancer That Was Removed By Surgery NCT00324805 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=26A1ECBB-6572-4421-E044-0003BA3F9857
Link
Keywords
Versions (5)
- 9/19/12 9/19/12 -
- 1/8/15 1/8/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 3/27/15 3/27/15 - Martin Dugas
Uploaded on
March 27, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer Hematology/Chemistry NCT00324805
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
- StudyEvent: E1505 Hematology/Chemistry Form
Description
ON/Off TREATMENT
Description
Cycle number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Description
PersonOff-TreatmentTimePeriodType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25601
- UMLS 2011AA Property-2
- C1518544
- NCI Thesaurus Property-3
- C25207
- UMLS 2011AA Property-3
- C0040223
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Pre-registration Hematology/chemistry
Description
HematologyAssessedInd-3
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C25217
- NCI Thesaurus ObjectClass
- C16673
- UMLS CUI-1
- C0474523
Description
HematologySpecimenCollectedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16673
- NCI Thesaurus ObjectClass-2
- C19157
- NCI Thesaurus Property
- C25452
- UMLS CUI-1
- C1317250
Description
Peripheral Granulocytes Count (AGC/ANC - If abnormal lab value, CTC AE Attribution Code must be provided - Do not report % granulocytes/neutrophils; report absolute count without decimal.)
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0857490
Description
Peripheral Platelet Count (/mm^3x1000 - If abnormal lab value, CTC AE Attribution Code must be provided)
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- UMLS CUI-1
- C0005821
Description
Hemoglobin
Data type
float
Alias
- NCI Thesaurus Property
- C16676
- UMLS CUI-1
- C0019046
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Description
Units
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C20989
- NCI Thesaurus Property
- C37984
- NCI Thesaurus ValueDomain
- C25709
- UMLS CUI-1
- C1519795
Description
CommonTerminologyCriteriaforAdverseEventsVersion4.0LowLevelTermName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus Property
- C49704
- NCI Thesaurus Property-2
- C45559
- NCI Thesaurus ValueDomain
- C45255
- NCI Thesaurus ValueDomain-2
- C49704
- NCI Thesaurus ValueDomain-3
- C42614
- NCI Thesaurus ValueDomain-4
- C45559
- NCI Thesaurus ValueDomain-5
- C25714
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Description
CTC AE Grade (Provide CTCAEv4 Grade only if extenuating circumstance per the CTCAEv4 grading criteria would trigger a higher grade Hypernatremia/ Hyponatremia than the Sodium lab value would indicate.)
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus Property
- C48309
- NCI Thesaurus Property-2
- C49705
- NCI Thesaurus Property-3
- C25676
- NCI Thesaurus ValueDomain
- C41331
- NCI Thesaurus ValueDomain-2
- C48309
- NCI Thesaurus ValueDomain-3
- C25676
- UMLS CUI-1
- C2985921
Description
Creatinine, serum ULN
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property
- C20200
- UMLS CUI-2
- C1519815
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
Description
Creatinine, Serum
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
Description
LaboratoryProcedureSodiumElectrolytesOutcomeUnspecifiedValue (NA mmol/L or mg/dl - If abnormal lab value, CTC AE Attribution Code must be provided)
Data type
float
Measurement units
- mmol/L
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C830
- NCI Thesaurus Property-3
- C464
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
- UMLS CUI-1
- C0337443
Description
Laboratory Procedure Not Performed
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0022885
- NCI Thesaurus Property
- C25594
- UMLS CUI-2
- C0445106
- NCI Thesaurus Property-2
- C38000
- NCI Thesaurus ObjectClass
- C25294
Description
CTC AE Attribution Code (Leave attribution box blank if no adverse event.)
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Description
DoseChemotherapyAdverseEventModificationStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25488
- NCI Thesaurus Property
- C15632
- NCI Thesaurus Property-2
- C41331
- NCI Thesaurus Property-3
- C25572
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0441472
Description
DoseBevacizumabAdverseEventModificationStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25488
- NCI Thesaurus Property
- C2039
- NCI Thesaurus Property-2
- C41331
- NCI Thesaurus Property-3
- C25572
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0178602
- UMLS CUI-2
- C0796392
- UMLS CUI-3
- C0877248
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INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
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