ID
10181
Description
CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; All Patients Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50D76F4-2138-330D-E034-080020C9C0E0
Lien
Mots-clés
Versions (2)
- 26/08/2012 26/08/2012 -
- 22/04/2015 22/04/2015 - Martin Dugas
Téléchargé le
22 avril 2015
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer ADJUVANT TREATMENT CALGB 49907 NCT00024102
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Description
Treatment Cycle Information
Description
TotalDoseofDrugsforCycle1
Type de données
float
Unités de mesure
- mg
Alias
- UMLS CUI-1
- C2986497
Description
Agent Name
Type de données
text
Alias
- UMLS CUI-1
- C0450442
Description
ReasonTreatmentEnded
Type de données
text
Description
Other,specify(reasontreatmentended)
Type de données
text
Description
Werethereanydosemodificationsoradditions/omissionstoprotocoltreatment?
Type de données
text
Alias
- UMLS CUI-1
- C1707811
Description
Wereanyoptionalprotocoltherapiesgiven?
Type de données
boolean
Description
optionalprotocoltherapyname(s)
Type de données
text
Description
Wasanyconcurrentnon-protocoltherapygivenduringprotocoltreatment?
Type de données
boolean
Alias
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Description
indicate below (concurrent non-protocol therapy given during protocol treatment) (mark all that apply with an X)
Type de données
text
Alias
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25509 (NCI Thesaurus ValueDomain-2)
C1279901 (UMLS 2011AA ValueDomain-2)
C0010583 (UMLS CUI-1)
C0025677 (UMLS CUI-1)
C0016360 (UMLS CUI-1)
C0671970 (UMLS CUI-1)
C1298908 (UMLS 2011AA)
C0087111 (UMLS CUI-2)
C0087111 (UMLS CUI-2)