ID
10181
Beskrivning
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
Länk
Nyckelord
Versioner (2)
- 2012-08-26 2012-08-26 -
- 2015-04-22 2015-04-22 - Martin Dugas
Uppladdad den
22 april 2015
DOI
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Licens
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.
Beskrivning
Treatment Cycle Information
Beskrivning
TotalDoseofDrugsforCycle1
Datatyp
float
Måttenheter
- mg
Alias
- UMLS CUI-1
- C2986497
Beskrivning
Agent Name
Datatyp
text
Alias
- UMLS CUI-1
- C0450442
Beskrivning
ReasonTreatmentEnded
Datatyp
text
Beskrivning
Other,specify(reasontreatmentended)
Datatyp
text
Beskrivning
Werethereanydosemodificationsoradditions/omissionstoprotocoltreatment?
Datatyp
text
Alias
- UMLS CUI-1
- C1707811
Beskrivning
Wereanyoptionalprotocoltherapiesgiven?
Datatyp
boolean
Beskrivning
optionalprotocoltherapyname(s)
Datatyp
text
Beskrivning
Wasanyconcurrentnon-protocoltherapygivenduringprotocoltreatment?
Datatyp
boolean
Alias
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Beskrivning
indicate below (concurrent non-protocol therapy given during protocol treatment) (mark all that apply with an X)
Datatyp
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)