ID
10186
Description
CALGB: 40101 TREATMENT SUMMARY SUBSET FORM Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer NCT00041119 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A46C8094-22BA-26B0-E034-080020C9C0E0
Link
Keywords
Versions (2)
- 8/26/12 8/26/12 -
- 4/24/15 4/24/15 - Martin Dugas
Uploaded on
April 24, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer Treatment CALGB 40101 NCT00041119
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 Statistical Center, Data Operations. 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
Breast cancer treatment
Alias
- UMLS CUI-1
- C1511300
Description
Current cycle number
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2045829
Description
BSA
Data type
text
Description
Totaldosageforthiscycle,Doxorubicin
Data type
float
Measurement units
- mg
Alias
- UMLS CUI-1
- C0013089
- UMLS CUI-2
- C0178602
Description
Totaldosageforthiscycle,Cyclophosphamide
Data type
float
Measurement units
- mg
Alias
- UMLS CUI-1
- C0010583
- UMLS CUI-2
- C0178602
Description
Totaldosageforthiscycle,Paclitaxel
Data type
float
Measurement units
- mg
Alias
- UMLS CUI-1
- C0144576
- UMLS CUI-2
- C0178602
Description
Dose adjustments (mark one with an X)
Data type
text
Alias
- UMLS CUI-1
- C2826232
Description
Reasonforadjustment
Data type
text
Alias
- UMLS CUI-1
- C2826286
Description
Specify(reasonforadjustment)
Data type
text
Alias
- UMLS CUI-1
- C2826286
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 Statistical Center, Data Operations. 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.
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C2045829 (UMLS CUI-1)
C0178602 (UMLS CUI-2)
C0178602 (UMLS CUI-2)
C0178602 (UMLS CUI-2)
C0205421 (UMLS CUI-2)
C1556365 (UMLS CUI-2)
C1560130 (UMLS CUI-2)
C1559311 (UMLS CUI-2)
C1560949 (UMLS CUI-2)
C1560950 (UMLS CUI-3)