ID

10196

Description

OFF TREATMENT NOTICE S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC NCT00020709 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4EE1-361C-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4EE1-361C-E034-080020C9C0E0

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 4/30/15 4/30/15 - Martin Dugas
Uploaded on

April 30, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung cancer OFF TREATMENT NCT00020709

English

No Instruction available.

1 forms  
  1. StudyEvent: OFF TREATMENT NOTICE
    1. No Instruction available.
Header
Description

Header

Alias
UMLS CUI-1
C1320722
SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

Registration Step

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ValueDomain-2
C16154
UMLS CUI-1
C1514821
Patient Initials (L, F,M)
Description

PatientInitials

Data type

text

Institution / Affiliate
Description

Institution/Affiliate

Data type

text

Physician
Description

Physician

Data type

text

Group Name (Groups other than SWOG )
Description

GroupName

Data type

text

Study No. (Groups other than SWOG )
Description

Study No. (Groups other than SWOG )

Data type

text

Pt. ID (Groups other than SWOG )
Description

Pt.ID

Data type

text

Patient data
Description

Patient data

Alias
UMLS CUI-1
C2707520
Treatment Start Date
Description

Treatment Start Date

Data type

date

Alias
UMLS CUI-1
C3173309
Treatment End Date
Description

Treatment End Date

Data type

date

Alias
UMLS CUI-1
C1531784
Regimen or Procedure or Site(s)
Description

RegimenorProcedureorSite(s)

Data type

text

Date of Last Contact (or death)
Description

DateofLastContact(ordeath):

Data type

date

Alias
UMLS CUI-1
C0805839
Vital Status
Description

Vital Status

Data type

text

Alias
UMLS CUI-1
C1148433
Notes
Description

Notes

Data type

text

Off treatment
Description

Off treatment

Alias
UMLS CUI-1
C1518544
Off Treatment Reason (select one:)
Description

OffTreatmentReason

Data type

text

Alias
UMLS CUI-1
C1518544
UMLS CUI-2
C0566251
Medically required, due to toxicity, specify
Description

Medicallyrequired,duetotoxicity,specify:

Data type

text

Patient refused, due to toxicity, specify
Description

Patientrefused,duetotoxicity,specify:

Data type

text

Progression or relapse. Sites
Description

Progressionorrelapse.Sites:

Data type

text

Other, specify
Description

Other,specify:

Data type

text

Date of completion, progression, death or decision to discontinue therapy (Off Treatment Date)
Description

Dateofcompletion,progression,deathordecisiontodiscontinuetherapy:

Data type

date

Alias
UMLS CUI-1
C1518544
UMLS CUI-2
C0011008
Will patient receive further treatment?
Description

Willpatientreceivefurthertreatment?

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1514821 (UMLS CUI-1)
PatientInitials
Item
Patient Initials (L, F,M)
text
Institution/Affiliate
Item
Institution / Affiliate
text
Physician
Item
Physician
text
GroupName
Item
Group Name (Groups other than SWOG )
text
StudyNo.
Item
Study No. (Groups other than SWOG )
text
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
Item Group
Patient data
C2707520 (UMLS CUI-1)
TreatmentStartDate
Item
Treatment Start Date
date
C3173309 (UMLS CUI-1)
TreatmentEndDate
Item
Treatment End Date
date
C1531784 (UMLS CUI-1)
Regimen or Procedure or Site(s)
Item
Regimen or Procedure or Site(s)
text
Date of Last Contact
Item
Date of Last Contact (or death)
date
C0805839 (UMLS CUI-1)
Item
Vital Status
text
C1148433 (UMLS CUI-1)
CL.6
Code List
Vital Status
CL Item
Alive (Alive)
C2584946 (UMLS CUI-1)
CL Item
Dead (Dead)
C0011065 (UMLS CUI-1)
Notes
Item
Notes
text
Item Group
Off treatment
C1518544 (UMLS CUI-1)
Item
Off Treatment Reason (select one:)
text
C1518544 (UMLS CUI-1)
C0566251 (UMLS CUI-2)
CL.1
Code List
Off Treatment Reason (select one:)
CL Item
Treatment completed per protocol criteria (Treatment completed per protocol criteria)
CL Item
Medically required, due to toxicity, specify (Medically required, due to toxicity, specify)
Item
Medically required, due to toxicity, specify
text
CL.2
Code List
Medically required, due to toxicity, specify
CL Item
Pt_refused_due_to_toxic2006857 (Patient refused, due to toxicity, specify)
Item
Patient refused, due to toxicity, specify
text
CL.3
Code List
Patient refused, due to toxicity, specify
CL Item
Pt_refused_oth_than_tox2006859 (Patient refused, other than toxicity, specify)
CL Item
Prog_or_relapse_sites_2006860 (Progression or relapse. Sites)
Item
Progression or relapse. Sites
text
CL.4
Code List
Progression or relapse. Sites
CL Item
Death_attach_notice_of_2006862 (Death (attach Notice of Death form))
CL Item
Other_specify_2006863 (Other, specify)
Other,specify:
Item
Other, specify
text
Off Treatment Date
Item
Date of completion, progression, death or decision to discontinue therapy (Off Treatment Date)
date
C1518544 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Item
Will patient receive further treatment?
text
CL.5
Code List
Will patient receive further treatment?
CL Item
No (No)
CL Item
Yes, specify (Yes, specify)
CL Item
Unknown (Unknown)
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