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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

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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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