ID

10261

Beschrijving

CALGB: 49808 RESPONSE/PROGRESSION FORM Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-867B-227A-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-867B-227A-E034-080020C9C0E0

Trefwoorden

Versies (3)
  1. 26-08-12 26-08-12 -
  2. 22-05-15 22-05-15 -
  3. 03-06-15 03-06-15 -
Geüploaded op

22 mei 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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CALGB: 49808 RESPONSE/PROGRESSION FORM

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
    1. No Instruction available.
CALGB Information
Beschrijving

CALGB Information

CALGB Form
Beschrijving

CALGBForm

Datatype

text

CALGB Study No
Beschrijving

CALGBProtocolNumber

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

From
Beschrijving

From

Datatype

text

To (Date of last contact or death)
Beschrijving

To

Datatype

text

Amended data?
Beschrijving

AmendedDataInd

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Patient clinical trial data
Beschrijving

Patient clinical trial data

Patient's Name
Beschrijving

Patient'sName

Datatype

text

Participating Group
Beschrijving

ParticipatingGroup

Datatype

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Beschrijving

PatientHospitalNumber

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Main Member Institution/Adjunct
Beschrijving

MainMemberInstitution/Adjunct

Datatype

text

Participating Group Patient No.
Beschrijving

ParticipatingGroupPatientNo.

Datatype

text

Response Assessment (clinical/radiographic)
Beschrijving

Response Assessment (clinical/radiographic)

Has the patient achieved a response (not previously reported)?
Beschrijving

Hasthepatientachievedaresponse(notpreviouslyreported)?

Datatype

text

Date overall partial response first documented
Beschrijving

Dateoverallpartialresponsefirstdocumented

Datatype

text

Date overall complete response first documented
Beschrijving

Dateoverallcompleteresponsefirstdocumented

Datatype

text

Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
Beschrijving

Hasthepatientbeendiagnosedwithanewprogressionduringthisreportingperiod(notpreviouslyreported)?

Datatype

text

Date response/stable disease last documented (IF NO:)
Beschrijving

Dateresponse/stablediseaselastdocumented

Datatype

text

Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
Beschrijving

Hasthepatientbeendiagnosedwithanewlocal-regionalrecurrencesincesubmissionofthelastfollow-upform?

Datatype

text

Date of new Local-Regional Recurrence
Beschrijving

DateofnewLocal-RegionalRecurrence

Datatype

text

Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
Beschrijving

Site(s)ofFirstLocal-RegionalRecurrence

Datatype

text

How was this recurrence information obtained?
Beschrijving

Howwasthisrecurrenceinformationobtained?

Datatype

text

Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
Beschrijving

Hasthepatientbeendiagnosedwithafirstdistantprogressionsincesubmissionofthelastfollow-upform?

Datatype

text

Date of First Distant Progression
Beschrijving

ProgressionDate,FirstDistant

Datatype

date

Site(s) of First Distant Progression
Beschrijving

Site(s)ofFirstDistantProgression

Datatype

text

How was this progression information obtained?
Beschrijving

Howwasthisprogressioninformationobtained?

Datatype

text

Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
CALGB Information
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
From
Item
From
text
To
Item
To (Date of last contact or death)
text
Item
Amended data?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Patient clinical trial data
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
Item Group
Response Assessment (clinical/radiographic)
Item
Has the patient achieved a response (not previously reported)?
text
CL.2
Code List
Has the patient achieved a response (not previously reported)?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateoverallpartialresponsefirstdocumented
Item
Date overall partial response first documented
text
Dateoverallcompleteresponsefirstdocumented
Item
Date overall complete response first documented
text
Item
Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
text
CL.3
Code List
Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateresponse/stablediseaselastdocumented
Item
Date response/stable disease last documented (IF NO:)
text
Item
Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
text
CL.4
Code List
Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
DateofnewLocal-RegionalRecurrence
Item
Date of new Local-Regional Recurrence
text
Item
Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
text
CL.5
Code List
Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
CL Item
Ipsilateral Breast (Ipsilateral breast)
CL Item
Chest Wall (Chest wall)
CL035093 (NCI Metathesaurus)
C62484 (NCI Thesaurus)
C0205076 (UMLS 2011AA)
CL Item
Axillary Nodes (Axillary nodes)
CL Item
Internal Mammary (Internal mammary)
CL Item
Supraclavicular Nodes (Supraclavicular nodes)
CL Item
Axilla (Axilla)
C12674 (NCI Thesaurus)
C0004454 (UMLS 2011AA)
CL Item
Infraclavicular Nodes (Infraclavicular nodes)
Item
How was this recurrence information obtained?
text
CL.6
Code List
How was this recurrence information obtained?
CL Item
Documented Clinical Assessment (Documented clinical assessment)
CL Item
Patient Self Report Only (Patient self report only)
Item
Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
text
CL.7
Code List
Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ProgressionDate,FirstDistant
Item
Date of First Distant Progression
date
Site(s)ofFirstDistantProgression
Item
Site(s) of First Distant Progression
text
Item
How was this progression information obtained?
text
CL.8
Code List
How was this progression information obtained?
CL Item
Documented Clinical Assessment (Documented clinical assessment)
CL Item
Patient Self Report Only (Patient self report only)
Item Group
Comments
Comments
Item
Comments
text
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