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ID
10292
Description
ECOG 3200 Long-Term Follow-up Form Combination Chemotherapy With or Without Bevacizumab Compared With Bevacizumab Alone in Treating Patients With Advanced or Metastatic Colorectal Cancer That Has Been Previously Treated Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1703F76-0F9C-684E-E034-080020C9C0E0
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Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 5/23/15 5/23/15 -
- 6/3/15 6/3/15 -
Uploaded on
May 23, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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ECOG 3200 Long-Term Follow-up Form
No Instruction available.
- StudyEvent: ECOG 3200 Long-Term Follow-up Form
Similar models
No Instruction available.
- StudyEvent: ECOG 3200 Long-Term Follow-up Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
StepNo.
Item
Step No.
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
IntervalReportFromDate
Item
Interval Report From Date
date
IntervalReportToDate
Item
Interval Report To Date
date
Patient'sVitalStatus
Item
Patient's Vital Status
text
DeathReason
Item
Death Reason
text
DeathReason,Specify
Item
Death Reason, Specify
text
DeathDate/LastContactDate
Item
Death Date/Last Contact Date
date
CancerFollow-upStatusInd
Item
Cancer Follow-up Status Ind
text
CancerFollow-upStatusDate
Item
Cancer Follow-up Status Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
ProgressionInd
Item
Progression Ind
text
ProgressionDate
Item
Progression Date
date
FormalProgressiveDiseaseDiagnosis
Item
Formal Progressive Disease Diagnosis
text
ProgressionSite
Item
Progression Site
text
NewPrimaryCancerInd
Item
New Primary Cancer Ind
text
NewPrimarySite
Item
New Primary Site
text
LateAdverseEventInd
Item
Late Adverse Event Ind
text
Nonprotocoltherapypriortofirstprogression
Item
Non protocol therapy prior to first progression
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date
NewPrimaryCancerDate
Item
New Primary Cancer Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)