ID

10360

Description

STAGE I - III LUNG CANCER PRESTUDY FORM (With SI Units for use by NCIC institutions only) S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4AA8-361C-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4AA8-361C-E034-080020C9C0E0

Keywords

Versions (5)
  1. 9/19/12 9/19/12 -
  2. 5/28/15 5/28/15 -
  3. 6/3/15 6/3/15 -
  4. 7/31/15 7/31/15 - Martin Dugas
  5. 9/20/21 9/20/21 -
Uploaded on

May 28, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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STAGE I - III BREAST CANCER PRESTUDY FORM (With SI Units for use by NCIC institutions only)

English

No Instruction available.

1 forms  
  1. StudyEvent: STAGE I - III BREAST CANCER PRESTUDY FORM (With SI Units for use by NCIC institutions only)
    1. No Instruction available.
SWOG clinical trial administrative data
Description

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C16154
UMLS 2011AA ValueDomain
C1704379
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

StudyNo.

Data type

double

Pt. ID (Groups other than SWOG )
Description

Pt.ID

Data type

text

Patient And Disease Description
Description

Patient And Disease Description

Height (cm)
Description

Height

Data type

text

Weight (kg)
Description

Weight

Data type

text

BSA (m 2)
Description

BSA

Data type

text

Performance Status
Description

PerformanceStatus

Data type

text

Weight Loss in Previous Six Months
Description

WeightLossPriorSixMonths

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3445
UMLS 2011AA Property
C0043096
FEV1 (L)
Description

FEV1

Data type

text

DLCO (%)
Description

DLCO

Data type

text

Date of Initial Diagnosis of Primary Tumor
Description

FirstPositiveBiopsyDate

Data type

date

Histologic Type
Description

HistologicType

Data type

text

Other, Specify
Description

Other,Specify

Data type

text

Tumor Stage T-status (select one)
Description

TumorStageT-status

Data type

text

Node Stage N-status (select one)
Description

NodeStageN-status

Data type

text

Current Laboratory Values (si Units)
Description

Current Laboratory Values (si Units)

Albumin (g%)
Description

Albumin

Data type

text

LDH (U/I)
Description

LDH

Data type

text

LDH ULN
Description

LDHULN

Data type

text

Notes
Description

Notes

Notes
Description

Notes

Data type

text

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No Instruction available.

1 forms
  1. StudyEvent: STAGE I - III BREAST CANCER PRESTUDY FORM (With SI Units for use by NCIC institutions only)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
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 )
double
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
Item Group
Patient And Disease Description
Height
Item
Height (cm)
text
Weight
Item
Weight (kg)
text
BSA
Item
BSA (m 2)
text
PerformanceStatus
Item
Performance Status
text
Item
Weight Loss in Previous Six Months
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3445 (NCI Thesaurus Property)
C0043096 (UMLS 2011AA Property)
CL.1
Code List
Weight Loss in Previous Six Months
CL Item
<5% (<5%)
CL Item
5 - < 10% (5 - < 10%)
CL Item
10 - < 20% (10 - < 20%)
CL Item
>=20% (>=20%)
FEV1
Item
FEV1 (L)
text
DLCO
Item
DLCO (%)
text
FirstPositiveBiopsyDate
Item
Date of Initial Diagnosis of Primary Tumor
date
Item
Histologic Type
text
CL.2
Code List
Histologic Type
CL Item
Squamous (Squamous)
CL Item
Adenocarcinoma (Adenocarcinoma)
CL Item
Large Cell Undifferentiated (Large Cell Undifferentiated)
CL Item
Bronchioloalveolar (BAC) (Bronchioloalveolar (BAC))
CL Item
NSCLC, NOS (NSCLC, NOS)
CL Item
Other, Specify (Other, Specify)
Other,Specify
Item
Other, Specify
text
Item
Tumor Stage T-status (select one)
text
CL.3
Code List
Tumor Stage T-status (select one)
CL Item
T1 (T1)
CL Item
T2 (T2)
CL Item
T3 (T3)
CL Item
T4 (T4)
Item
Node Stage N-status (select one)
text
CL.4
Code List
Node Stage N-status (select one)
CL Item
N0 (N0)
CL Item
N1 (N1)
CL Item
N2 (N2)
CL Item
N3 (N3)
Item Group
Current Laboratory Values (si Units)
Albumin
Item
Albumin (g%)
text
LDH
Item
LDH (U/I)
text
LDHULN
Item
LDH ULN
text
Item Group
Notes
Notes
Item
Notes
text
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