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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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    Similar models

    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
    Back to the top of the page 

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