Description:

NSABP PROTOCOL B-35 ON-STUDY FORM Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A051F12F-A237-0456-E034-080020C9C0E0 NCT00053898

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A051F12F-A237-0456-E034-080020C9C0E0

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Versions (3) ▾
  1. 12/18/14
  2. 6/2/15
  3. 6/3/15
Uploaded on:

June 3, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL B-35 ON-STUDY FORM NCT00053898

Form ON (04-30-2002) Submit within 30 days of registration. Attach All applicable Operative Reports and Pathology Reports.

NSABP administration data
Are data amended? (If Yes, circle the amended items in red.)
Biopsy results
Fine Needle Aspiration Cytology (Circle Y or N for Yes, No)
Core (or Tru Cut) Needle Biopsy (Circle Y or N for Yes, No)
Incisional Biopsy (Circle Y or N for Yes, No)
Excisional Biopsy or Lumpectomy (Circle Y or N for Yes, No)
Resection of Lumpectomy Margins (Circle Y or N for Yes, No)
Sentinel Node Biopsy (Circle Y or N for Yes, No)
Axillary Dissection (Circle Y or N for Yes, No)
Disease Description
Tumor Laterality
Was the tumor or microcalcification evident on mammogram?
Was the tumor evident by ultrasound?
Was the tumor palpable?
Were there any breast symptoms? (e.g., pain, nipple discharge or retraction, skin dimpling)
Receptor Status (by Ihc)
ER Status
PgR
Quality Of Life
Did the patient complete the Quality of Life baseline form?
If the baseline QOL form was not completed, indicate the reason below. (Protocol Approved Reasons)

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