ID

10486

Description

E3200 Treatment Summary Form NCT00025337 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=A16FACD4-477B-6CEF-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16FACD4-477B-6CEF-E034-080020C9C0E0

Keywords

Versions (3)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 6/2/15 6/2/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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E3200 Treatment Summary Form NCT00025337

English

No Instruction available.

1 forms  
  1. StudyEvent: E3200 Treatment Summary Form
    1. No Instruction available.
Treatment Summary
Description

Treatment Summary

Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Step No.
Description

StepNo.

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Treatment Arm Number
Description

TreatmentArmNumber

Data type

text

Treatment Begin Date
Description

TreatmentBeginDate

Data type

date

Treatment End Date
Description

TreatmentEndDate

Data type

date

Off Treatment Reason
Description

OffTreatmentReason

Data type

text

Off Treatment Reason, Complicating Disease
Description

OffTreatmentReason,ComplicatingDisease

Data type

text

Off Treatment Reason, Other
Description

OffTreatmentReason,Other

Data type

text

Total Course Number
Description

TotalCourseNumber

Data type

double

Dose Modification (Change)
Description

DoseModification(Change)

Data type

text

Dose Modification (Change)
Description

DoseModification(Change)

Data type

text

Therapy Modification Name
Description

TherapyModificationName

Data type

text

Therapy Modification Type
Description

TherapyModificationType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25572
Therapy Modification Reason
Description

TherapyModificationReason

Data type

text

Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E3200 Treatment Summary Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Treatment Summary
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)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
TreatmentArmNumber
Item
Treatment Arm Number
text
TreatmentBeginDate
Item
Treatment Begin Date
date
TreatmentEndDate
Item
Treatment End Date
date
OffTreatmentReason
Item
Off Treatment Reason
text
OffTreatmentReason,ComplicatingDisease
Item
Off Treatment Reason, Complicating Disease
text
OffTreatmentReason,Other
Item
Off Treatment Reason, Other
text
TotalCourseNumber
Item
Total Course Number
double
DoseModification(Change)
Item
Dose Modification (Change)
text
DoseModification(Change)
Item
Dose Modification (Change)
text
TherapyModificationName
Item
Therapy Modification Name
text
TherapyModificationType
Item
Therapy Modification Type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
TherapyModificationReason
Item
Therapy Modification Reason
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
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