ID

10590

Beskrivning

CALGB: 80101 Follow-up/Relapse Form NCT00052910 Chemotherapy and Radiation Therapy After Surgery in Treating Patients With Stomach or Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A3614107-525D-15BB-E034-080020C9C0E0

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A3614107-525D-15BB-E034-080020C9C0E0

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-05-28 2015-05-28 -
  3. 2015-06-03 2015-06-03 -
Uppladdad den

3 juni 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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CALGB: 80101 Follow-up/Relapse Form NCT00052910

No Instruction available.

  1. StudyEvent: CALGB: 80101 Follow-up/Relapse Form
    1. No Instruction available.
CALGB clinical trial administrative data
Beskrivning

CALGB clinical trial administrative data

CALGB Form
Beskrivning

CALGBForm

Datatyp

text

CALGB Study No
Beskrivning

CALGBProtocolNumber

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

Reporting period start date
Beskrivning

IntervalReportFromDate

Datatyp

date

To: (Date of Last contact or death)
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Are data amended?
Beskrivning

AmendedDataInd

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
patient demographics
Beskrivning

patient demographics

Patient's Name
Beskrivning

Patient'sName

Datatyp

text

Participating Group
Beskrivning

ParticipatingGroup

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital No
Beskrivning

PatientHospitalNumber

Datatyp

text

Participating Group Protocol No
Beskrivning

ParticipatingGroupProtocolNo.

Datatyp

text

Institution/Affiliate
Beskrivning

MainMemberInstitution/Affiliate

Datatyp

text

Participating Group Patient ID
Beskrivning

ParticipatingGroupPatientID

Datatyp

text

Patient's vital status (mark one with an X)
Beskrivning

Patient'sVitalStatus

Datatyp

text

Primary cause of death (mark one with an X)
Beskrivning

DeathReason

Datatyp

text

Due to other cause, specify
Beskrivning

DeathReason,Specify

Datatyp

text

Notice Of Progression/relapse
Beskrivning

Notice Of Progression/relapse

Has the patient developed a progression (or relapse) during this time period that has not been previously reported?
Beskrivning

DiseaseRelapseProgressionInd-3

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C38155
UMLS 2011AA Property
C0277556
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus Property
C19987
UMLS 2011AA Property
C0242656
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Date progressive or recurrent disease diagnosed
Beskrivning

Dateprogressiveorrecurrentdiseasediagnosed

Datatyp

text

Site(s) of progression/relapse (mark all that apply with an X)
Beskrivning

Site(s)ofprogression/relapse

Datatyp

text

Other, specify (sites of progression)
Beskrivning

Other,specify(sitesofprogression)

Datatyp

text

Lymph nodes, specify site
Beskrivning

ProgressionSite,LymphNodes

Datatyp

text

Stat Use Only
Beskrivning

Stat Use Only

Location of relapse
Beskrivning

RelapseLocationType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C18265
Notice Of New Primary
Beskrivning

Notice Of New Primary

Has a new primary cancer or AML/MDS been diagnosed that has not been previously reported?
Beskrivning

Hasanewprimarycancerormyelodysplasticsyndrome(MDS)beendiagnosedthathasnotbeenpreviouslyreported?

Datatyp

text

Date of diagnosis
Beskrivning

NewPrimaryCancerDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Site(s) of new primary
Beskrivning

NewPrimarySite

Datatyp

text

Completed by (First Name, Last Name)
Beskrivning

CompletedBy

Datatyp

text

Date completed
Beskrivning

DateCompleted

Datatyp

date

Ccrr Module For Calgb: 80101 Follow-up/relapse Form
Beskrivning

Ccrr Module For Calgb: 80101 Follow-up/relapse Form

Similar models

No Instruction available.

  1. StudyEvent: CALGB: 80101 Follow-up/Relapse Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
CALGB clinical trial administrative data
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
IntervalReportFromDate
Item
Reporting period start date
date
DeathDate/LastContactDate
Item
To: (Date of Last contact or death)
date
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
patient demographics
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital No
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
Item
Patient's vital status (mark one with an X)
text
Code List
Patient's vital status (mark one with an X)
CL Item
Alive (Alive)
CL Item
Dead (Dead)
CL Item
Lost (Lost)
Item
Primary cause of death (mark one with an X)
text
Code List
Primary cause of death (mark one with an X)
CL Item
Due To Protocol Treatment (Due to protocol treatment)
CL Item
Due To This Disease (Due to this disease)
CL Item
Due To Other Cause, Specify (Due to other cause, specify)
DeathReason,Specify
Item
Due to other cause, specify
text
Item Group
Notice Of Progression/relapse
Item
Has the patient developed a progression (or relapse) during this time period that has not been previously reported?
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C19987 (NCI Thesaurus Property)
C0242656 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Code List
Has the patient developed a progression (or relapse) during this time period that has not been previously reported?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateprogressiveorrecurrentdiseasediagnosed
Item
Date progressive or recurrent disease diagnosed
text
Item
Site(s) of progression/relapse (mark all that apply with an X)
text
Code List
Site(s) of progression/relapse (mark all that apply with an X)
CL Item
Anastomosis (Anastomosis)
C15609 (NCI Thesaurus)
C0677554 (UMLS 2011AA)
CL Item
Tumor Bed/regional Organs (Tumor bed/regional organs)
CL Item
Residual Stomach (Residual stomach)
CL Item
Lymph Nodes (Lymph nodes)
CL Item
Mesentery/peritoneum (Mesentery/peritoneum)
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Cns/brain (CNS/Brain)
CL Item
Other, Specify (Other, specify)
Other,specify(sitesofprogression)
Item
Other, specify (sites of progression)
text
ProgressionSite,LymphNodes
Item
Lymph nodes, specify site
text
Item Group
Stat Use Only
Item
Location of relapse
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18265 (NCI Thesaurus ObjectClass)
Code List
Location of relapse
CL Item
Local-regional (Local-regional)
C25388 (NCI Thesaurus)
C1947913 (UMLS 2011AA)
CL Item
Distant (Distant)
C25321 (NCI Thesaurus)
C0443203 (UMLS 2011AA)
Item Group
Notice Of New Primary
Item
Has a new primary cancer or AML/MDS been diagnosed that has not been previously reported?
text
Code List
Has a new primary cancer or AML/MDS been diagnosed that has not been previously reported?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
NewPrimaryCancerDate
Item
Date of diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
Site(s) of new primary
text
CompletedBy
Item
Completed by (First Name, Last Name)
text
DateCompleted
Item
Date completed
date
Item Group
Ccrr Module For Calgb: 80101 Follow-up/relapse Form

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