ID

10603

Description

ECOG 3200 Non-Protocol Therapy 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=A170529B-26A1-6913-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A170529B-26A1-6913-E034-080020C9C0E0

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 5/23/15 5/23/15 -
  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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ECOG 3200 Non-Protocol Therapy Form NCT00025337

English

No Instruction available.

1 forms  
  1. StudyEvent: ECOG 3200 Non-Protocol Therapy Form
    1. No Instruction available.
ECOG Non-Protocol Therapy Form
Description

ECOG Non-Protocol Therapy Form

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
Non-Protocol Therapy Date, First
Description

Non-ProtocolTherapyDate,First

Data type

date

Non-Protocol Chemotherapy Ind
Description

Non-ProtocolChemotherapyInd

Data type

text

Non-Protocol Hormonal Therapy Ind
Description

Non-ProtocolHormonalTherapyInd

Data type

text

Non-Protocol Immunotherapy Ind
Description

Non-ProtocolImmunotherapyInd

Data type

text

Non-Protocol HDC/ASCT Ind
Description

Non-ProtocolHDC/ASCTInd

Data type

text

Non-Protocol Surgery Ind
Description

Non-protocolSurgeryPerformedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus ObjectClass
C25590
UMLS 2011AA ObjectClass
C1518384
Non-Protocol RT Ind
Description

Non-ProtocolRTInd

Data type

text

Other Non-Protocol Therapy Ind
Description

OtherNon-ProtocolTherapyInd

Data type

text

Other Non-Protocol Therapy Name
Description

OtherNon-ProtocolTherapyName

Data type

text

Non-Protocol Therapy given for disease
Description

Non-ProtocolTherapygivenfordisease

Data type

text

Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

Non-Protocol Therapy not previously rpt
Description

Non-ProtocolTherapynotpreviouslyrpt

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: ECOG 3200 Non-Protocol Therapy Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
ECOG Non-Protocol Therapy Form
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)
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date
Non-ProtocolChemotherapyInd
Item
Non-Protocol Chemotherapy Ind
text
Non-ProtocolHormonalTherapyInd
Item
Non-Protocol Hormonal Therapy Ind
text
Non-ProtocolImmunotherapyInd
Item
Non-Protocol Immunotherapy Ind
text
Non-ProtocolHDC/ASCTInd
Item
Non-Protocol HDC/ASCT Ind
text
Non-protocolSurgeryPerformedInd-3
Item
Non-Protocol Surgery Ind
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass)
C1518384 (UMLS 2011AA ObjectClass)
Non-ProtocolRTInd
Item
Non-Protocol RT Ind
text
OtherNon-ProtocolTherapyInd
Item
Other Non-Protocol Therapy Ind
text
OtherNon-ProtocolTherapyName
Item
Other Non-Protocol Therapy Name
text
Non-ProtocolTherapygivenfordisease
Item
Non-Protocol Therapy given for disease
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
Non-ProtocolTherapynotpreviouslyrpt
Item
Non-Protocol Therapy not previously rpt
text
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