Description:

NSABP PROTOCOL B-36 Follow-Up Menstrual History Questionnaire NCT00087178 Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C891F490-0A7E-745C-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C891F490-0A7E-745C-E034-0003BA12F5E7

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Versions (3) ▾
  1. 8/26/12
  2. 5/22/15
  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-36 Follow-Up Menstrual History Questionnaire NCT00087178

(For participants in the follow-up phase of the Menstrual History Study)

  1. StudyEvent: NSABP PROTOCOL B-36 Follow-Up Menstrual History Questionnaire
    1. (For participants in the follow-up phase of the Menstrual History Study)
Header Module
Data Amended Ind-3
Time Point for this Questionnaire (Evaluations should be carried out according to schedule, even if the patient discontinues protocol therapy. Patients who have experienced breast cancer recurrence or second primary cancer do not need to fill out this form.)
Menstrual history
Have you had your uterus removed?
Have you had both your ovaries removed?
Have you had a menstrual period or vaginal bleeding in the last 12 months?
did you period stop or become less frequent during the last 12 months? (If yes,)
Ccrr Module For Nsabp Protocol B-36 Follow-up Menstrual History Questionnaire

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