0 Bewertungen

ID

10623

Beschreibung

CALGB: 49808 RADIOTHERAPY REPORT FORM NCT00016276 Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8724-227A-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-8724-227A-E034-080020C9C0E0

Stichworte

  1. 26.08.12 26.08.12 -
  2. 22.05.15 22.05.15 -
  3. 03.06.15 03.06.15 -
Hochgeladen am

3. Juni 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy

Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Itemgroup Kommentare für :

Item Kommentare für :


    Keine Kommentare

    Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

    CALGB: 49808 RADIOTHERAPY REPORT FORM NCT00016276

    No Instruction available.

    1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
      1. No Instruction available.
    CALGB clinical trial administrative data
    Beschreibung

    CALGB clinical trial administrative data

    CALGB Form
    Beschreibung

    CALGBForm

    Datentyp

    text

    CALGB Study No
    Beschreibung

    CALGBProtocolNumber

    Datentyp

    text

    CALGB Patient ID
    Beschreibung

    CALGBPatientID

    Datentyp

    text

    From
    Beschreibung

    From

    Datentyp

    text

    To (Date of last contact or death)
    Beschreibung

    To

    Datentyp

    text

    Amended data?
    Beschreibung

    AmendedDataInd

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Patient clinical trial data
    Beschreibung

    Patient clinical trial data

    Patient's Name
    Beschreibung

    Patient'sName

    Datentyp

    text

    Participating Group
    Beschreibung

    ParticipatingGroup

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17005 (undefined)
    UMLS 2011AA ObjectClass
    C1257890 (Population Group)
    SNOMED
    389109008
    LOINC
    LA12078-4
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Patient Hospital Number
    Beschreibung

    PatientHospitalNumber

    Datentyp

    text

    Participating Group Protocol No.
    Beschreibung

    ParticipatingGroupProtocolNo.

    Datentyp

    text

    Main Member Institution/Adjunct
    Beschreibung

    MainMemberInstitution/Adjunct

    Datentyp

    text

    Participating Group Patient No.
    Beschreibung

    ParticipatingGroupPatientNo.

    Datentyp

    text

    Radiation Treatment
    Beschreibung

    Radiation Treatment

    Has the patient received radiation therapy?
    Beschreibung

    Hasthepatientreceivedradiationtherapy?

    Datentyp

    text

    If No, reason
    Beschreibung

    IfNo,reason

    Datentyp

    text

    Date radiation therapy ended
    Beschreibung

    Dateradiationtherapyended

    Datentyp

    text

    What was the total number of days the patient was treated with radiation?
    Beschreibung

    Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?

    Datentyp

    text

    Was there a break in radiation treatment due to toxicity?
    Beschreibung

    Wasthereabreakinradiationtreatmentduetotoxicity?

    Datentyp

    text

    If Yes, reason
    Beschreibung

    IfYes,reason

    Datentyp

    text

    Date of last radiation therapy prior to break
    Beschreibung

    Dateoflastradiationtherapypriortobreak

    Datentyp

    text

    Date of first radiation therapy after break
    Beschreibung

    Dateoffirstradiationtherapyafterbreak

    Datentyp

    text

    Fields of radiation therapy (mark all that apply with an X)
    Beschreibung

    Fieldsofradiationtherapy

    Datentyp

    text

    Fields of radiation therapy Other, specify
    Beschreibung

    FieldsofradiationtherapyOther,specify

    Datentyp

    text

    Did patient begin taking tamoxifen during this reporting period?
    Beschreibung

    Didpatientbegintakingtamoxifenduringthisreportingperiod?

    Datentyp

    text

    If Yes, date tamoxifen started
    Beschreibung

    IfYes,datetamoxifenstarted

    Datentyp

    text

    Comments
    Beschreibung

    Comments

    Comments
    Beschreibung

    Comments

    Datentyp

    text

    Ähnliche Modelle

    No Instruction available.

    1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    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
    From
    Item
    From
    text
    To
    Item
    To (Date of last contact or death)
    text
    Item
    Amended data?
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    Code List
    Amended data?
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item Group
    Patient clinical trial data
    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 Number
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    MainMemberInstitution/Adjunct
    Item
    Main Member Institution/Adjunct
    text
    ParticipatingGroupPatientNo.
    Item
    Participating Group Patient No.
    text
    Item Group
    Radiation Treatment
    Item
    Has the patient received radiation therapy?
    text
    Code List
    Has the patient received radiation therapy?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    IfNo,reason
    Item
    If No, reason
    text
    Dateradiationtherapyended
    Item
    Date radiation therapy ended
    text
    Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?
    Item
    What was the total number of days the patient was treated with radiation?
    text
    Item
    Was there a break in radiation treatment due to toxicity?
    text
    Code List
    Was there a break in radiation treatment due to toxicity?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    IfYes,reason
    Item
    If Yes, reason
    text
    Dateoflastradiationtherapypriortobreak
    Item
    Date of last radiation therapy prior to break
    text
    Dateoffirstradiationtherapyafterbreak
    Item
    Date of first radiation therapy after break
    text
    Item
    Fields of radiation therapy (mark all that apply with an X)
    text
    Code List
    Fields of radiation therapy (mark all that apply with an X)
    CL Item
    Ipsilateral Breast (Ipsilateral breast)
    CL Item
    Supraclavicular Field (Supraclavicular field)
    CL Item
    Axillary Fields (Axillary fields)
    CL Item
    Internal Mammary Fields (Internal mammary fields)
    CL Item
    Ipsilateral Chest Wall (Ipsilateral chest wall)
    CL Item
    Other, Specify: (Other, specify)
    FieldsofradiationtherapyOther,specify
    Item
    Fields of radiation therapy Other, specify
    text
    Item
    Did patient begin taking tamoxifen during this reporting period?
    text
    Code List
    Did patient begin taking tamoxifen during this reporting period?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    IfYes,datetamoxifenstarted
    Item
    If Yes, date tamoxifen started
    text
    Item Group
    Comments
    Comments
    Item
    Comments
    text

    Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

    Zum Video