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ID

10623

Description

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

Lien

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

Mots-clés

  1. 26/08/2012 26/08/2012 -
  2. 22/05/2015 22/05/2015 -
  3. 03/06/2015 03/06/2015 -
Téléchargé le

3 juin 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

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    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
    Description

    CALGB clinical trial administrative data

    CALGB Form
    Description

    CALGBForm

    Type de données

    text

    CALGB Study No
    Description

    CALGBProtocolNumber

    Type de données

    text

    CALGB Patient ID
    Description

    CALGBPatientID

    Type de données

    text

    From
    Description

    From

    Type de données

    text

    To (Date of last contact or death)
    Description

    To

    Type de données

    text

    Amended data?
    Description

    AmendedDataInd

    Type de données

    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
    Description

    Patient clinical trial data

    Patient's Name
    Description

    Patient'sName

    Type de données

    text

    Participating Group
    Description

    ParticipatingGroup

    Type de données

    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
    Description

    PatientHospitalNumber

    Type de données

    text

    Participating Group Protocol No.
    Description

    ParticipatingGroupProtocolNo.

    Type de données

    text

    Main Member Institution/Adjunct
    Description

    MainMemberInstitution/Adjunct

    Type de données

    text

    Participating Group Patient No.
    Description

    ParticipatingGroupPatientNo.

    Type de données

    text

    Radiation Treatment
    Description

    Radiation Treatment

    Has the patient received radiation therapy?
    Description

    Hasthepatientreceivedradiationtherapy?

    Type de données

    text

    If No, reason
    Description

    IfNo,reason

    Type de données

    text

    Date radiation therapy ended
    Description

    Dateradiationtherapyended

    Type de données

    text

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

    Whatwasthetotalnumberofdaysthepatientwastreatedwithradiation?

    Type de données

    text

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

    Wasthereabreakinradiationtreatmentduetotoxicity?

    Type de données

    text

    If Yes, reason
    Description

    IfYes,reason

    Type de données

    text

    Date of last radiation therapy prior to break
    Description

    Dateoflastradiationtherapypriortobreak

    Type de données

    text

    Date of first radiation therapy after break
    Description

    Dateoffirstradiationtherapyafterbreak

    Type de données

    text

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

    Fieldsofradiationtherapy

    Type de données

    text

    Fields of radiation therapy Other, specify
    Description

    FieldsofradiationtherapyOther,specify

    Type de données

    text

    Did patient begin taking tamoxifen during this reporting period?
    Description

    Didpatientbegintakingtamoxifenduringthisreportingperiod?

    Type de données

    text

    If Yes, date tamoxifen started
    Description

    IfYes,datetamoxifenstarted

    Type de données

    text

    Comments
    Description

    Comments

    Comments
    Description

    Comments

    Type de données

    text

    Similar models

    No Instruction available.

    1. StudyEvent: CALGB: 49808 RADIOTHERAPY REPORT FORM
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    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

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