Patient clinical trial data
Patient'sName
text
ParticipatingGroup
text
PatientHospitalNumber
text
ParticipatingGroupProtocolNo.
text
MainMemberInstitution/Adjunct
text
ParticipatingGroupPatientNo.
text
Patient vital status
Disease Assessment
Haspatienthadadocumentedclinicalassessmentforthiscancersincesubmissionofthepreviousfollow-upform?
text
CancerFollow-upStatusDate
date
Notice Of Progression
Hasthepatientbeendiagnosedwithanewlocal-regionalrecurrencesincesubmissionofthelastfollow-upform?
text
DateofnewLocal-RegionalRecurrence
text
Site(s)ofFirstLocal-RegionalRecurrence
text
Howwasthisrecurrenceinformationobtained?
text
Hasthepatientbeendiagnosedwithafirstdistantprogressionsincesubmissionofthelastfollow-upform?
text
ProgressionDate,FirstDistant
date
Site(s)ofFirstDistantProgression
text
Howwasthisprogressioninformationobtained?
text
Notice Of New Primary
Hasanewprimarycancerormyelodysplasticsyndrome(MDS)beendiagnosedthathasnotbeenpreviouslyreported?
text
NewPrimaryCancerDate
date
NewPrimarySite
text
Long-term Toxicity
IMTCode
text
CTCAdverseEventTerm
text
CTCGrade
text
DateofOnset
text
Hasthepatientexperienced(priortodiagnosisofrecurrenceorsecondprimary)anysevere(Grade>=3),longtermtoxicityrelatedtoprotocoltreatmentthathasnotbeenpreviouslyreported?
text
Long-term Therapy
PastTamoxifenInd
text
CurrentTamoxifenInd
text
Ifpatientdiscontinuedtamoxifensincelastfollow-up,givedate.
text
CompletedBy
text
DateCompleted
date