ID
1062
Description
CALGB: 40601 POST-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A7CAEA0-52A1-0226-E044-0003BA3F9857
Link
Keywords
Versions (3)
- 8/26/12 8/26/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/18/15 6/18/15 -
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August 26, 2012
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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00770809 Follow-Up - CALGB: 40601 POST-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM - 2683039v1.0
INSTRUCTIONS: Complete all information on this form. Submit within one week of registration along with the On-Study Form.
- StudyEvent: CALGB: 40601 POST-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM
Description
Unnamed2
Description
PatientInitialsName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25536
- UMLS 2011AA Property
- C1555582
Description
PatientMedicalRecordNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25261
- UMLS 2011AA Property
- C0205476
- NCI Thesaurus Property
- C25198
- UMLS 2011AA Property
- C0034869
Description
CombinedInstitutionName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS 2011AA ObjectClass
- C0205195
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ValueDomain
- C21541
- UMLS 2011AA ValueDomain
- C0018704
Description
ParticipatingGroupName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25608
- UMLS 2011AA ObjectClass
- C0679823
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
ProtocolParticipatingIdentifierNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25320
- UMLS 2011AA ObjectClass
- C1507394
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
PatientParticipatingIdentifierNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
Breast Conserving Therapy
Description
BreastConservationTreatmentPostNeoadjuvantTherapyQualificationInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C43608
- UMLS 2011AA Property
- C1709790
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
BreastConservationTreatmentPostNeoadjuvantTherapyNotQualificationReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C43608
- UMLS 2011AA Property
- C1709790
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
BreastConservationTreatmentPostNeoadjuvantTherapyNotQualificationSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C43608
- UMLS 2011AA Property
- C1709790
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
BreastConservationTreatmentRadiationTherapyMedicalContraindicationReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C50646
- UMLS 2011AA Property
- C1301624
Description
BreastConservationTreatmentRadiationTherapyConnectiveTissueDisorderMedicalContraindicationSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C26729
- UMLS 2011AA Property
- C0009782
- NCI Thesaurus Property
- C50646
- UMLS 2011AA Property
- C1301624
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
BreastConservationTreatmentPostNeoadjuvantTherapyAttemptInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C39769
- UMLS 2011AA Property
- C1516084
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
BreastConservationTreatmentPostNeoadjuvantTherapyNotAttemptReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C39769
- UMLS 2011AA Property
- C1516084
- NCI Metathesaurus Property
- CL052458
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
BreastConservationTreatmentPostNeoadjuvantTherapyNotAttemptSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C39769
- UMLS 2011AA Property
- C1516084
- NCI Metathesaurus Property
- CL052458
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
BreastConservationTreatmentPostNeoadjuvantTherapyRefuse
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C49161
- UMLS 2011AA Property
- C1705116
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
BreastConservationTreatmentPostNeoadjuvantTherapySuccessPerformedInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C25362
- UMLS 2011AA Property
- C0597535
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
BreastConservationTreatmentPostNeoadjuvantTherapyFailedPerformedReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C44281
- UMLS 2011AA Property
- C0231175
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
BreastConservationTreatmentPostNeoadjuvantTherapyFailedPerformedSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus Property
- C44281
- UMLS 2011AA Property
- C0231175
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Axillary Node
Description
AxillaryLymphNodePostNeoadjuvantTherapyEvaluationInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12904
- UMLS 2011AA ObjectClass
- C0729594
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
AssessmentMethodType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
Description
AssessmentMethodSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
Description
AxillaryLymphNodePostNeoadjuvantTherapyEvaluationResult
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12904
- UMLS 2011AA ObjectClass
- C0729594
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property
- C15665
- UMLS 2011AA Property
- C0600558
- NCI Thesaurus ValueDomain
- C20200
- UMLS 2011AA ValueDomain
- C1274040
Description
LesionAssessmentDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C3824
- UMLS 2011AA ObjectClass
- C0221198
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain
- C25367
Description
SentinelLymphNodeBiopsyBlueDyeUseInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15667
- UMLS 2011AA ObjectClass
- C0796693
- NCI Thesaurus Property
- C461
- UMLS 2011AA Property
- C0013343
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus Property
- C48333
- UMLS 2011AA Property
- C1260957
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
SentinelLymphNodeBiopsyTechnetium99mDextranUseInd-2
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15667
- UMLS 2011AA ObjectClass
- C0796693
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus Property
- C1243
- UMLS 2011AA Property
- C0076028
Description
Required Laboratory Values
Description
Footer Module
Description
ResponsiblePersonName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
FormCompleteDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C40988
- UMLS 2011AA ObjectClass
- C1516308
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus ValueDomain
- C25367
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C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C1456803 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C0729594 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property)
C0600558 (UMLS 2011AA Property)
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
C0332241 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C0796693 (UMLS 2011AA ObjectClass)
C461 (NCI Thesaurus Property)
C0013343 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C48333 (NCI Thesaurus Property)
C1260957 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C15667 (NCI Thesaurus ObjectClass)
C0796693 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C1243 (NCI Thesaurus Property)
C0076028 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)