ID

10632

Description

CALGB: 49808 RESPONSE/PROGRESSION 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-867B-227A-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-867B-227A-E034-080020C9C0E0

Keywords

Versions (3)
  1. 8/26/12 8/26/12 -
  2. 5/22/15 5/22/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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CALGB: 49808 RESPONSE/PROGRESSION FORM NCT00016276

English

No Instruction available.

1 forms  
  1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
    1. No Instruction available.
CALGB clinical trial administrative data
Description

CALGB clinical trial administrative data

CALGB Form
Description

CALGBForm

Data type

text

CALGB Study No
Description

CALGBProtocolNumber

Data type

text

CALGB Patient ID
Description

CALGBPatientID

Data type

text

From
Description

From

Data type

text

To (Date of last contact or death)
Description

To

Data type

text

Amended data?
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Patient clinical trial data
Description

Patient clinical trial data

Patient's Name
Description

Patient'sName

Data type

text

Participating Group
Description

ParticipatingGroup

Data type

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Description

PatientHospitalNumber

Data type

text

Participating Group Protocol No.
Description

ParticipatingGroupProtocolNo.

Data type

text

Main Member Institution/Adjunct
Description

MainMemberInstitution/Adjunct

Data type

text

Participating Group Patient No.
Description

ParticipatingGroupPatientNo.

Data type

text

Response Assessment (clinical/radiographic)
Description

Response Assessment (clinical/radiographic)

Has the patient achieved a response (not previously reported)?
Description

Hasthepatientachievedaresponse(notpreviouslyreported)?

Data type

text

Date overall partial response first documented
Description

Dateoverallpartialresponsefirstdocumented

Data type

text

Date overall complete response first documented
Description

Dateoverallcompleteresponsefirstdocumented

Data type

text

Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
Description

Hasthepatientbeendiagnosedwithanewprogressionduringthisreportingperiod(notpreviouslyreported)?

Data type

text

Date response/stable disease last documented (IF NO:)
Description

Dateresponse/stablediseaselastdocumented

Data type

text

Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
Description

Hasthepatientbeendiagnosedwithanewlocal-regionalrecurrencesincesubmissionofthelastfollow-upform?

Data type

text

Date of new Local-Regional Recurrence
Description

DateofnewLocal-RegionalRecurrence

Data type

text

Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
Description

Site(s)ofFirstLocal-RegionalRecurrence

Data type

text

How was this recurrence information obtained?
Description

Howwasthisrecurrenceinformationobtained?

Data type

text

Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
Description

Hasthepatientbeendiagnosedwithafirstdistantprogressionsincesubmissionofthelastfollow-upform?

Data type

text

Date of First Distant Progression
Description

ProgressionDate,FirstDistant

Data type

date

Site(s) of First Distant Progression
Description

Site(s)ofFirstDistantProgression

Data type

text

How was this progression information obtained?
Description

Howwasthisprogressioninformationobtained?

Data type

text

Comments
Description

Comments

Comments
Description

Comments

Data type

text

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No Instruction available.

1 forms
  1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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)
CL.1
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
Response Assessment (clinical/radiographic)
Item
Has the patient achieved a response (not previously reported)?
text
CL.2
Code List
Has the patient achieved a response (not previously reported)?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateoverallpartialresponsefirstdocumented
Item
Date overall partial response first documented
text
Dateoverallcompleteresponsefirstdocumented
Item
Date overall complete response first documented
text
Item
Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
text
CL.3
Code List
Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateresponse/stablediseaselastdocumented
Item
Date response/stable disease last documented (IF NO:)
text
Item
Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
text
CL.4
Code List
Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
DateofnewLocal-RegionalRecurrence
Item
Date of new Local-Regional Recurrence
text
Item
Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
text
CL.5
Code List
Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
CL Item
Ipsilateral Breast (Ipsilateral breast)
CL Item
Chest Wall (Chest wall)
CL035093 (NCI Metathesaurus)
C62484 (NCI Thesaurus)
C0205076 (UMLS 2011AA)
CL Item
Axillary Nodes (Axillary nodes)
CL Item
Internal Mammary (Internal mammary)
CL Item
Supraclavicular Nodes (Supraclavicular nodes)
CL Item
Axilla (Axilla)
C12674 (NCI Thesaurus)
C0004454 (UMLS 2011AA)
CL Item
Infraclavicular Nodes (Infraclavicular nodes)
Item
How was this recurrence information obtained?
text
CL.6
Code List
How was this recurrence information obtained?
CL Item
Documented Clinical Assessment (Documented clinical assessment)
CL Item
Patient Self Report Only (Patient self report only)
Item
Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
text
CL.7
Code List
Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ProgressionDate,FirstDistant
Item
Date of First Distant Progression
date
Site(s)ofFirstDistantProgression
Item
Site(s) of First Distant Progression
text
Item
How was this progression information obtained?
text
CL.8
Code List
How was this progression information obtained?
CL Item
Documented Clinical Assessment (Documented clinical assessment)
CL Item
Patient Self Report Only (Patient self report only)
Item Group
Comments
Comments
Item
Comments
text
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