Description:

CALGB: 49808 FOLLOW-UP 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-87AF-227A-E034-080020C9C0E0

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-87AF-227A-E034-080020C9C0E0

Keywords:
Versions (4) ▾
  1. 8/26/12
  2. 5/22/15
  3. 6/3/15
  4. 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 FOLLOW-UP FORM NCT00016276

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  1. StudyEvent: CALGB: 49808 FOLLOW-UP FORM
    1. No Instruction available.
CALGB clinical trial administrative data
Amended data?
Patient demographics
Patient vital status
Patient's Vital Status (mark one with an X)
Cause of death (if dead) (mark one with an X)
Disease Assessment
Has patient had a documented clinical assessment for this cancer since submission of the previous follow-up form?
Notice Of Progression
Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form?
Site(s) of first local-regional recurrence (mark all that apply with an X)
How was this recurrence information obtained? (mark one with an X)
Has the patient been diagnosed with a first distant progression since submission of the last follow-up form?
How was this progression information obtained?
Notice Of New Primary
Has a new primary cancer or myelodysplastic syndrome (MDS) been diagnosed that has not been previously reported?
Long-term Toxicity
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity related to protocol treatment that has not been previously reported?
Long-term Therapy
Did this patient receive any tamoxifen?
Is the patient still receiving tamoxifen? (If Yes: )