ID

10647

Description

NSABP PROTOCOL C-09: Treatment Form for Group 2 Patients NCT00268463 Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBE35C9-1452-58D9-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBE35C9-1452-58D9-E034-0003BA3F9857

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  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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NSABP PROTOCOL C-09: Treatment Form for Group 2 Patients NCT00268463

English

Submit this form when protocol treatment has ended in a Group 2 patient, or when it is certain patient will not receive protocol therapy

1 forms  
Header module
Description

Header module

Patient Initials (Last First Middle)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
NSABP Patient ID
Description

Patient ID NSABP

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1513905
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Affiliate Name
Description

Affiliate Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS CUI-1
C1510825
NCI Thesaurus ObjectClass-2
C25413
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Person Completing Form Last Name
Description

Person Completing Form Last Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1301584
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25191
Person Completing Form First Name
Description

Person Completing Form First Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1443235
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25509
NCI Thesaurus ValueDomain
C25191
Person Completing Form Phone
Description

Person Completing Form Phone

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25190
UMLS CUI-2
C1515258
NCI Thesaurus ObjectClass-2
C25657
NCI Thesaurus Property
C25395
Total Number of Cycles Given (0, 1, 2, 3, 4, 5, 6, 7, 8)
Description

Total number of cycles

Data type

float

Alias
NCI Thesaurus Property
C25304
UMLS CUI-1
C2045831
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain
C25463
NCI Thesaurus Property-2
C25379
Treatment End Date (last dose of last cycle Leave blank if treatment was not begun)
Description

Treatment End Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1531784
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25275
NCI Thesaurus Property-2
C25496
Are data amended (Check box if yes, and circle amended items)
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient Height (cm)
Description

Patient Height

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0489786
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
cm
Assessment of Chemotherapy
Description

Assessment of Chemotherapy

Cycle Number
Description

Cycle Number

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2045829
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25379
Cycle Start Date (*)
Description

Chemotherapy Cycle Start Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1302181
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-2
C3173309
NCI Thesaurus Property
C25379
Patient Weight (If unknown, leave boxes blank)
Description

Patient Weight

Data type

float

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Agent Name (total mg)
Description

Agent

Data type

text

Alias
NCI Thesaurus Property
C25364
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
Agent Total Dose (on each cycle)
Description

Agent Total Dose

Data type

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS CUI-1
C2986497
NCI Thesaurus Property
C25379
NCI Thesaurus ValueDomain-2
C25488
NCI Thesaurus ObjectClass
C1708
Was less than full dose administered because of toxicity?
Description

ProtocolAgentNotCompleteAdministrationAdverseEventInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C41161
UMLS 2011AA ObjectClass
C1521826
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property-2
C25594
UMLS 2011AA Property-2
C1518422
NCI Thesaurus Property-3
C25409
UMLS 2011AA Property-3
C1533734
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ValueDomain-2
C41331
UMLS 2011AA ValueDomain-2
C0877248
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Description

NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15818
UMLS 2011AA ObjectClass
C1513905
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Description

NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15818
UMLS 2011AA ObjectClass
C1513905
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Description

NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15818
UMLS 2011AA ObjectClass
C1513905
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Treatment Group 2. Complications Related To Hai Catheter Or Pump
Description

Treatment Group 2. Complications Related To Hai Catheter Or Pump

Were there any complications related to the HAI catheter or pump (complete table per specifications)
Description

IntrahepaticInfusionProcedureCatheterPumpComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C17446
UMLS 2011AA Property
C0085590
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
NCI Thesaurus Property-3
C17625
UMLS 2011AA Property-3
C0182537
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Pump Malfunction (if yes, complete this row)
Description

IntrahepaticInfusionProcedurePumpDefectComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C2959
UMLS 2011AA Property
C0009566
NCI Thesaurus Property-2
C43429
UMLS 2011AA Property-2
C1457869
NCI Thesaurus Property-3
C17625
UMLS 2011AA Property-3
C0182537
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Catheter Occlusion (if yes, complete this row)
Description

IntrahepaticInfusionProcedureCatheterOcclusionComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C17446
UMLS 2011AA Property
C0085590
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
NCI Thesaurus Property-3
C50678
UMLS 2011AA Property-3
C1947917
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Misperfusion (if yes, complete this row)
Description

IntrahepaticInfusionProcedurePerfusionDefectComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C2959
UMLS 2011AA Property
C0009566
NCI Thesaurus Property-2
C43429
UMLS 2011AA Property-2
C1457869
NCI Thesaurus Property-3
C15295
UMLS 2011AA Property-3
C0031001
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Bleeding (if yes, complete this row)
Description

IntrahepaticInfusionProcedureActiveHemorrhageComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C26791
UMLS 2011AA Property
C0019080
NCI Thesaurus Property-2
C45329
UMLS 2011AA Property-2
C0205177
NCI Thesaurus Property-3
C2959
UMLS 2011AA Property-3
C0009566
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Infection (if yes, complete this row)
Description

IntrahepaticInfusionProcedureInfectionComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C26726
UMLS 2011AA Property
C0009450
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
Other (if yes, complete this row)
Description

IntrahepaticInfusionProcedureOtherComplicationInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
Other, specify
Description

IntrahepaticInfusionProcedureOtherComplicationSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
Cycle Number (Mark all that apply)
Description

TherapyCourseAdministeredCount

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25379
UMLS 2011AA Property
C0750729
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
Management of Complication (Mark all that apply)
Description

IntrahepaticInfusionProcedureManagementComplicationType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C2959
UMLS 2011AA Property
C0009566
NCI Thesaurus Property-2
C61372
UMLS 2011AA Property-2
C1273870
Other, specify
Description

IntrahepaticInfusionProcedureManagementComplicationSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property
C2959
UMLS 2011AA Property
C0009566
NCI Thesaurus Property-2
C61372
UMLS 2011AA Property-2
C1273870
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Similar models

Submit this form when protocol treatment has ended in a Group 2 patient, or when it is certain patient will not receive protocol therapy

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header module
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Affiliate Name
Item
Affiliate Name
text
C21541 (NCI Thesaurus ObjectClass)
C1510825 (UMLS CUI-1)
C25413 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Person Completing Form Last Name
Item
Person Completing Form Last Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Person Completing Form First Name
Item
Person Completing Form First Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1443235 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Person Completing Form Phone
Item
Person Completing Form Phone
text
C25337 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
Total number of cycles
Item
Total Number of Cycles Given (0, 1, 2, 3, 4, 5, 6, 7, 8)
float
C25304 (NCI Thesaurus Property)
C2045831 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C25379 (NCI Thesaurus Property-2)
Treatment End Date
Item
Treatment End Date (last dose of last cycle Leave blank if treatment was not begun)
date
C25164 (NCI Thesaurus ValueDomain)
C1531784 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C25496 (NCI Thesaurus Property-2)
Data amended
Item
Are data amended (Check box if yes, and circle amended items)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Patient Height
Item
Patient Height (cm)
float
C25209 (NCI Thesaurus ValueDomain)
C0489786 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
Item Group
Assessment of Chemotherapy
Cycle Number
Item
Cycle Number
integer
C25337 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property)
Chemotherapy Cycle Start Date
Item
Cycle Start Date (*)
date
C25164 (NCI Thesaurus ValueDomain)
C1302181 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25431 (NCI Thesaurus ValueDomain-2)
C3173309 (UMLS CUI-2)
C25379 (NCI Thesaurus Property)
Patient Weight
Item
Patient Weight (If unknown, leave boxes blank)
float
C25209 (NCI Thesaurus ValueDomain)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
Agent
Item
Agent Name (total mg)
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
Agent Total Dose
Item
Agent Total Dose (on each cycle)
float
C25304 (NCI Thesaurus ValueDomain)
C2986497 (UMLS CUI-1)
C25379 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
ProtocolAgentNotCompleteAdministrationAdverseEventInd-2
Item
Was less than full dose administered because of toxicity?
boolean
C41161 (NCI Thesaurus ObjectClass)
C1521826 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25594 (NCI Thesaurus Property-2)
C1518422 (UMLS 2011AA Property-2)
C25409 (NCI Thesaurus Property-3)
C1533734 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ValueDomain-2)
C0877248 (UMLS 2011AA ValueDomain-2)
Item
Why did treatment end or not begin (CAPECITABINE Select primary reason)
text
C15818 (NCI Thesaurus ObjectClass)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.5
Code List
Why did treatment end or not begin (CAPECITABINE Select primary reason)
CL Item
Adverse Event/side Effects/complications (Adverse event/side effects/complications)
CL Item
Alternative Therapy (Alternative therapy)
CL Item
Death, Recurrence, Or Second Primary Cancer (Death, recurrence, or second primary cancer)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Patient Withdrawal Or Refusal (Patient withdrawal or refusal)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
Item
Why did treatment end or not begin (CAPECITABINE Select primary reason)
text
C15818 (NCI Thesaurus ObjectClass)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.5
Code List
Why did treatment end or not begin (CAPECITABINE Select primary reason)
CL Item
Adverse Event/side Effects/complications (Adverse event/side effects/complications)
CL Item
Alternative Therapy (Alternative therapy)
CL Item
Death, Recurrence, Or Second Primary Cancer (Death, recurrence, or second primary cancer)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Patient Withdrawal Or Refusal (Patient withdrawal or refusal)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
Item
Why did treatment end or not begin (CAPECITABINE Select primary reason)
text
C15818 (NCI Thesaurus ObjectClass)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.5
Code List
Why did treatment end or not begin (CAPECITABINE Select primary reason)
CL Item
Adverse Event/side Effects/complications (Adverse event/side effects/complications)
CL Item
Alternative Therapy (Alternative therapy)
CL Item
Death, Recurrence, Or Second Primary Cancer (Death, recurrence, or second primary cancer)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Patient Withdrawal Or Refusal (Patient withdrawal or refusal)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
Item Group
Treatment Group 2. Complications Related To Hai Catheter Or Pump
IntrahepaticInfusionProcedureCatheterPumpComplicationInd-2
Item
Were there any complications related to the HAI catheter or pump (complete table per specifications)
boolean
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C17446 (NCI Thesaurus Property)
C0085590 (UMLS 2011AA Property)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
C17625 (NCI Thesaurus Property-3)
C0182537 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntrahepaticInfusionProcedurePumpDefectComplicationInd-2
Item
Pump Malfunction (if yes, complete this row)
boolean
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property)
C0009566 (UMLS 2011AA Property)
C43429 (NCI Thesaurus Property-2)
C1457869 (UMLS 2011AA Property-2)
C17625 (NCI Thesaurus Property-3)
C0182537 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntrahepaticInfusionProcedureCatheterOcclusionComplicationInd-2
Item
Catheter Occlusion (if yes, complete this row)
boolean
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C17446 (NCI Thesaurus Property)
C0085590 (UMLS 2011AA Property)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
C50678 (NCI Thesaurus Property-3)
C1947917 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntrahepaticInfusionProcedurePerfusionDefectComplicationInd-2
Item
Misperfusion (if yes, complete this row)
boolean
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property)
C0009566 (UMLS 2011AA Property)
C43429 (NCI Thesaurus Property-2)
C1457869 (UMLS 2011AA Property-2)
C15295 (NCI Thesaurus Property-3)
C0031001 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntrahepaticInfusionProcedureActiveHemorrhageComplicationInd-2
Item
Bleeding (if yes, complete this row)
boolean
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
C45329 (NCI Thesaurus Property-2)
C0205177 (UMLS 2011AA Property-2)
C2959 (NCI Thesaurus Property-3)
C0009566 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntrahepaticInfusionProcedureInfectionComplicationInd-2
Item
Infection (if yes, complete this row)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C26726 (NCI Thesaurus Property)
C0009450 (UMLS 2011AA Property)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
IntrahepaticInfusionProcedureOtherComplicationInd-2
Item
Other (if yes, complete this row)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
IntrahepaticInfusionProcedureOtherComplicationSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
Item
Cycle Number (Mark all that apply)
text
C15368 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25379 (NCI Thesaurus Property)
C0750729 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
CL.13
Code List
Cycle Number (Mark all that apply)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5-8 (5-8)
Item
Management of Complication (Mark all that apply)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property)
C0009566 (UMLS 2011AA Property)
C61372 (NCI Thesaurus Property-2)
C1273870 (UMLS 2011AA Property-2)
CL.14
Code List
Management of Complication (Mark all that apply)
CL Item
Removal Of Catheter/pump (Removal of catheter/pump)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
IntrahepaticInfusionProcedureManagementComplicationSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property)
C0009566 (UMLS 2011AA Property)
C61372 (NCI Thesaurus Property-2)
C1273870 (UMLS 2011AA Property-2)
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