Description:

E5202 Long-Term Follow-up Form NCT00217737 Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF243F73-4DAD-3443-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF243F73-4DAD-3443-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/8/15
  3. 6/8/15
Uploaded on:

June 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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E5202 Long-Term Follow-up Form NCT00217737

INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).

ECOG clinical trial administrative data
Patient demographics
Off protocol treatment period
Off Treatment Report Period (since initial registration)
Data amendment
Reporting period
Vital Status
Patient's Vital Status
Primary Cause of Death (if applicable)
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)
Notice Of Recurrence
Has the patient been diagnosed with a first recurrence since the last Follow-Up Form? (Long-Term)
Site of recurrence (s)
Did a physician make a formal diagnosis of recurrence
Was the recurrence treated by surgery
Notice Of New Primary (including Second Colon Primary)
Has a new primary cancer or myelodysplastic syndrome been diagnosed that has not been previously reported (MDS)
Adverse Events
Has the patient experienced any severe long term toxicity that has not been previously reported (prior to diagnosis of progression/relapse)
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first recurrence (not previously reported)
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