ID
10704
Descripción
E5204 Long-Term Follow-up Form NCT00303628 Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Had Surgery for Stage II or Stage III Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=089B477B-71CC-38F7-E044-0003BA3F9857
Link
Palabras clave
Versiones (3)
- 27/8/12 27/8/12 -
- 8/1/15 8/1/15 - Martin Dugas
- 8/6/15 8/6/15 -
Subido en
8 de junio de 2015
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0 Legacy
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E5204 Long-Term Follow-up Form NCT00303628
INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
- StudyEvent: E5204 Long-Term Follow-up Form
Descripción
Data amendment
Descripción
Data amended
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Descripción
Data amended date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property
- C25416
- NCI Thesaurus ValueDomain-2
- C25367
Descripción
Vital Status
Descripción
Patient Status
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Descripción
Date last contact
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0805839
- NCI Thesaurus Property
- C25461
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Descripción
Primary Cause of Death
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Descripción
Cause of Death, specify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C28554
Descripción
Section II - Reporting Period
Descripción
Reporting Period Start Date
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25616
- UMLS CUI-1
- C2361257
- NCI Thesaurus Property-2
- C25651
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
Descripción
Reporting Period End Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2361259
- NCI Thesaurus Property
- C25616
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property-2
- C25651
Descripción
Notice Of New Primary (including Second Colon Primary)
Descripción
New primary cancer
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C0751623
- NCI Thesaurus ObjectClass
- C25586
- NCI Thesaurus ObjectClass-2
- C9305
- NCI Thesaurus Property
- C15220
Descripción
NewCancerSiteText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass-2
- C9305
- UMLS 2011AA ObjectClass-2
- C0006826
Descripción
Disease Follow-up Status
Descripción
Documented clinical assessment for this cancer
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1522577
- NCI Thesaurus Property
- C16033
- UMLS CUI-2
- C0006826
- NCI Thesaurus ObjectClass
- C9305
- NCI Thesaurus Property-2
- C25365
Descripción
CancerUnknownFollow-upAssessmentSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus Property-2
- C17998
- UMLS 2011AA Property-2
- C0439673
- NCI Thesaurus Property-3
- C16033
- UMLS 2011AA Property-3
- C1522577
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Descripción
Follow-Up Date
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS CUI-1
- C3694716
- NCI Thesaurus Property
- C16033
- NCI Thesaurus Property-2
- C25365
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Descripción
Cea
Descripción
CarcinoembryonicAntigenSpecimenCollectionDate
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25159
- UMLS 2011AA ObjectClass
- C0007082
- NCI Thesaurus Property
- C25453
- UMLS 2011AA Property
- C1516698
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
Descripción
LaboratoryProcedureCarcinoembryonicAntigenOutcomeValue
Tipo de datos
text
Alias
- NCI Thesaurus Property
- C25159
- UMLS 2011AA Property
- C0007082
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Descripción
LaboratoryProcedureCarcinoembryonicAntigenOutcomeUpperLimitNormalValue
Tipo de datos
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C25159
- UMLS 2011AA Property
- C0007082
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Descripción
Notice Of Recurrence
Descripción
RecurrentDiseaseFirstDiagnosisInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C38155
- UMLS 2011AA ObjectClass
- C0277556
- NCI Thesaurus Property
- C25509
- UMLS 2011AA Property
- C1279901
- NCI Thesaurus Property-2
- C15220
- UMLS 2011AA Property-2
- C0011900
Descripción
DiseaseRecurrenceDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C3352
- UMLS 2011AA Property
- C0034897
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
Descripción
ColorectalCarcinomaRecurrentDiseaseAnatomicSite
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus ObjectClass
- C2955
- UMLS 2011AA ObjectClass
- C0009402
Descripción
ColorectalRecurrentDiseaseLocationUnknownText
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C2955
- UMLS 2011AA ObjectClass
- C0009402
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus ValueDomain-2
- C25704
- UMLS 2011AA ValueDomain-2
- C1527021
- NCI Thesaurus ValueDomain-3
- C17998
- UMLS 2011AA ValueDomain-3
- C0439673
Descripción
PhysicianRecurrentDiseaseDiagnosisInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25741
- UMLS 2011AA ObjectClass
- C0031831
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property-2
- C15220
- UMLS 2011AA Property-2
- C0011900
Descripción
PhysicianRecurrentDiseaseDiagnosisSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25741
- UMLS 2011AA ObjectClass
- C0031831
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property-2
- C15220
- UMLS 2011AA Property-2
- C0011900
Descripción
SurgicalProcedureRecurrentDiseaseTreatmentInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property-2
- C15368
Descripción
Adverse Events
Descripción
RadiationTherapyOncologyGroupAdverseEventRelapseReportInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C19778
- UMLS 2011AA ObjectClass
- C1514695
- NCI Thesaurus ObjectClass-2
- C41331
- UMLS 2011AA ObjectClass-2
- C0877248
- NCI Thesaurus Property
- C18265
- NCI Thesaurus Property-2
- C25375
- UMLS 2011AA Property
- C0684224
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Descripción
Non-protocol Therapy
Descripción
Non-ProtocolTherapyFirstRecurrenceInd-3
Tipo de datos
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C3352
- UMLS 2011AA Property
- C0034897
- NCI Thesaurus Property-2
- C25509
- UMLS 2011AA Property-2
- C1279901
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Descripción
Comments
Descripción
Investigator Signature
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Descripción
Investigator Signature Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- UMLS CUI-2
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
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INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
- StudyEvent: E5204 Long-Term Follow-up Form
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C1521902 (UMLS CUI-2)
C28554 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property)
C2361257 (UMLS CUI-1)
C25651 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
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C25616 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
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C0751623 (UMLS CUI-1)
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C0006826 (UMLS 2011AA ObjectClass-2)
C1522577 (UMLS CUI-1)
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C1705108 (UMLS 2011AA)
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C16033 (NCI Thesaurus Property-3)
C1522577 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3694716 (UMLS CUI-1)
C16033 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS 2011AA ValueDomain)
C25159 (NCI Thesaurus ObjectClass)
C0007082 (UMLS 2011AA ObjectClass)
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C1274040 (UMLS 2011AA Property-2)
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C0011900 (UMLS 2011AA Property-2)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
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C0012634 (UMLS 2011AA ObjectClass)
C1515974 (UMLS 2011AA ValueDomain)
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C0277556 (UMLS 2011AA Property)
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C0009402 (UMLS 2011AA ObjectClass)
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C0003962 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0005953 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
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C0277556 (UMLS 2011AA Property)
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C3352 (NCI Thesaurus Property)
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C1279901 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)