Description:

E2805 Long-Term Follow-up Form NCT00326898 Sunitinib or Sorafenib in Treating Patients With Kidney Cancer That Was Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=058702CD-40BF-2F26-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=058702CD-40BF-2F26-E044-0003BA3F9857

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Versions (3) ▾
  1. 9/19/12
  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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E2805 Long-Term Follow-up Form NCT00326898

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

Header
Patient demographics
Off protocol treatment period
Off Treatment Report Period (since initial registration)
Data amendment
Vital Status
Patient Vital Status
Primary Cause of Death (if applicable)
Section II - Reporting Period
Notice Of New Primary (including Second Colon Primary)
Has a new primary cancer or MDS been diagnosed that has not been previously reported (MDS)
Section V - Last Cycle Of Protocol Therapy
Was a MUGA performed (this reporting period?)
Was an Echocardiogram (ECHO) performed (this reporting period?)
%
%
%
%
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (this reporting period)
Adverse Events
Has the patient experienced any severe long term toxicity that has not been previously reported (prior to diagnosis of recurrence Grade >4 hematologic, Grade >3 non-hematologic NOTE: Do not report adverse events occurring after start of non-protocol therapy.)
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first recurrence (not previously reported)
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