Description:

E2805 Treatment 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=054B80EC-08C8-3374-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=054B80EC-08C8-3374-E044-0003BA3F9857

Keywords:
Versions (4) ▾
  1. 9/19/12
  2. 8/8/14
  3. 1/8/15
  4. 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 Treatment Form NCT00326898

INSTRUCTIONS: Complete this form at the end of each cycle (1 cycle = 3 weeks), and at required follow-ups if specified by the Long-Term Follow-Up Form (to report late adverse events).

Header
On Treatment Report Period (1 cycle = 6 weeks Choose one X)
Patient demographics
Data amendment
Section I - Vital Status
Vital Status
Primary Cause of Death (if applicable)
Section Ii - Patient Characteristics
ECOG Performance Status (Day 1 of this cycle)
Agent Name: Sorafenib/placebo
Did the patient complete and return the Patient Pill Calendar this cycle
Did the patient return their BAYER bottle this cycle
What was the source of the pill count
Dose Modifications
Were there any dose modifications or additions/omissions to protocol treatment (this report period)
Reason for therapy modification
Assessment of medication
Did the patient return their Pfizer bottle this cycle
What was the source of the pill count
Dose Modifications
Were there any dose modifications or additions/omissions to protocol treatment (this report period)
Reason for therapy modification
Section Iv - Blood Pressure
Section V - Last Cycle Of Protocol Therapy
%
%
%
%
Section Vi - Non-protocol Therapy
Was any non-protocol cancer therapy given during protocol treatment (not previously reported)

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