Description:

E5202 Disease Assessment 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=F64D15FD-EE93-52E3-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F64D15FD-EE93-52E3-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 Disease Assessment Form NCT00217737

Details

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
Data amendment
Cycle number
On Treatment Report 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)
11 more items in the detailed view.
Did a physician make a formal diagnosis of recurrence
Was the recurrence treated by surgery
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