ID

10829

Description

NCI Cooperative Group Not For Arm G Patients Colorectal Cancer - Secondary Resection Follow Up Form NCT00079274 Comparison of Combination Chemotherapy Regimens With or Without Cetuximab in Treating Patients Who Have Undergone Surgery For Stage III Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=764CD4CF-27B8-E740-E040-BB89AD435E74

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=764CD4CF-27B8-E740-E040-BB89AD435E74

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 08/06/2015 08/06/2015 -
Téléchargé le

8 juin 2015

DOI

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Creative Commons BY-NC 3.0 Legacy

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    NCI Cooperative Group Not For Arm G Patients Colorectal Cancer - Secondary Resection Follow Up Form NCT00079274

    Instructions: Submit this CRF only if the patient has developed a first recurrence and a secondary resection was performed but not previously reported. Submit this form once, per patient. DO NOT complete this form if the secondary resection was reported on the Addendum #10 ¿Not For Arm G Patients Follow-Up Form¿ Submit operative and pathology reports with this CRF. In the event of serial or sequential resections following the first evidence of recurrent disease, submit this form for the first secondary resection of the recurrent disease. The answers to the questions below are relevant to the intent and outcome of only the first attempted resection following recurrent disease.

    Clinical trial administrative data
    Description

    Clinical trial administrative data

    Coordinating Group Protocol Number
    Description

    Protocol ID Coordinating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1711341
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Coordinating Group Code
    Description

    Coordinating Group Code

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI-1
    C1711341
    NCI Thesaurus ObjectClass
    C17005
    UMLS CUI-2
    C0805701
    NCI Thesaurus ObjectClass-2
    C25462
    NCI Thesaurus Property
    C25364
    Protocol Title
    Description

    Protocol Title

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986303
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C42774
    Patient Study ID
    Description

    Patient Study ID

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Patient Medical Record Number
    Description

    Medical Record Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Patient Initials (L, FM)
    Description

    Patient Initials

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Participating Group Code (Cooperative Group where credit will be applied)
    Description

    ParticipatingGroupIdentifierCode

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass-2
    C17005
    UMLS 2011AA ObjectClass-2
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Institution Name (treating location/performance site)
    Description

    Institution Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Resection
    Description

    Resection

    Date of secondary resection (submit operative and pathology reports)
    Description

    SurgicalProcedureRe-excisionFirstCancerProgressionPerformedDate

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus Property
    C48600
    UMLS 2011AA Property
    C0184913
    NCI Thesaurus Property-2
    C38000
    UMLS 2011AA Property-2
    C0884358
    NCI Thesaurus Property-3
    C25509
    UMLS 2011AA Property-3
    C1279901
    NCI Thesaurus Property-4
    C19987
    UMLS 2011AA Property-4
    C0242656
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Intent of resection (check one)
    Description

    SurgicalProcedureRe-excisionFirstCancerProgressionPerformedType

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus Property
    C48600
    UMLS 2011AA Property
    C0184913
    NCI Thesaurus Property-2
    C38000
    UMLS 2011AA Property-2
    C0884358
    NCI Thesaurus Property-3
    C25509
    UMLS 2011AA Property-3
    C1279901
    NCI Thesaurus Property-4
    C19987
    UMLS 2011AA Property-4
    C0242656
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Sites of resection (secondary)
    Description

    PatientSurgicalResectionSite

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25698
    NCI Thesaurus Property-2
    C15232
    UMLS 2011AA Property
    C0728940
    Specify
    Description

    PatientSurgicalResectionAnatomicSiteSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25698
    NCI Thesaurus Property-2
    C15232
    UMLS 2011AA Property
    C0728940
    Comments
    Description

    Comments

    Comments
    Description

    Research Comments

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Similar models

    Instructions: Submit this CRF only if the patient has developed a first recurrence and a secondary resection was performed but not previously reported. Submit this form once, per patient. DO NOT complete this form if the secondary resection was reported on the Addendum #10 ¿Not For Arm G Patients Follow-Up Form¿ Submit operative and pathology reports with this CRF. In the event of serial or sequential resections following the first evidence of recurrent disease, submit this form for the first secondary resection of the recurrent disease. The answers to the questions below are relevant to the intent and outcome of only the first attempted resection following recurrent disease.

    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Clinical trial administrative data
    Protocol ID Coordinating Group
    Item
    Coordinating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1711341 (UMLS CUI-2)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Coordinating Group Code
    Item
    Coordinating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C1711341 (UMLS CUI-1)
    C17005 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25462 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Protocol Title
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986303 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C42774 (NCI Thesaurus Property)
    Patient Study ID
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Medical Record Number
    Item
    Patient Medical Record Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    Patient Initials (L, FM)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    ParticipatingGroupIdentifierCode
    Item
    Participating Group Code (Cooperative Group where credit will be applied)
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C1257890 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Institution Name
    Item
    Institution Name (treating location/performance site)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Item Group
    Resection
    SurgicalProcedureRe-excisionFirstCancerProgressionPerformedDate
    Item
    Date of secondary resection (submit operative and pathology reports)
    date
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C48600 (NCI Thesaurus Property)
    C0184913 (UMLS 2011AA Property)
    C38000 (NCI Thesaurus Property-2)
    C0884358 (UMLS 2011AA Property-2)
    C25509 (NCI Thesaurus Property-3)
    C1279901 (UMLS 2011AA Property-3)
    C19987 (NCI Thesaurus Property-4)
    C0242656 (UMLS 2011AA Property-4)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    Item
    Intent of resection (check one)
    text
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C48600 (NCI Thesaurus Property)
    C0184913 (UMLS 2011AA Property)
    C38000 (NCI Thesaurus Property-2)
    C0884358 (UMLS 2011AA Property-2)
    C25509 (NCI Thesaurus Property-3)
    C1279901 (UMLS 2011AA Property-3)
    C19987 (NCI Thesaurus Property-4)
    C0242656 (UMLS 2011AA Property-4)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    Intent of resection (check one)
    CL Item
    Curative Intent And Successful R0 Resection (Curative intent and successful R0 resection)
    CL Item
    Curative Intent But Less Than R0 Resection (Curative intent but less than R0 resection)
    CL Item
    Palliative Intent (Palliative intent)
    Item
    Sites of resection (secondary)
    text
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25698 (NCI Thesaurus Property)
    C15232 (NCI Thesaurus Property-2)
    C0728940 (UMLS 2011AA Property)
    Code List
    Sites of resection (secondary)
    CL Item
    Local (Local)
    CL Item
    Local (Local)
    CL Item
    Regional (Regional)
    C25643 (NCI Thesaurus)
    C0205147 (UMLS 2011AA)
    CL Item
    Regional (Regional)
    C25643 (NCI Thesaurus)
    C0205147 (UMLS 2011AA)
    CL Item
    Liver (Liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Lung (Lung)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientSurgicalResectionAnatomicSiteSpecify
    Item
    Specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25698 (NCI Thesaurus Property)
    C15232 (NCI Thesaurus Property-2)
    C0728940 (UMLS 2011AA Property)
    Item Group
    Comments
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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