Description:

E2108 Optimal Systemic Therapy Summary Form NCT01242800 Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E1D8B2-2FF5-DD0A-E040-BB89AD434391

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E1D8B2-2FF5-DD0A-E040-BB89AD434391

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Versions (3) ▾
  1. 12/18/14
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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E2108 Optimal Systemic Therapy Summary Form NCT01242800

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
Report Period
Reporting Period
Data amendment
Arm A And Arm B
Vital Status
Patient's Vital Status
Primary Cause of Death (if applicable)
Therapy Administered - Chemotherapy
Has the patient received any chemotherapy during this reporting period? (as part of optimal systemic therapy)
Chemotherapy Course 1
Chemotherapy Course 2
Chemotherapy Course 3
Therapy Administered - Hormone Therapy
Has the patient received any hormone therapy during this reporting period? (as part of optimal systemic therapy)
Hormone Therapy Course 1
Hormone Therapy Course 2
Hormone Therapy Course 3
Therapy Administered - New Progression
Has the patient been diagnosed with a new progression? (while receiving systemic therapy)
Basis for Progressive Disease
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