Description:

PACCT-1 TAILORx On-Study Form NCT00310180 Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05D9BCF6-1191-5BFE-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05D9BCF6-1191-5BFE-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 6/18/15
Uploaded on:

June 18, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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PACCT-1 TAILORx On-Study Form NCT00310180

No Instruction available.

  1. StudyEvent: PACCT-1 TAILORx On-Study Form
    1. No Instruction available.
Header
Reporting Period
Menopausal status
Menopausal status (NOTE: See TAILORx Forms Completion Guidelines for defintions)
Breast: Surgical Procedures
Most Extensive Primary Surgery (check one)
Was sentinel node sampling performed
Was axillary dissection performed?
Breast: Disease Description
Mammogram (Breast cancer was detectable by the following answer yes or no for each of the following:)
Physical Exam
Other
Tumor Laterality
Histologic Grade (For breast cancer, a combined histologic grade is used according to SBR/Elston classification)
Nuclear Grade
Receptor Status, ER (as defined by local laboratory; borderline results should be reported as positive)
Receptor Status, PgR
Pathologic N Stage (CRF says "TNM Nodal Staging" - CDE is Recommended Term)
After receiving the treatment assignment, indicate which treatment(s) patient has agreed to receive (Choose all that apply)
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