ID
11100
Description
CALGB: 40601 PRE-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM NCT00770809 Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A963C4E-69F2-4844-E044-0003BA3F9857
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Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/18/15 6/18/15 -
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June 18, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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CALGB: 40601 PRE-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM NCT00770809
INSTRUCTIONS: Complete all information on this form. Submit within one week of registration along with the On-Study Form.
- StudyEvent: CALGB: 40601 PRE-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM
Description
Patient demographics
Description
Patient Initials
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Medical Record Number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Description
Institution Name
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass-2
- C21541
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Description
Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Description
Study Number Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Trial subject ID Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Breast Conserving Therapy
Description
ClinicalBreastExaminationNormalEvaluationInd-2
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property-2
- C14165
- UMLS 2011AA Property-2
- C0205307
- NCI Thesaurus ObjectClass
- C70552
- UMLS 2011AA ObjectClass
- C2347781
Description
ClinicalBreastExaminationAbnormalEvaluationText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property-2
- C25401
- UMLS 2011AA Property-2
- C0205161
- NCI Thesaurus ObjectClass
- C70552
- UMLS 2011AA ObjectClass
- C2347781
Description
BreastConservationTreatmentPriorNeoadjuvantTherapyQualificationInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property-2
- C15665
- UMLS 2011AA Property-2
- C0600558
- NCI Thesaurus Property-3
- C43608
- UMLS 2011AA Property-3
- C1709790
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
BreastConservationTreatmentPriorNeoadjuvantTherapyNotQualificationReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property-2
- C15665
- UMLS 2011AA Property-2
- C0600558
- NCI Metathesaurus Property
- CL052458
- NCI Thesaurus Property-3
- C43608
- UMLS 2011AA Property-3
- C1709790
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
BreastConservationTreatmentPriorNeoadjuvantTherapyNotQualificationSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15280
- UMLS 2011AA ObjectClass
- C0917927
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property-2
- C15665
- UMLS 2011AA Property-2
- C0600558
- NCI Metathesaurus Property
- CL052458
- NCI Thesaurus Property-3
- C43608
- UMLS 2011AA Property-3
- C1709790
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
BreastConservationTreatmentRadiationTherapyMedicalContraindicationReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass-2
- C15280
- UMLS 2011AA ObjectClass-2
- C0917927
- NCI Thesaurus Property
- C50646
- UMLS 2011AA Property
- C1301624
Description
BreastConservationTreatmentRadiationTherapyConnectiveTissueDisorderMedicalContraindicationSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass-2
- C15280
- UMLS 2011AA ObjectClass-2
- C0917927
- NCI Thesaurus Property
- C26729
- UMLS 2011AA Property
- C0009782
- NCI Thesaurus Property-2
- C50646
- UMLS 2011AA Property-2
- C1301624
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Axillary Node
Description
AxillaryLymphNodePriorNeoadjuvantTherapyEvaluationInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C12904
- UMLS 2011AA ObjectClass
- C0729594
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property-2
- C25629
- UMLS 2011AA Property-2
- C0332152
- NCI Thesaurus Property-3
- C15665
- UMLS 2011AA Property-3
- C0600558
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
Evaluation method
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2911685
- NCI Thesaurus ObjectClass
- C20989
- NCI Thesaurus Property
- C16847
Description
BreastTumorClinicalNStage
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C12971
- UMLS 2011AA ObjectClass-2
- C0006141
- NCI Thesaurus Property
- C25398
- UMLS 2011AA Property
- C0205210
- NCI Thesaurus Property-2
- C25580
- UMLS 2011AA Property-2
- C0456532
- NCI Thesaurus ValueDomain
- C16899
- UMLS 2011AA ValueDomain
- C1300072
Description
AxillaryLymphNodePostNeoadjuvantTherapyEvaluationResult
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12904
- UMLS 2011AA ObjectClass
- C0729594
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property-2
- C38008
- UMLS 2011AA Property-2
- C0687676
- NCI Thesaurus Property-3
- C15665
- UMLS 2011AA Property-3
- C0600558
- NCI Thesaurus ValueDomain
- C20200
- UMLS 2011AA ValueDomain
- C1274040
Description
UltrasoundImagingPositiveFindingResultText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C38758
- UMLS 2011AA Property
- C1514241
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C17230
- UMLS 2011AA ObjectClass
- C0041618
Description
LesionAssessmentDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C3824
- UMLS 2011AA ObjectClass
- C0221198
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain-2
- C25367
Description
Evaluation method, specify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C2911685
- NCI Thesaurus ObjectClass
- C20989
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C16847
Description
SentinelNodeBiopsyDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C15189
- UMLS 2011AA Property
- C0005558
- NCI Thesaurus ObjectClass
- C12947
- UMLS 2011AA ObjectClass
- C1522495
Description
SentinelLymphNodeBiopsyBlueDyeUseInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C15667
- UMLS 2011AA ObjectClass
- C0796693
- NCI Thesaurus Property
- C461
- UMLS 2011AA Property
- C0013343
- NCI Thesaurus Property-2
- C25340
- UMLS 2011AA Property-2
- C0457083
- NCI Thesaurus Property-3
- C48333
- UMLS 2011AA Property-3
- C1260957
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
SentinelLymphNodeBiopsyTechnetium99mDextranUseInd-2
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15667
- UMLS 2011AA ObjectClass
- C0796693
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus Property-2
- C1243
- UMLS 2011AA Property-2
- C0076028
Description
LymphNodeDissectionDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
- NCI Thesaurus Property
- C15227
- UMLS 2011AA Property
- C0012737
Description
Footer Module
Description
Research Comments
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0947611
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
Description
Person Completing Form
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Description
Date Form Completed
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
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INSTRUCTIONS: Complete all information on this form. Submit within one week of registration along with the On-Study Form.
- StudyEvent: CALGB: 40601 PRE-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM
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