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ID

11188

Description

ACNS0122 Eligibility Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD908887-2F0D-1578-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD908887-2F0D-1578-E034-0003BA12F5E7

Mots-clés

Versions (3)
  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 21/06/2015 21/06/2015 -
Téléchargé le

21 juin 2015

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Creative Commons BY-NC 3.0 Legacy
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    ACNS0122 Eligibility Worksheet NCT00047320

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    No Instruction available.

    1 Formulaires  
    1. StudyEvent: ACNS0122 Eligibility Worksheet
      1. No Instruction available.
    Header
    Description

    Header

    Name
    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
    Study Number
    Description

    Protocol ID COG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516477
    NCI Thesaurus Property
    C25364
    Study Number
    Description

    Protocol ID COG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516477
    NCI Thesaurus Property
    C25364
    COG Number
    Description

    PatientCOGIdentifierNumber

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C39353
    UMLS 2011AA Property-2
    C1516477
    Patient Name
    Description

    Patient Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299487
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    Today's date
    Description

    Form Completion Date

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Date worksheet entered into RDE
    Description

    DataEnteredDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C37949
    UMLS 2011AA Property
    C1521975
    Eligibility Assessment
    Description

    Eligibility Assessment

    Was the patient greater than 3 years of age and less than 25 years of age at diagnosis?
    Description

    PatientRequiredAgeInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25652
    UMLS 2011AA Property
    C1514873
    NCI Thesaurus Property-2
    C25150
    UMLS 2011AA Property-2
    C0001779
    Did the patient have histologic verification of one of the following? -Endodermal sinus tumor (yolk sac tumor); -Embryonal carcinoma; -Choriocarcinoma; -Immature teratoma; -Teratoma with malignant transformation; -Mixed germ cell tumor
    Description

    DiseaseHistologicDiagnosisInd

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus ObjectClass
    C2991
    UMLS 2011AA ObjectClass
    C0012634
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Did the patient have any histologically confirmed germ cell tumor with elevation of serum/CSF beta HCG >50 IU/dl or any elevation of CSF alpha fetoprotein >10IU/L
    Description

    GermCellTumorEligibilityInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C25171
    UMLS 2011AA Property
    C0013893
    Did the patient have histologically unconfirmed pineal and/or suprasellar tumors with serum/CSF tumor markers of beta>50 IU/dl or any elevation of alpha fetoprotein >10 IU/L?
    Description

    BrainTumorEligibilityInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C25171
    UMLS 2011AA Property
    C0013893
    Was surgery performed?
    Description

    PriorSurgeryPerformedInd-3

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    was a cranial MRI with gadolinium obtained prior to induction or pre-operative and post-operative? (If yes,)
    Description

    CranialMRIPerformedInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    No
    Description

    SpinalMRIPerformedInd-2

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    No
    Description

    SpinalMRIPerformedInd-2

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    No
    Description

    SpinalMRIPerformedInd-2

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    Will the start of treatment begin within 31 days of initial diagnosis and within 7 days from study enrollment?
    Description

    TreatmentRequiredBeginDateInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25275
    UMLS 2011AA Property
    C2745955
    Karnofsky Performance Score
    Description

    KarnofskyPerformanceStatusScale

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ObjectClass
    C28013
    UMLS 2011AA ObjectClass
    C0206065
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Lansky Play Score
    Description

    LanskyPerformanceStatusScale

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ObjectClass
    C25361
    UMLS 2011AA ObjectClass
    C0597198
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Does the patient have a life expectancy of more than or equal to 2 months?
    Description

    PatientLifeExpectancyEligibilityDeterminationInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C37987
    UMLS 2011AA Property
    C0376558
    NCI Thesaurus Property-2
    C25171
    UMLS 2011AA Property-2
    C0013893
    NCI Thesaurus Property-3
    C25359
    UMLS 2011AA Property-3
    C0679138
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Does the patient have a life expectancy of more than or equal to 2 months?
    Description

    PatientLifeExpectancyEligibilityDeterminationInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C37987
    UMLS 2011AA Property
    C0376558
    NCI Thesaurus Property-2
    C25171
    UMLS 2011AA Property-2
    C0013893
    NCI Thesaurus Property-3
    C25359
    UMLS 2011AA Property-3
    C0679138
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Has patient received prior treatment other than surgery and corticosteriods?
    Description

    CancerPriorTreatmentInd-3

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C25629
    UMLS 2011AA Property
    C0332152
    NCI Thesaurus Property-2
    C15368
    Did patient receive growth hormone therapy?
    Description

    PriorGrowthHormoneTherapyInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C15368
    Does the patient have adequate bone marrow function?
    Description

    PatientBoneMarrowFunctionRequiredInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25518
    UMLS 2011AA Property
    C0542341
    Does the patient have adequate renal function?
    Description

    PatientRenalFunctionRequiredInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25518
    UMLS 2011AA Property
    C0542341
    Does the patient have adequate Central Nervous System function?
    Description

    PatientCNSFunctionRequiredInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25518
    UMLS 2011AA Property
    C0542341
    is the patient pregnant and/or breastfeeding? (If female,)
    Description

    PatientPregnancyInd

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25742
    UMLS 2011AA Property
    C0032961
    Has the patient and/or their parents or legal guardians signed a written informed consent?
    Description

    InformedConsentFormSignedDate

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C16468
    UMLS 2011AA ObjectClass
    C0009797
    NCI Thesaurus Property
    C25679
    Have all institutional, FDA, and NCI requirements for human studies been met?
    Description

    StudyCompleteRequirementsInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C15206
    UMLS 2011AA ObjectClass
    C0008972
    NCI Thesaurus Property
    C38015
    Ccrr Module For Acns0122 Eligibility Worksheet
    Description

    Ccrr Module For Acns0122 Eligibility Worksheet

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    1 Formulaires
    1. StudyEvent: ACNS0122 Eligibility Worksheet
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Institution Name
    Item
    Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Protocol ID COG
    Item
    Study Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516477 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Protocol ID COG
    Item
    Study Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516477 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    PatientCOGIdentifierNumber
    Item
    COG Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C39353 (NCI Thesaurus Property-2)
    C1516477 (UMLS 2011AA Property-2)
    Patient Name
    Item
    Patient Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299487 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Today's date
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    DataEnteredDate
    Item
    Date worksheet entered into RDE
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C37949 (NCI Thesaurus Property)
    C1521975 (UMLS 2011AA Property)
    Item Group
    Eligibility Assessment
    PatientRequiredAgeInd-2
    Item
    Was the patient greater than 3 years of age and less than 25 years of age at diagnosis?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25652 (NCI Thesaurus Property)
    C1514873 (UMLS 2011AA Property)
    C25150 (NCI Thesaurus Property-2)
    C0001779 (UMLS 2011AA Property-2)
    DiseaseHistologicDiagnosisInd
    Item
    Did the patient have histologic verification of one of the following? -Endodermal sinus tumor (yolk sac tumor); -Embryonal carcinoma; -Choriocarcinoma; -Immature teratoma; -Teratoma with malignant transformation; -Mixed germ cell tumor
    boolean
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C2991 (NCI Thesaurus ObjectClass)
    C0012634 (UMLS 2011AA ObjectClass)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    GermCellTumorEligibilityInd-2
    Item
    Did the patient have any histologically confirmed germ cell tumor with elevation of serum/CSF beta HCG >50 IU/dl or any elevation of CSF alpha fetoprotein >10IU/L
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25171 (NCI Thesaurus Property)
    C0013893 (UMLS 2011AA Property)
    BrainTumorEligibilityInd-2
    Item
    Did the patient have histologically unconfirmed pineal and/or suprasellar tumors with serum/CSF tumor markers of beta>50 IU/dl or any elevation of alpha fetoprotein >10 IU/L?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25171 (NCI Thesaurus Property)
    C0013893 (UMLS 2011AA Property)
    PriorSurgeryPerformedInd-3
    Item
    Was surgery performed?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    CranialMRIPerformedInd-2
    Item
    was a cranial MRI with gadolinium obtained prior to induction or pre-operative and post-operative? (If yes,)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    SpinalMRIPerformedInd-2
    Item
    No
    text
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    SpinalMRIPerformedInd-2
    Item
    No
    text
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    SpinalMRIPerformedInd-2
    Item
    No
    text
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    TreatmentRequiredBeginDateInd-2
    Item
    Will the start of treatment begin within 31 days of initial diagnosis and within 7 days from study enrollment?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    Item
    Karnofsky Performance Score
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C28013 (NCI Thesaurus ObjectClass)
    C0206065 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL.9
    Code List
    Karnofsky Performance Score
    CL Item
    100 (Normal, no complaints, no evidence of disease.)
    CL Item
    90 (Able to carry on normal activity, minor signs or symptoms of disease.)
    CL Item
    80 (Normal activity with effort, some signs or symptoms of disease.)
    CL Item
    70 (Cares for self. Unable to carry on normal activity or to do active work.)
    CL Item
    60 (Requires occasional assistance, but is able to care for most of own needs.)
    CL Item
    50 (Requires considerable assistance and frequent medical care.)
    CL Item
    40 (Disabled, requires special care and assistance.)
    CL Item
    30 (Severely disabled, hospitalization is indicated although death is not imminent.)
    CL Item
    20 (Hospitalization necessary, very sick, active supportive treatment necessary,)
    CL Item
    10 (Moribund, fatal processes progressing rapidly.)
    CL Item
    0 (Dead.)
    C0919414 (NCI Metathesaurus)
    Item
    Lansky Play Score
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C25361 (NCI Thesaurus ObjectClass)
    C0597198 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL.10
    Code List
    Lansky Play Score
    CL Item
    100 (Fully active, normal)
    CL Item
    90 (Minor restrictions in physically strenuous activity.)
    CL Item
    80 (Active, but tires more quickly.)
    CL Item
    70 (Both greater restriction of and less time spent in play activity.)
    CL Item
    60 (Up and around, but minimal active play; keeps busy with quieter activities.)
    CL Item
    50 (Gets dressed but lies around much of the day, no active play, able to participate in all quiet play and activities.)
    CL Item
    40 (Mostly in bed; participates in quiet activities.)
    CL Item
    30 (In bed; needs assistance even for quiet play.)
    CL Item
    20 (Often sleeping; play entirely limited to very passive activities.)
    CL Item
    10 (No play; does not get out of bed.)
    CL Item
    0 (Unresponsive.)
    C0919414 (NCI Metathesaurus)
    PatientLifeExpectancyEligibilityDeterminationInd-2
    Item
    Does the patient have a life expectancy of more than or equal to 2 months?
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C37987 (NCI Thesaurus Property)
    C0376558 (UMLS 2011AA Property)
    C25171 (NCI Thesaurus Property-2)
    C0013893 (UMLS 2011AA Property-2)
    C25359 (NCI Thesaurus Property-3)
    C0679138 (UMLS 2011AA Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PatientLifeExpectancyEligibilityDeterminationInd-2
    Item
    Does the patient have a life expectancy of more than or equal to 2 months?
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C37987 (NCI Thesaurus Property)
    C0376558 (UMLS 2011AA Property)
    C25171 (NCI Thesaurus Property-2)
    C0013893 (UMLS 2011AA Property-2)
    C25359 (NCI Thesaurus Property-3)
    C0679138 (UMLS 2011AA Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    CancerPriorTreatmentInd-3
    Item
    Has patient received prior treatment other than surgery and corticosteriods?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus Property)
    C0332152 (UMLS 2011AA Property)
    C15368 (NCI Thesaurus Property-2)
    PriorGrowthHormoneTherapyInd-2
    Item
    Did patient receive growth hormone therapy?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus Property)
    PatientBoneMarrowFunctionRequiredInd-2
    Item
    Does the patient have adequate bone marrow function?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25518 (NCI Thesaurus Property)
    C0542341 (UMLS 2011AA Property)
    PatientRenalFunctionRequiredInd-2
    Item
    Does the patient have adequate renal function?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25518 (NCI Thesaurus Property)
    C0542341 (UMLS 2011AA Property)
    PatientCNSFunctionRequiredInd-2
    Item
    Does the patient have adequate Central Nervous System function?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25518 (NCI Thesaurus Property)
    C0542341 (UMLS 2011AA Property)
    Item
    is the patient pregnant and/or breastfeeding? (If female,)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25742 (NCI Thesaurus Property)
    C0032961 (UMLS 2011AA Property)
    CL.17
    Code List
    is the patient pregnant and/or breastfeeding? (If female,)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    CL Item
    No, And Not Nursing (no, and not nursing)
    CL Item
    No, But Nursing (no, but nursing)
    InformedConsentFormSignedDate
    Item
    Has the patient and/or their parents or legal guardians signed a written informed consent?
    boolean
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C16468 (NCI Thesaurus ObjectClass)
    C0009797 (UMLS 2011AA ObjectClass)
    C25679 (NCI Thesaurus Property)
    StudyCompleteRequirementsInd-2
    Item
    Have all institutional, FDA, and NCI requirements for human studies been met?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C15206 (NCI Thesaurus ObjectClass)
    C0008972 (UMLS 2011AA ObjectClass)
    C38015 (NCI Thesaurus Property)
    Item Group
    Ccrr Module For Acns0122 Eligibility Worksheet
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