ID
11195
Description
CALGB 40601 FOLLOW-UP 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=3A098B5D-E41F-1055-E044-0003BA3F9857
Link
Keywords
Versions (4)
- 8/27/12 8/27/12 -
- 1/8/15 1/8/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 6/21/15 6/21/15 -
Uploaded on
June 21, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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CALGB 40601 FOLLOW-UP FORM NCT00770809
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.
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
Vital Status
Description
Patient Status
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Description
Primary Cause of Death
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Description
Cause of Death, specify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C28554
Description
NeoadjuvantTherapyFollow-upCyclophosphamideDoxorubicinAdministrationInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C456
- UMLS 2011AA Property
- C0013089
- NCI Thesaurus Property-2
- C405
- UMLS 2011AA Property-2
- C0010583
- NCI Thesaurus Property-3
- C25409
- UMLS 2011AA Property-3
- C1533734
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
TherapeuticProcedureRegimenType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C49236
- UMLS 2011AA ObjectClass
- C0087111
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
Description
NeoadjuvantTherapyFollow-upTrastuzumabAdministrationInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C1647
- UMLS 2011AA Property
- C0338204
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
NeoadjuvantTherapyFollow-upTrastuzumabAdministrationBeginDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C1647
- UMLS 2011AA Property
- C0338204
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Description
NeoadjuvantTherapyFollow-upTrastuzumabAdministrationEndDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C1647
- UMLS 2011AA Property
- C0338204
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
NeoadjuvantTherapyFollow-upEndocrineTherapyAdministrationInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C15445
- UMLS 2011AA Property
- C0279025
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
NeoadjuvantTherapyFollow-upEndocrineTherapyAdministrationBeginDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C15445
- UMLS 2011AA Property
- C0279025
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Description
NeoadjuvantTherapyFollow-upEndocrineTherapyAdministrationEndDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16033
- UMLS 2011AA ObjectClass
- C1522577
- NCI Thesaurus ObjectClass-2
- C15665
- UMLS 2011AA ObjectClass-2
- C0600558
- NCI Thesaurus Property
- C15445
- UMLS 2011AA Property
- C0279025
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Documented clinical assessment for this cancer
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1522577
- NCI Thesaurus Property
- C16033
- UMLS CUI-2
- C0006826
- NCI Thesaurus ObjectClass
- C9305
- NCI Thesaurus Property-2
- C25365
Description
Follow-Up Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS CUI-1
- C3694716
- NCI Thesaurus Property
- C16033
- NCI Thesaurus Property-2
- C25365
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
BreastNewStageInd-3
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25586
- UMLS 2011AA Property
- C0205314
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus Property-2
- C16899
- UMLS 2011AA Property-2
- C1300072
Description
OverallTumorResponseType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C25605
- UMLS 2011AA ObjectClass-2
- C1561607
- NCI Thesaurus Property
- C25755
- UMLS 2011AA Property
- C0871261
Description
Complete Response First Observed Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS CUI-1
- C0677874
- NCI Thesaurus ObjectClass-2
- C25250
- UMLS CUI-2
- C1115465
- NCI Thesaurus Property
- C25509
- NCI Thesaurus Property-2
- C25599
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
Partial Response First Observed Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS CUI-1
- C1521726
- NCI Thesaurus ObjectClass-2
- C25378
- UMLS CUI-2
- C1115465
- NCI Thesaurus Property
- C25509
- NCI Thesaurus Property-2
- C25599
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
Notice Of Progression
Description
Neoplasm Recurrence, locoregional
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C19987
- UMLS CUI-1
- C0027643
- NCI Thesaurus Property
- C25388
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus Property-3
- C15220
- NCI Thesaurus ValueDomain
- C38148
Description
Local-RegionalProgressionFirstDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25331
- NCI Thesaurus ObjectClass-2
- C25388
- UMLS 2011AA ObjectClass
- C1947913
- NCI Thesaurus Property
- C25509
- UMLS 2011AA Property
- C1279901
- NCI Thesaurus Property-2
- C25275
- UMLS 2011AA Property-2
- C2745955
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25509
- UMLS 2011AA ValueDomain-2
- C1279901
Description
BreastFirstProgressionLocal-RegionalSite
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C25331
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus Property-2
- C25509
- UMLS 2011AA Property
- C1279901
Description
Neoplasm recurrence, Distal
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C19987
- UMLS CUI-1
- C0027627
- NCI Thesaurus Property
- C25321
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus Property-3
- C15220
- NCI Thesaurus ValueDomain
- C25180
Description
Date of Neoplasm distal recurrence
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0027627
- NCI Thesaurus ObjectClass
- C25331
- NCI Thesaurus ValueDomain-2
- C25509
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property
- C25275
Description
RecurrentDiseaseFirstDistantDiagnosisText
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C38155
- UMLS 2011AA ObjectClass
- C0277556
- NCI Thesaurus Property
- C25321
- UMLS 2011AA Property
- C0443203
- NCI Thesaurus Property-2
- C25509
- UMLS 2011AA Property-2
- C1279901
- NCI Thesaurus Property-3
- C15220
- UMLS 2011AA Property-3
- C0011900
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Description
ProgressionAssessmentSource
Data type
text
Alias
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ObjectClass
- C25331
- NCI Thesaurus ValueDomain
- C25683
- UMLS 2011AA ValueDomain
- C0449416
Description
ProgressionAssessmentSource
Data type
text
Alias
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ObjectClass
- C25331
- NCI Thesaurus ValueDomain
- C25683
- UMLS 2011AA ValueDomain
- C0449416
Description
Expected Adverse Events
Description
Adverse Event
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25648
- UMLS CUI-1
- C0877248
- NCI Thesaurus ObjectClass-2
- C41331
- NCI Thesaurus ObjectClass-3
- C15368
- NCI Metathesaurus Property
- C0684224
- NCI Thesaurus ValueDomain
- C38148
Description
MedDRACode
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Metathesaurus ObjectClass
- CL104089
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C45559
Description
CTC Adverse Event Grade
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Description
CTC Adverse Event Attribution Category
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1706735
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
Description
Adverse Event Onset Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985916
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25279
Description
Comments
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 and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.
C3262252 (UMLS CUI-1)
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C0027651 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus ObjectClass-2)
C1561607 (UMLS 2011AA ObjectClass-2)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C0677874 (UMLS CUI-1)
C25250 (NCI Thesaurus ObjectClass-2)
C1115465 (UMLS CUI-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C1521726 (UMLS CUI-1)
C25378 (NCI Thesaurus ObjectClass-2)
C1115465 (UMLS CUI-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0027643 (UMLS CUI-1)
C25388 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C15220 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
C25388 (NCI Thesaurus ObjectClass-2)
C1947913 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25509 (NCI Thesaurus ValueDomain-2)
C1279901 (UMLS 2011AA ValueDomain-2)
C1515974 (UMLS 2011AA ValueDomain)
C25331 (NCI Thesaurus Property)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property)
C62484 (NCI Thesaurus)
C0205076 (UMLS 2011AA)
C0004454 (UMLS 2011AA)
C0027627 (UMLS CUI-1)
C25321 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C15220 (NCI Thesaurus Property-3)
C25180 (NCI Thesaurus ValueDomain)
C0027627 (UMLS CUI-1)
C25331 (NCI Thesaurus ObjectClass)
C25509 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA ObjectClass)
C25321 (NCI Thesaurus Property)
C0443203 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property-2)
C15220 (NCI Thesaurus Property-3)
C0011900 (UMLS 2011AA Property-3)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C0031809 (UMLS 2011AA Property)
C25331 (NCI Thesaurus ObjectClass)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
C0031809 (UMLS 2011AA Property)
C25331 (NCI Thesaurus ObjectClass)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
C0877248 (UMLS CUI-1)
C41331 (NCI Thesaurus ObjectClass-2)
C15368 (NCI Thesaurus ObjectClass-3)
C0684224 (NCI Metathesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL104089 (NCI Metathesaurus ObjectClass)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C45559 (NCI Thesaurus Property)
C0018995 (UMLS 2011AA)
C0151313 (UMLS 2011AA)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C0445356 (UMLS 2011AA)
C2985916 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)