ID

11289

Descrição

ANBL0321: Eligibility Worksheet NCT00053326 Fenretinide in Treating Children With Recurrent or Resistant Neuroblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C42A6818-CD59-6B25-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C42A6818-CD59-6B25-E034-0003BA12F5E7

Palavras-chave

Versões (4)
  1. 20/09/2012 20/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 09/01/2015 09/01/2015 - Martin Dugas
  4. 27/06/2015 27/06/2015 -
Transferido a

27 de junho de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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ANBL0321: Eligibility Worksheet NCT00053326

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: ANBL0321: Eligibility Worksheet
    1. No Instruction available.
Header
Descrição

Header

Study Number
Descrição

Protocol ID COG

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516477
NCI Thesaurus Property
C25364
Name
Descrição

Institution Name

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
COG Number
Descrição

PatientCOGIdentifierNumber

Tipo de dados

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
Descrição

Patient Name

Tipo de dados

text

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

Form Completion Date

Tipo de dados

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
Descrição

DataEnteredDate

Tipo de dados

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
Descrição

Eligibility Assessment

Will patient begin treatment within five calendar days of fulfilling all eligibility criteria?
Descrição

TherapyBeginRequirementInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25431
UMLS 2011AA Property
C0439659
NCI Thesaurus Property-2
C38015
Was patient no greater than 21 years of age inclusive when originally diagnosed with neuroblastoma?
Descrição

PatientRequiredAgeInd-2

Tipo de dados

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
Does patient have high-risk neuroblastoma with one of the following: 1) Recurrent disease; or 2) Resistant/refractory disease
Descrição

High-riskNeuroblastomaDiagnosisInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ObjectClass
C3270
UMLS 2011AA ObjectClass
C0027819
Has patient ever had a relapse?
Descrição

DiseaseRelapseInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C18265
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Does patient have one of the following sites of disease
Descrição

NeuroblastomaEligibilityAssessmentType

Tipo de dados

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25171
UMLS 2011AA ObjectClass
C0013893
Has the patient had previous histologic verification of neuroblastoma and/or demonstration of tumor cells in the bone marrow with increased urinary catecholamines?
Descrição

DiseaseHistologicDiagnosisInd

Tipo de dados

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Has patient fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study?
Descrição

PatientRecoveryEligibilityInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25746
UMLS 2011AA Property
C2004454
Did patient received growth factors within 2 days of entry onto this study?
Descrição

PriorGrowthFactorReceivedInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C20424
UMLS 2011AA ObjectClass-2
C0018284
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
Does patient have hemoglobin greater than 7.5 gm/dl?
Descrição

Hemoglobin

Tipo de dados

boolean

Alias
NCI Thesaurus Property
C16676
UMLS CUI-1
C0019046
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
Does patient have adequate renal function?
Descrição

PatientRenalFunctionRequiredInd-2

Tipo de dados

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 patient have adequate liver function?
Descrição

PatientLiverFunctionRequiredInd-2

Tipo de dados

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 patient have adequate central nervous system function?
Descrição

PatientCNSFunctionRequiredInd-2

Tipo de dados

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 patient meet the following criteria at time of study enrollment?
Descrição

Eligibility for trial

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C1302261
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25171
Is the patient pregnant?
Descrição

PatientPregnancyInd

Tipo de dados

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
Agent
Descrição

Agent

Tipo de dados

text

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
UMLS CUI-1
C1521826
Has patient received Fenretinide?
Descrição

AgentReceivedInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
Has patient received an allogeneic stem cell transplant?
Descrição

HematopoieticStemCellTransplantationPerformedInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C15342
UMLS 2011AA ObjectClass-2
C0029216
Is the patient able to take the number of capsules prescribed by protocol in intact form?
Descrição

PatientCapsuleAbilityInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
Have the patient and/or the parents or legal guardians signed a written informed consent?
Descrição

Consent signed

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS CUI-1
C0742766
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25678
NCI Thesaurus Property-2
C25460
Have all institutional, FDA, and NCI requirements for human studies been met?
Descrição

StudyCompleteRequirementsInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus Property
C38015
Performance status
Descrição

Performance status

Karnofsky Performance Score
Descrição

KarnofskyPerformanceStatusScale

Tipo de dados

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
Descrição

LanskyPerformanceStatusScale

Tipo de dados

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 patient have a life expectancy of greater than or equal to 2 months?
Descrição

PatientLifeExpectancyEligibilityDeterminationInd-2

Tipo de dados

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
Comments
Descrição

Comments

Comments
Descrição

Research Comments

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Ccrr Module For Anbl0321: Eligibility Worksheet
Descrição

Ccrr Module For Anbl0321: Eligibility Worksheet

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1 Formulários
  1. StudyEvent: ANBL0321: Eligibility Worksheet
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header
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)
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)
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
TherapyBeginRequirementInd-2
Item
Will patient begin treatment within five calendar days of fulfilling all eligibility criteria?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C38015 (NCI Thesaurus Property-2)
PatientRequiredAgeInd-2
Item
Was patient no greater than 21 years of age inclusive when originally diagnosed with neuroblastoma?
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)
High-riskNeuroblastomaDiagnosisInd-2
Item
Does patient have high-risk neuroblastoma with one of the following: 1) Recurrent disease; or 2) Resistant/refractory disease
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C3270 (NCI Thesaurus ObjectClass)
C0027819 (UMLS 2011AA ObjectClass)
DiseaseRelapseInd-2
Item
Has patient ever had a relapse?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18265 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
Item
Does patient have one of the following sites of disease
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25171 (NCI Thesaurus ObjectClass)
C0013893 (UMLS 2011AA ObjectClass)
CL.5
Code List
Does patient have one of the following sites of disease
CL Item
Measurable Tumor On Mri Or Ct Scan Or X-ray (Measurable tumor on MRI or CT scan or X-ray)
CL Item
Mibg Scan With Positive Uptake At Minimum Of One Site (MIBG scan with positive uptake at minimum of one site)
CL Item
Bone Marrow With Tumor Cells Seen On Routine Morphology Of Bilateral Aspirate And/or Biopsy (Bone marrow with tumor cells seen on routine morphology of bilateral aspirate and/or biopsy)
CL Item
>= 5 Tumor Cells/10^6 Normal Mononuclear Cells In The Bone Marrow By Immunocytologic Analysis (Greater than or equal to 5 tumor cells/10^6 normal mononuclear cells in the bone marrow by immunocytologic analysis on two successive bone marrows done at least three weeks apart)
DiseaseHistologicDiagnosisInd
Item
Has the patient had previous histologic verification of neuroblastoma and/or demonstration of tumor cells in the bone marrow with increased urinary catecholamines?
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
PatientRecoveryEligibilityInd-2
Item
Has patient fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25746 (NCI Thesaurus Property)
C2004454 (UMLS 2011AA Property)
PriorGrowthFactorReceivedInd-2
Item
Did patient received growth factors within 2 days of entry onto this study?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C20424 (NCI Thesaurus ObjectClass-2)
C0018284 (UMLS 2011AA ObjectClass-2)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
Hemoglobin
Item
Does patient have hemoglobin greater than 7.5 gm/dl?
boolean
C16676 (NCI Thesaurus Property)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
PatientRenalFunctionRequiredInd-2
Item
Does 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)
PatientLiverFunctionRequiredInd-2
Item
Does patient have adequate liver 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 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)
Eligibility for trial
Item
Does patient meet the following criteria at time of study enrollment?
boolean
C38148 (NCI Thesaurus ValueDomain)
C1302261 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
Item
Is the patient pregnant?
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?
CL Item
No (No)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
N/A, patient is male (N/A, patient is male)
CL Item
No, And Not Nursing (no, and not nursing)
CL Item
No, But Nursing (no, but nursing)
Agent
Item
Agent
text
C25364 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C1521826 (UMLS CUI-1)
AgentReceivedInd-2
Item
Has patient received Fenretinide?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
HematopoieticStemCellTransplantationPerformedInd-2
Item
Has patient received an allogeneic stem cell transplant?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
PatientCapsuleAbilityInd-2
Item
Is the patient able to take the number of capsules prescribed by protocol in intact form?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
Consent signed
Item
Have the patient and/or the parents or legal guardians signed a written informed consent?
boolean
C38147 (NCI Thesaurus ValueDomain)
C0742766 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25678 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property-2)
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
Performance status
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.7
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.8
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 patient have a life expectancy of greater 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)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item Group
Ccrr Module For Anbl0321: Eligibility Worksheet
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