RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
ECOGProtocolNo.
Item
ECOG Protocol No.
text
ECOGProtocolNo.
Item
ECOG Protocol No.
text
ECOGPatientID
Item
ECOG Patient ID
text
ECOGPatientID
Item
ECOG Patient ID
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Are data amended?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Menopausal Status (Choose one:)
text
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Menopausal Status (Choose one:)
CL Item
Post (Post)
C38008 (NCI Thesaurus)
C0687676 (UMLS 2011AA)
CL Item
Above Categories Not Applicable And Age <50 (Above categories not applicable AND Age <50)
CL Item
Above Categories Not Applicable And Age >= 50 (Above categories not applicable AND Age >= 50)
Item
ER Status (most recent)
text
Code List
ER Status (most recent)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
ERTiming,Other
Item
ER Timing, Other, Specify
text
Item
PgR Status (most recent)
text
Code List
PgR Status (most recent)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Receptor Status Timing (most recent)
text
Code List
Receptor Status Timing (most recent)
CL Item
Initial Diagnosis (Initial Diagnosis)
CL Item
At Recurrence (At Recurrence)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Item
Receptor Status Timing (most recent)
text
Code List
Receptor Status Timing (most recent)
CL Item
Initial Diagnosis (Initial Diagnosis)
CL Item
At Recurrence (At Recurrence)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PgRTiming,Other
Item
PgR Timing, Other, Specify
text
Item
Her2/Neu expression status by immunohistochemistry (Choose one:)
text
Code List
Her2/Neu expression status by immunohistochemistry (Choose one:)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
Item
Her2/Neu expression status by FISH (Choose one:)
text
Code List
Her2/Neu expression status by FISH (Choose one:)
CL Item
Non-amplified (Non-amplified)
CL Item
Amplified (Amplified)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
FirstPositiveBiopsyDate
Item
Date of Initial Diagnosis of Primary Tumor (M D Y)
date
DateRecurrent,Progressive,orMetastaticDiseaseFirstDiagnosed
Item
Date Recurrent, Progressive, or Metastatic Disease First Diagnosed (M D Y)
date
Item
Ipsilateral supraclavicular nodes (sites of involvement)
text
Code List
Ipsilateral supraclavicular nodes (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Opposite breast (sites of involvement)
text
Code List
Opposite breast (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Distant nodes (sites of involvement)
text
Code List
Distant nodes (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Distant skin/subcutaneous tissue (sites of involvement)
text
Code List
Distant skin/subcutaneous tissue (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Bone (sites of involvement)
text
Code List
Bone (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Bone marrow (sites of involvement)
text
Code List
Bone marrow (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Lung (sites of involvement)
text
Code List
Lung (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Liver (sites of involvement)
text
Code List
Liver (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Pleura (sites of involvement)
text
Code List
Pleura (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Brain (sites of involvement)
text
Code List
Brain (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Other CNS (sites of involvement)
text
Code List
Other CNS (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
First Other, specify (sites of involvement)
text
Code List
First Other, specify (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Second Other, specify (sites of involvement)
text
Code List
Second Other, specify (sites of involvement)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
FirstOther,specify
Item
First Other, specify
text
SecondOther,specify
Item
Second Other, specify
text
Item
Local-regional (sites of involvement) (Circle the involved local-regional sites listed in below:)
text
Code List
Local-regional (sites of involvement) (Circle the involved local-regional sites listed in below:)
CL Item
ipsilateraly breast (ipsilateraly breast)
CL Item
chest wall (chest wall)
CL Item
axillary, internal mammary and infraclavicular nodes (axillary, internal mammary and infraclavicular nodes)
CL Item
local regional skin and subcutaneous tissue (local regional skin and subcutaneous tissue)
Item
Local-regional (sites of involvement) (Circle the involved local-regional sites listed in below:)
text
Code List
Local-regional (sites of involvement) (Circle the involved local-regional sites listed in below:)
CL Item
ipsilateraly breast (ipsilateraly breast)
CL Item
chest wall (chest wall)
CL Item
axillary, internal mammary and infraclavicular nodes (axillary, internal mammary and infraclavicular nodes)
CL Item
local regional skin and subcutaneous tissue (local regional skin and subcutaneous tissue)
Item
Prior Adjuvant Hormonal Therapy? (do not include steroids given with chemotherapy)
text
Code List
Prior Adjuvant Hormonal Therapy? (do not include steroids given with chemotherapy)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Metastatic/Recurrent Hormonal Therapy? (do not include steroids given with chemotherapy)
text
Code List
Prior Metastatic/Recurrent Hormonal Therapy? (do not include steroids given with chemotherapy)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Adjuvant Chemotherapy? (include pre-op chemotherapy at diagnosis)
text
Code List
Prior Adjuvant Chemotherapy? (include pre-op chemotherapy at diagnosis)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Chemotherapy for Metastasis or Recurrence?
text
Code List
Prior Chemotherapy for Metastasis or Recurrence?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Adjuvant High Dose Chemotherapy/Autologous Stem Cell Transplant?
text
Code List
Prior Adjuvant High Dose Chemotherapy/Autologous Stem Cell Transplant?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior High Dose Chemotherapy/Autologous Stem Cell Transplant for Metastasis or Recurrence?
text
Code List
Prior High Dose Chemotherapy/Autologous Stem Cell Transplant for Metastasis or Recurrence?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Adjuvant Immunotherapy?
text
Code List
Prior Adjuvant Immunotherapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Immunotherapy for Metastasis or Recurrence?
text
Code List
Prior Immunotherapy for Metastasis or Recurrence?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Adjuvant Other Therapy?
text
Code List
Prior Adjuvant Other Therapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Metastatic/Recurrent Other Therapy?
text
Code List
Prior Metastatic/Recurrent Other Therapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
PriorTreatmentRegimenName(s)
Item
Prior Treatment Regimen Name(s)
text
PriorTreatmentRegimenBeginDate
Item
Prior Treatment Regimen Start Date (M/D/Y)
date
PriorTreatmentRegimenEndDate
Item
Prior Treatment Regimen End Date (M/D/Y)
date
Item
Prior Treatment Regimen Type
text
Code List
Prior Treatment Regimen Type
CL Item
Adjuvant (adjuvant)
C25722 (NCI Thesaurus)
C1522673 (UMLS 2011AA)
CL Item
Neoadjuvant (neoadjuvant)
CL Item
Advanced (advanced)
C25411 (NCI Thesaurus)
C0205179 (UMLS 2011AA)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Comments
Item
Comments
text
InvestigatorSignature
Item
Investigator Signature
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)