Description:

NCT01366183 Fast Fact Sheet for Protocol 0273 (Ovary, Fallopian Tube, Peritoneal) Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A6C752A1-D805-7EE2-E040-BB89AD43385E

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A6C752A1-D805-7EE2-E040-BB89AD43385E

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 7/3/15
Uploaded on:

July 3, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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NCT01366183 Fast Fact Sheet for Protocol 0273 (Ovary, Fallopian Tube, Peritoneal)

No Instruction available.

  1. StudyEvent: Fast Fact Sheet for Protocol 0273 (Ovary, Fallopian Tube, Peritoneal)
    1. No Instruction available.
Tracking Information
Miscellaneous Patient Information
Did the patient sign an approved informed consent
Has HIPAA authorization been obtained?
Did the patient agree to provide blood samples from which plasma will be extracted to be tested for research purposes?
Does the patient have histologically or cytologically confirmed epithelial ovarian, fallopian tube or primary peritoneal cancer?
What is the primary disease site
What is the cell type
Stage
Was primary staging surgery done?
If primary surgery was not done, what was the method used to diagnosis disease?
Has the patient had any previous treatment for this malignancy other than surgery?
Has the patient recovered from the effects of recent surgery?
ANC greater than or equal to 1,500/mcl?
Platelets greater than or equal to 100,000/mcl?
Is Bilirubin less than or equal to ULN?
Is the Serum Creatinine less than or equal to ULN
Performance Status
Is the patient age 75 years or older?
Does the patient and physician agree that they plan to conduct treatment according to Regimen 1 or Regimen 2, as described in Appendix I or II respectively?
Which treatment regimen will the patient be receiving?
Is the patient able to understand and read English?
Is the patient free of active infection requiring antibiotics
Has the patient had previous cancer treatment which contraindicates this protocol therapy
Does that patient have any medical history or conditions not otherwise previously specified which in the opinion of the investigator should exclude participation in this study?
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