Description:

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH (S0227) NCT00057928 S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C42A3E-20F3-39F5-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C42A3E-20F3-39F5-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/27/12
  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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SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH (S0227) NCT00057928

Instructions: Answer all questions and explain any blank fields or blank dates in the Notes section. Place an X in appropriate boxes. Circle AMENDED items in red.

Header
Date of death
Causes Of Death
Any cancer (select one)
If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
Toxicity from disease related treatment (select one)
Non-cancer and non-treatment related causes (select one)
Autopsy done?
Death information obtained from (select all that apply)
Notes
Ccrr Module For Southwest Oncology Group Notice Of Death (s0227)

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