ID

11363

Beschrijving

NCT00057928 SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE (S0227) 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=A9C44FD3-7B1D-3AAB-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C44FD3-7B1D-3AAB-E034-0003BA12F5E7

Trefwoorden

  1. 27-08-12 27-08-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 03-07-15 03-07-15 -
Geüploaded op

3 juli 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

NCT00057928 SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE (S0227)

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE (S0227)
    1. No Instruction available.
Header
Beschrijving

Header

SWOG Patient ID
Beschrijving

SWOGPatientID

Datatype

text

SWOG Study No.
Beschrijving

SWOGStudyNo.

Datatype

text

Registration Step
Beschrijving

RegistrationStep

Datatype

text

Patient Initials (L, F M)
Beschrijving

Patient Initials

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution / Affiliate
Beschrijving

InstitutionName

Datatype

text

Physician (Groups other than SWOG)
Beschrijving

RegisteredInvestigator

Datatype

text

Group Name
Beschrijving

ParticipatingGroupName

Datatype

text

Study No.
Beschrijving

Particip.GroupProtocolNumber

Datatype

float

Pt. ID
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Treatment period
Beschrijving

Treatment period

Treatment Start Date
Beschrijving

TreatmentStartDate

Datatype

date

Treatment End Date
Beschrijving

TreatmentEndDate

Datatype

date

Regimen or Procedure or Site(s)
Beschrijving

RegimenorProcedureorSite(s)

Datatype

text

Off-protocol treatment
Beschrijving

Off-protocol treatment

Off Treatment Reason
Beschrijving

OffTreatmentReason

Datatype

text

Patient refused, other than toxicity, specify
Beschrijving

Patientrefused,otherthantoxicity,specify

Datatype

text

Progression or relapse, specify site
Beschrijving

Progressionorrelapse,specifysite

Datatype

text

Other, specify (Off Treatment Date)
Beschrijving

OffTreatmentReason,Other

Datatype

text

Date of completion, progression, death or decision to discontinue therapy
Beschrijving

Dateofcompletion,progression,deathordecisiontodiscontinuetherapy

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Further treatment
Beschrijving

Further treatment

Will patient receive further treatment?
Beschrijving

FurtherTreatmentInd

Datatype

text

Yes, specify
Beschrijving

Yes,specify

Datatype

text

Vital status
Beschrijving

Vital status

Date of Last Contact (or death)
Beschrijving

DeathDate/LastContactDate

Datatype

date

Vital Status
Beschrijving

Patient'sVitalStatus

Datatype

text

Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice (s0227)
Beschrijving

Ccrr Module For Southwest Oncology Group Off Treatment Notice (s0227)

Similar models

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE (S0227)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
Particip.GroupProtocolNumber
Item
Study No.
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID
text
Item Group
Treatment period
TreatmentStartDate
Item
Treatment Start Date
date
TreatmentEndDate
Item
Treatment End Date
date
RegimenorProcedureorSite(s)
Item
Regimen or Procedure or Site(s)
text
Item Group
Off-protocol treatment
Item
Off Treatment Reason
text
Code List
Off Treatment Reason
CL Item
Patient Withdrawal, Medically Required Due To Toxicity (Medically required, due to toxicity)
CL Item
Patient Withdrawal Or Refusal Subsequent To Toxicity (Patient refused, due to toxicity)
CL Item
Patient Withdrawal Or Refusal For Reason Other Than Toxicity (Patient refused, other than toxicity, specify)
CL Item
Progression or relapse, specify site (Progression or relapse, specify site)
CL Item
Death (Death)
CL Item
Specify Other Reason (Other, specify)
Patientrefused,otherthantoxicity,specify
Item
Patient refused, other than toxicity, specify
text
Progressionorrelapse,specifysite
Item
Progression or relapse, specify site
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
Dateofcompletion,progression,deathordecisiontodiscontinuetherapy
Item
Date of completion, progression, death or decision to discontinue therapy
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Further treatment
Item
Will patient receive further treatment?
text
Code List
Will patient receive further treatment?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Yes,specify
Item
Yes, specify
text
Item Group
Vital status
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Off Treatment Notice (s0227)

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial