ID

11415

Beschreibung

S0205 Off Treatment Notice NCT00075686 S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A11E1F7E-5275-2148-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A11E1F7E-5275-2148-E034-080020C9C0E0

Stichworte

  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 03.07.15 03.07.15 -
Hochgeladen am

3. Juli 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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S0205 Off Treatment Notice NCT00075686

Instructions: For each registration step, submit this form within 2 weeks after completion (or discontinuation) of treatment.

SWOG clinical trial administrative data
Beschreibung

SWOG clinical trial administrative data

SWOG Patient ID
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

text

Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution
Beschreibung

InstitutionName

Datentyp

text

Affiliate
Beschreibung

AffiliateName

Datentyp

text

Physician (Groups other than SWOG)
Beschreibung

RegisteredInvestigator

Datentyp

text

Group Name
Beschreibung

GroupName

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Study No.
Beschreibung

StudyNo.

Datentyp

text

Pt. ID
Beschreibung

Pt.ID

Datentyp

text

Reporting period
Beschreibung

Reporting period

Treatment Start Date
Beschreibung

TreatmentStartDate

Datentyp

date

Treatment End Date
Beschreibung

TreatmentEndDate

Datentyp

date

Regimen or Procedure or Site(s)
Beschreibung

RegimenorProcedureorSite(s)

Datentyp

text

Off Treatment Reason (select one)
Beschreibung

OffTreatmentReason

Datentyp

text

Patient refused, due to toxicity, specify
Beschreibung

OffTreatmentReason,Toxicity

Datentyp

text

Patient refused, due to toxicity, specify
Beschreibung

OffTreatmentReason,Toxicity

Datentyp

text

Sites
Beschreibung

ProgressionSite,Other

Datentyp

text

Other, specify (Off Treatment Date)
Beschreibung

OffTreatmentReason,Other

Datentyp

text

Other, specify (Off Treatment Date)
Beschreibung

OffTreatmentReason,Other

Datentyp

text

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

OffTreatmentDate

Datentyp

date

Will patient receive further treatment?
Beschreibung

FurtherTreatmentInd

Datentyp

text

Yes, specify
Beschreibung

Yes,specify

Datentyp

text

Date of Last Contact (or death)
Beschreibung

DeathDate/LastContactDate

Datentyp

date

Vital Status
Beschreibung

Patient'sVitalStatus

Datentyp

text

Notes
Beschreibung

Notes

Notes
Beschreibung

Comments

Datentyp

text

Ccrr Module For S0205 Off Treatment Notice
Beschreibung

Ccrr Module For S0205 Off Treatment Notice

Ähnliche Modelle

Instructions: For each registration step, submit this form within 2 weeks after completion (or discontinuation) of treatment.

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
SWOG clinical trial administrative data
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
text
AffiliateName
Item
Affiliate
text
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
GroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Reporting period
TreatmentStartDate
Item
Treatment Start Date
date
TreatmentEndDate
Item
Treatment End Date
date
RegimenorProcedureorSite(s)
Item
Regimen or Procedure or Site(s)
text
Item
Off Treatment Reason (select one)
text
Code List
Off Treatment Reason (select one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Medically required, due to toxicity, specify (Medically required, due to toxicity, specify)
CL Item
Patient refused, due to toxicity, specify (Patient refused, due to toxicity, specify)
CL Item
Patient refused, other than toxicity, specify (Patient refused, other than toxicity, specify)
CL Item
Progression or relapse (Progression or relapse)
CL Item
Death (Death)
CL Item
Other, Specify (Other, specify)
CL Item
Death After Beginning Protocol Therapy (Death after beginning protocol therapy)
CL Item
Death On Study (Death on study)
CL Item
Death Prior To Beginning Protocol Therapy (Death prior to beginning protocol therapy)
CL Item
Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
CL Item
Disease Progression, Relapse Prior To Beginning Protocol Therapy (Disease progression, relapse prior to beginning protocol therapy)
CL Item
Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal after beginning protocol therapy)
CL Item
Patient Withdrawal Or Refusal Prior To Beginning Protocol Therapy (Patient withdrawal or refusal prior to beginning protocol therapy)
CL Item
Toxicity/side Effects/complications (Toxicity/Side effects/Complications)
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
ProgressionSite,Other
Item
Sites
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentDate
Item
Date of completion, progression, death or decision to discontinue therapy
date
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, specify (Yes, specify)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Yes,specify
Item
Yes, specify
text
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
Notes
Comments
Item
Notes
text
Item Group
Ccrr Module For S0205 Off Treatment Notice

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