ID

11484

Descrição

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH (S0226) NCT00075764 S0226 Anastrozole With or Without Fulvestrant as First-Line Therapy in Postmenopausal Women With Metastatic Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C3223013-0891-25E5-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C3223013-0891-25E5-E034-0003BA12F5E7

Palavras-chave

  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 05/07/2015 05/07/2015 -
Transferido a

5 de julho de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy

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SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH (S0226) NCT00075764

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
Descrição

Header

SWOG Patient ID
Descrição

Trial subject ID SWOG

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
Most Recent SWOG Study No.
Descrição

MostRecentSWOGStudyNo.

Tipo de dados

text

Patient Initials (L, F, M)
Descrição

Patient Initials

Tipo de dados

text

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

Institution Name

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Physician
Descrição

Investigator Name

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2826892
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus ObjectClass-2
C25644
Participating Group Name
Descrição

Participating Group

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Study No.
Descrição

Study Number Participating Group

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Patient ID
Descrição

Trial subject ID Participating Group

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Date of death
Descrição

Date of death

Date of Death (month / day / year)
Descrição

DeathDocumentedDate

Tipo de dados

date

Causes Of Death
Descrição

Causes Of Death

Any cancer (select one)
Descrição

Anycancer

Tipo de dados

text

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
Descrição

PersonCancerAssociatedDeathType

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus Property-2
C9305
UMLS 2011AA Property-2
C0006826
NCI Thesaurus Property-3
C25281
UMLS 2011AA Property-3
C0332281
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Cancer of most recent SWOG study, specify cancer
Descrição

CancerofmostrecentSWOGstudy,specifycancer

Tipo de dados

text

Cancer of other SWOG study, specify cancer
Descrição

SouthwestOncologyGroupMalignantNeoplasmOtherProtocolSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C25699
UMLS 2011AA ObjectClass
C1519429
NCI Thesaurus ObjectClass-2
C9305
UMLS 2011AA ObjectClass-2
C0006826
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25320
UMLS 2011AA Property-2
C1507394
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other cancer, specify
Descrição

Othercancer,specify

Tipo de dados

text

Toxicity from disease related treatment (select one)
Descrição

Toxicityfromdiseaserelatedtreatment

Tipo de dados

text

If Primary Cause, Contributory or Possible, specify treatment and toxicity
Descrição

IfPrimaryCause,ContributoryorPossible,specifytreatmentandtoxicity

Tipo de dados

text

Non-cancer and non-treatment related causes (select one)
Descrição

Non-cancerandnon-treatmentrelatedcauses

Tipo de dados

text

If Primary Cause, Contributory or Possible, specify
Descrição

IfPrimaryCause,ContributoryorPossible,specify

Tipo de dados

text

Autopsy?
Descrição

AutopsyPerformedInd-3

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25153
UMLS 2011AA ObjectClass
C0004398
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Source of death information (select all that apply)
Descrição

DeathInformationSource

Tipo de dados

text

Other, specify
Descrição

PatientDeathSourceSpecify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
Comments
Descrição

Comments

Comments
Descrição

Research Comments

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Ccrr Module For Southwest Oncology Group Notice Of Death (s0226)
Descrição

Ccrr Module For Southwest Oncology Group Notice Of Death (s0226)

Similar models

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.

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
MostRecentSWOGStudyNo.
Item
Most Recent SWOG Study No.
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)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Investigator Name
Item
Physician
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
Participating Group
Item
Participating Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Date of death
DeathDocumentedDate
Item
Date of Death (month / day / year)
date
Item Group
Causes Of Death
Item
Any cancer (select one)
text
Code List
Any cancer (select one)
CL Item
No2005686 (No)
CL Item
Primary_cause2005687 (Primary Cause)
CL Item
Contributory2005688 (Contributory)
CL Item
Possible2005689 (Possible)
CL Item
Unknown2005690 (Unknown)
Item
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
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property-2)
C25281 (NCI Thesaurus Property-3)
C0332281 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
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
CL Item
Cancer_of_most_recent_s2005692 (Cancer of most recent SWOG study, specify cancer)
CL Item
Cancer_of_oth_swog_stdy2005693 (Cancer of other SWOG study, specify cancer)
CL Item
Other_cancer_specify2005694 (Other cancer, specify)
CancerofmostrecentSWOGstudy,specifycancer
Item
Cancer of most recent SWOG study, specify cancer
text
SouthwestOncologyGroupMalignantNeoplasmOtherProtocolSpecify
Item
Cancer of other SWOG study, specify cancer
text
C25699 (NCI Thesaurus ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25320 (NCI Thesaurus Property-2)
C1507394 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Othercancer,specify
Item
Other cancer, specify
text
Item
Toxicity from disease related treatment (select one)
text
Code List
Toxicity from disease related treatment (select one)
CL Item
No2005697 (No)
CL Item
Primary_cause2005698 (Primary Cause)
CL Item
Contributory2005699 (Contributory)
CL Item
Possible2005700 (Possible)
CL Item
Unknown2005701 (Unknown)
IfPrimaryCause,ContributoryorPossible,specifytreatmentandtoxicity
Item
If Primary Cause, Contributory or Possible, specify treatment and toxicity
text
Item
Non-cancer and non-treatment related causes (select one)
text
Code List
Non-cancer and non-treatment related causes (select one)
CL Item
No2005705 (No)
CL Item
Primary_cause2005706 (Primary Cause)
CL Item
Contributory2005707 (Contributory)
CL Item
Possible2005708 (Possible)
CL Item
Unknown2005709 (Unknown)
IfPrimaryCause,ContributoryorPossible,specify
Item
If Primary Cause, Contributory or Possible, specify
text
Item
Autopsy?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25153 (NCI Thesaurus ObjectClass)
C0004398 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Code List
Autopsy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Source of death information (select all that apply)
text
Code List
Source of death information (select all that apply)
CL Item
Autopsy Was The Source Of Information On The Patient's Death (Autopsy report)
CL Item
Death Certificate Was The Source Of Information On The Patient's Death (Medical record / Death certificate)
CL Item
Clinical Evidence Was The Source Of Information On The Patient's Death (Physician)
CL Item
The Source Of Information On The Patient's Death Is Not On This List, Specify Other (Relative or friend)
CL Item
The Source Of Information On The Patient's Death Is Not On This List, Specify Other (Other, specify)
PatientDeathSourceSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item Group
Ccrr Module For Southwest Oncology Group Notice Of Death (s0226)

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