ID

11485

Description

SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE NCT00070564 Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Mots-clés

Versions (3)
  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 05/07/2015 05/07/2015 -
Téléchargé le

5 juillet 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE NCT00070564

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Header
Description

Header

SWOG Patient ID
Description

SWOGPatientID

Type de données

text

SWOG Study No.
Description

SWOGStudyNo.

Type de données

text

Registration Step
Description

RegistrationStep

Type de données

text

Patient Initials (L, F M)
Description

Patient Initials

Type de données

text

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

MainMemberInstitution/AffiliateNumber

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Physician (Groups other than SWOG)
Description

RegisteredInvestigator

Type de données

text

Group Name (Groups other than SWOG)
Description

ParticipatingGroupName

Type de données

text

Study No. (Groups other than SWOG)
Description

Particip.GroupProtocolNumber

Type de données

float

Pt. ID (Groups other than SWOG)
Description

PatientStudyID,ParticipatingGroup

Type de données

text

Treatment period
Description

Treatment period

Treatment Start Date
Description

TreatmentStartDate

Type de données

date

Treatment End Date
Description

TreatmentEndDate

Type de données

date

Regimen or Procedure or Site(s)
Description

RegimenorProcedureorSite(s)

Type de données

text

Off-protocol treatment
Description

Off-protocol treatment

Off Treatment Reason (select one)
Description

OffTreatmentReason

Type de données

text

Patient refused, due to toxicity, specify
Description

OffTreatmentReason,Toxicity

Type de données

text

Patient refused, due to toxicity, specify
Description

OffTreatmentReason,Toxicity

Type de données

text

Progression or relapse. Sites
Description

ProgressionSite

Type de données

text

Other, specify (Off Treatment Date)
Description

OffTreatmentReason,Other

Type de données

text

Other, specify (Off Treatment Date)
Description

OffTreatmentReason,Other

Type de données

text

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

OffTreatmentDate

Type de données

date

Further treatment
Description

Further treatment

Will patient receive further treatment?
Description

FurtherTreatmentInd

Type de données

text

Yes, specify
Description

TreatmentType,Specify

Type de données

text

Vital status
Description

Vital status

Date of Last Contact (or death)
Description

DeathDate/LastContactDate

Type de données

date

Vital Status
Description

Patient'sVitalStatus

Type de données

text

COMMENTS
Description

COMMENTS

Comments
Description

Comments

Type de données

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice
Description

Ccrr Module For Southwest Oncology Group Off Treatment Notice

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Similar models

No Instruction available.

1 Formulaires
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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)
MainMemberInstitution/AffiliateNumber
Item
Institution / Affiliate
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name (Groups other than SWOG)
text
Particip.GroupProtocolNumber
Item
Study No. (Groups other than SWOG)
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Groups other than SWOG)
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 (select one)
text
CL.1
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. Sites (Progression or relapse. Sites)
CL Item
Death (Death)
CL Item
Other, Specify (Other, specify)
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
ProgressionSite
Item
Progression or relapse. 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 Group
Further treatment
Item
Will patient receive further treatment?
text
CL.2
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)
TreatmentType,Specify
Item
Yes, specify
text
Item Group
Vital status
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
CL.3
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
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