Description:

Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1CB5F031-5BC1-01E3-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1CB5F031-5BC1-01E3-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 12/18/14
  2. 1/9/15
  3. 8/4/15
Uploaded on:

August 4, 2015

DOI:
No DOI assigned. To request one pleaselog in.
License:
Creative Commons BY-NC 3.0 Legacy
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Enrollment Form HIV Anal Cancer AMC-045 NCT00324415

045A

  1. StudyEvent: AMC-045 Enrollement Form (ENR)
    1. 045A
General information
Karnofsky Performance Status
years
Inclusion Criteria
Inclusion Criteria
Exclusion Criteria
Exclusion Criteria
Consent Module
Patient's initial consent given for diagnostic biopsy specimen use for research on future studies (This procedure has already been performed and requires no additional procedures)
Patient's initial consent given for anal swab specimen use for research on future studies (This procedure requires putting an anal swab in the anal canal)
Patient's initial consent given for an additional diagnostic biopsy for research on future studies (This will require another biopsy to be done)
Patient's Initial Consent given for specimen kept for future use in research to learn about, prevent, or treat cancer
Patient's initial consent given for specimen(s) may be kept for use in research to learn about, prevent, or treat other health problems (for example: diabetes, Alzheimer's disease, or heart disease)
Patient's initial consent given for further contact to participate in research on future studies (their doctor or someone from the AMC)
Comments Module