ID

11849

Beschreibung

ALTTO (Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation) Study; BIG 2-06/N063D Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=32A4A72C-3292-3DF0-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=32A4A72C-3292-3DF0-E044-0003BA3F9857

Stichworte

Versionen (4)
  1. 19.09.12 19.09.12 -
  2. 08.08.14 08.08.14 - Martin Dugas
  3. 09.01.15 09.01.15 - Martin Dugas
  4. 08.08.15 08.08.15 - Martin Dugas
Hochgeladen am

8. August 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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On-Study Form Week 37 Breast Cancer ALTTO BIG 2-06 NCCTG N063D EGF106708 NCT00490139

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: BIG 2-06 / NCCTG N063D / EGF106708 - Week 37
    1. No Instruction available.
Header Module
Beschreibung

Header Module

Centre No.
Beschreibung

Institution Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Subject No.
Beschreibung

Patient Study ID

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Patient Status
Beschreibung

Patient Status

Physical Examination
Beschreibung

Physical Examination

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0011008
Not done
Beschreibung

AssessmentMethodText

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Are there any changes since the previous assessment
Beschreibung

PatientModifiedAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25573
Are there any changes since the previous assessment
Beschreibung

PatientModifiedAssessmentType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25573
Last Contact Date
Beschreibung

Last Contact Date

Datentyp

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C47954
NCI Thesaurus ObjectClass-2
C25551
UMLS CUI [1]
C0585085
Body weight
Beschreibung

Body weight

Datentyp

float

Maßeinheiten
  • kg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
UMLS CUI [1]
C0005910
kg
ECOG Performance Status
Beschreibung

ECOG Performance Status

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS CUI-1
C1520224
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain-2
C25491
NCI Thesaurus ObjectClass
C20641
Systolic
Beschreibung

Systolic

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25298
UMLS CUI [1]
C0871470
mmHg
Diastolic
Beschreibung

Diastolic

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25299
UMLS CUI [1]
C0428883
mmHg
Menopausal Status
Beschreibung

Menopausal Status

Menopausal Status
Beschreibung

PatientMenopauseCategory

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C3231
NCI Thesaurus ValueDomain-2
C3231
UMLS CUI [1]
C0455962
Date of last menstrual period
Beschreibung

LastMenstrualCycleOccurrenceDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25551
NCI Thesaurus Property
C25275
NCI Thesaurus ObjectClass-2
C16838
UMLS CUI [1]
C0425932
Cardiac Monitoring
Beschreibung

Cardiac Monitoring

Date Left Ventricular Ejection Fraction
Beschreibung

Date Left Ventricular Ejection Fraction

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C12727
NCI Thesaurus Property
C25294
NCI Thesaurus Property-2
C37946
UMLS CUI [1,1]
C0428772
UMLS CUI [1,2]
C0011008
Left Ventricular Ejection Fraction
Beschreibung

Left Ventricular Ejection Fraction

Datentyp

float

Maßeinheiten
  • %
Alias
NCI Thesaurus ObjectClass
C12727
NCI Thesaurus Property
C25294
NCI Thesaurus Property-2
C37946
NCI Thesaurus ValueDomain
C25613
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI [1]
C0428772
%
Method of Evaluation
Beschreibung

Evaluation method

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
LVEF Status
Beschreibung

LVEF Status

Datentyp

integer

Alias
NCI Thesaurus ObjectClass
C12727
NCI Thesaurus Property
C25294
NCI Thesaurus Property-2
C37946
NCI Thesaurus ValueDomain
C25688
UMLS CUI [1]
C0428772
Symptomatic CHF
Beschreibung

Symptomatic CHF

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25626
NCI Thesaurus ObjectClass
C3080
NCI Thesaurus ObjectClass-2
C25269
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C0231220
New York Heart Association Classification
Beschreibung

New York Heart Association Classification

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus Property
C20989
NCI Thesaurus ObjectClass
C13306
NCI Metathesaurus ObjectClass
CL092952
UMLS CUI [1]
C1275491
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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: BIG 2-06 / NCCTG N063D / EGF106708 - Week 37
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header Module
Institution Number
Item
Centre No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Study ID
Item
Subject No.
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Patient Status
Date of Physical Exam
Item
Physical Examination
date
C25164 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
AssessmentMethodText
Item
Not done
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
PatientModifiedAssessmentInd-2
Item
Are there any changes since the previous assessment
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25573 (NCI Thesaurus Property-2)
Item
Are there any changes since the previous assessment
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25573 (NCI Thesaurus Property-2)
CL.2
Code List
Are there any changes since the previous assessment
CL Item
Recurrence Of Disease (Recurrence of disease)
CL Item
Second Primary Malignancy Or Contralateral Breast Cancer (Second primary malignancy or contralateral breast cancer)
CL Item
Significant Cardiac Disease (Significant cardiac disease)
CL Item
Adverse Event (Adverse Event)
C41331 (NCI Thesaurus)
C0877248 (UMLS 2011AA)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
CL Item
Lost To Follow-up (Lost To Follow-up)
CL310949 (NCI Metathesaurus)
CL Item
Patient Withdrew Study Consent (Patient withdrew study consent)
CL Item
Patient Withdrew From Treatment And Will Continue With Follow-up (Patient withdrew from treatment and will continue with follow-up)
Last Contact Date
Item
Last Contact Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C47954 (NCI Thesaurus ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C0585085 (UMLS CUI [1])
Weight
Item
Body weight
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI [1])
Item
ECOG Performance Status
text
C25664 (NCI Thesaurus ValueDomain)
C1520224 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C25491 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
CL.3
Code List
ECOG Performance Status
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
CL Item
Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
CL Item
Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
CL Item
Dead (5)
Systolic blood pressure
Item
Systolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25298 (NCI Thesaurus ObjectClass)
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Diastolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25299 (NCI Thesaurus ObjectClass)
C0428883 (UMLS CUI [1])
Item Group
Menopausal Status
Item
Menopausal Status
text
C25372 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C3231 (NCI Thesaurus Property)
C3231 (NCI Thesaurus ValueDomain-2)
C0455962 (UMLS CUI [1])
CL.4
Code List
Menopausal Status
CL Item
Post (prior Bilateral Ovariectomy Or >12 Mo Since Lmp With No Prior Hysterectomy And Not Currently Receiving Therapy With Lh-rh Analogs [e.g., Zoladex]) (Post (prior bilateral ovariectomy OR >12 mo since LMP with no prior hysterectomy AND not currently receiving therapy with LH-RH analogs (e.g., Zoladex)))
CL Item
Post (prior Bilateral Ovariectomy Or >12 Mo Since Lmp With No Prior Hysterectomy) (Post (prior bilateral ovariectomy OR >12 mo since LMP with no prior hysterectomy))
CL Item
Above Categories Not Applicable And Age <50 (Above categories not applicable AND Age < 50)
CL Item
50=Above Categories Not Applicable And Age >= 50 (Above categories not applicable AND Age >)
Date of last menstrual period
Item
Date of last menstrual period
date
C25164 (NCI Thesaurus ValueDomain)
C25551 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C16838 (NCI Thesaurus ObjectClass-2)
C0425932 (UMLS CUI [1])
Item Group
Cardiac Monitoring
LVEF date
Item
Date Left Ventricular Ejection Fraction
date
C25164 (NCI Thesaurus ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus Property)
C37946 (NCI Thesaurus Property-2)
C0428772 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
LVEF
Item
Left Ventricular Ejection Fraction
float
C12727 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus Property)
C37946 (NCI Thesaurus Property-2)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0428772 (UMLS CUI [1])
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
CL.5
Code List
Method of Evaluation
CL Item
Echocardiogram (Echocardiogram)
C37945 (NCI Thesaurus)
C2243117 (UMLS 2011AA)
CL Item
Muga Scan (MUGA scan)
Item
LVEF Status
integer
C12727 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus Property)
C37946 (NCI Thesaurus Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0428772 (UMLS CUI [1])
CL.6
Code List
LVEF Status
CL Item
Normal (1)
CL Item
Abnormal - Not Clinically Significant (2)
CL Item
Abnormal - Clinically Significant (3)
CHF symptomatic
Item
Symptomatic CHF
boolean
C38148 (NCI Thesaurus ValueDomain)
C25626 (NCI Thesaurus Property)
C3080 (NCI Thesaurus ObjectClass)
C25269 (NCI Thesaurus ObjectClass-2)
C0018802 (UMLS CUI [1,1])
C0231220 (UMLS CUI [1,2])
Item
New York Heart Association Classification
text
C25664 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus Property)
C13306 (NCI Thesaurus ObjectClass)
CL092952 (NCI Metathesaurus ObjectClass)
C1275491 (UMLS CUI [1])
CL.8
Code List
New York Heart Association Classification
CL Item
Patients With Cardiac Disease But Without Resulting Limitation Of Physical Activity. Ordinary Physical Activity Does Not Cause Undue Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class I)
CL Item
Patients With Cardiac Disease Resulting In Slight Limitation Of Physical Activity. They Are Comfortable At Rest. Ordinary Physical Activity Results In Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class II)
CL Item
Patients With Cardiac Disease Resulting In Marked Limitation Of Physical Activity. They Are Comfortable At Rest. Less Than Ordinary Activity Causes Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class III)
CL Item
Patients With Cardiac Disease Resulting In Inability To Carry On Any Physical Activity Without Discomfort. Symptoms Of Heart Failure Or The Anginal Syndrome May Be Present Even At Rest. If Any Physical Activity Is Undertaken, Discomfort Increases. (Class IV)
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