Description:

On-Study Form Bladder Cancer NCT00014534 CALGB-90104 NCT00014534 NCI Cooperative Group On-Study Form-Revised (CALGB-90104) Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 8/21/15
Uploaded on:

August 21, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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On-Study Form Bladder Cancer NCT00014534 CALGB-90104

Details

No Instruction available.

  1. StudyEvent: NCI Cooperative Group On-Study Form-Revised (CALGB-90104)
    1. No Instruction available.
Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder
Prior Intravesical Therapy (Note: If no, skip to Prior Surgery below)
Type of Prior Immunotherapy
Type of Prior Chemotherapy
Prior Surgery (for urothelial disease)
Prior Surgery Type
Any Other Prior Therapy
Prior Therapy Date
Chest X-ray results
CT results
1000/ul
1000/uL
mg/dL
mg/dL
mg/dL
mL/min
U/L
U/L
U/L
U/L
Ccrr Module For Nci Cooperative Group On-study Form-revised (calgb-90104)
Are data amended?
Has the patient had a prior history of superficial disease?
Histologic Type (mark all that apply)
Histologic Grade (check the highest grade)
Pathologic T Stage (Indicate highest stage at the current presentation of disease)
3 more items in the detailed view.
Pathologic N Stage (Distant Metastasis)
Pathologic M Stage
Lymph Node Type (unnamed)
Lymph Node Involvement (unnamed)
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