Description:

SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227) S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer NCT00057928 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA4D01C2-8134-3CDA-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA4D01C2-8134-3CDA-E034-0003BA12F5E7

Keywords:

Uterine Cervical Neoplasms

Clinical Trial

Treatment Form

Uploaded on:

August 22, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Treatment form Cervical Cancer SWOG S0227 NCT00057928

Details

No Instruction available.

1 forms

StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
1. No Instruction available.

SWOG clinical trial administrative data

SWOG Patient ID

SWOG Study No.

Registration Step

Patient Initials (L, F M)

Cycle #

Institution / Affiliate

Physician (Groups other than SWOG)

Group Name

Study No.

Pt. ID

Status

Date of Last Contact or Death

Vital Status

Alive (Alive)

Dead (Dead)

First Cycle Of Treatment

Cycle start date (same as treatment start date)

Cycle end date (Date immediately prior to the date next cycle begins, or date decision made to discontinue patient from protocol treatment if last cycle)

Weight (First day of this cycle)

Body surface area

m²

Were there any dose modifications or additions/omissions to protocol treatment

No (No)

(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned, specify in comments)

(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned, specify in comments)

Total dose for this cycle: gemcitabine (Arm 2 only)

CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS

Others, specify

Start Date

Stop Date

Comments

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