ID

11921

Descripción

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

Palabras clave

Versiones (4)
  1. 18/12/14 18/12/14 - Martin Dugas
  2. 2/6/15 2/6/15 -
  3. 3/6/15 3/6/15 -
  4. 22/8/15 22/8/15 - Martin Dugas
Subido en

22 de agosto de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Treatment form Cervical Cancer SWOG S0227 NCT00057928

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
    1. No Instruction available.
SWOG clinical trial administrative data
Descripción

SWOG clinical trial administrative data

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Patient Initials (L, F M)
Descripción

PatientInitials

Tipo de datos

text

Cycle #
Descripción

CourseIdentification

Tipo de datos

float

Institution / Affiliate
Descripción

InstitutionName

Tipo de datos

text

Physician (Groups other than SWOG)
Descripción

RegisteredInvestigator

Tipo de datos

text

Group Name
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No.
Descripción

Particip.GroupProtocolNumber

Tipo de datos

float

Pt. ID
Descripción

PatientStudyID,ParticipatingGroup

Tipo de datos

text

Status
Descripción

Status

Date of Last Contact or Death
Descripción

DeathDate/LastContactDate

Tipo de datos

date

Vital Status
Descripción

Patient'sVitalStatus

Tipo de datos

text

First Cycle Of Treatment
Descripción

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Descripción

CourseBeginDate

Tipo de datos

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)
Descripción

Cycleenddate

Tipo de datos

text

Weight (First day of this cycle)
Descripción

PatientWeight

Tipo de datos

float

Body surface area
Descripción

BSA: First day of this cycle

Tipo de datos

float

Unidades de medida
  • m²
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25157
UMLS CUI [1]
C0005902
m²
Were there any dose modifications or additions/omissions to protocol treatment
Descripción

DoseModification(Change)

Tipo de datos

text

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

AgentTotalDose(percourse)

Tipo de datos

float

CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS
Descripción

CONCOMITANTMEDICATIONS/MEDICALINTERVENTIONS

Tipo de datos

text

Alias
UMLS CUI [1]
C2347852
Others, specify
Descripción

AgentName

Tipo de datos

text

Start Date
Descripción

AgentBeginDate

Tipo de datos

date

Stop Date
Descripción

AgentEndDate

Tipo de datos

date

Comments
Descripción

Comments

Tipo de datos

text

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitials
Item
Patient Initials (L, F M)
text
CourseIdentification
Item
Cycle #
float
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
Particip.GroupProtocolNumber
Item
Study No.
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID
text
Item Group
Status
DeathDate/LastContactDate
Item
Date of Last Contact or Death
date
Item
Vital Status
text
CL.1
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
First Cycle Of Treatment
CourseBeginDate
Item
Cycle start date (same as treatment start date)
date
Cycleenddate
Item
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)
text
PatientWeight
Item
Weight (First day of this cycle)
float
BSA
Item
Body surface area
float
C16960 (NCI Thesaurus ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI [1])
Item
Were there any dose modifications or additions/omissions to protocol treatment
text
CL.2
Code List
Were there any dose modifications or additions/omissions to protocol treatment
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned, specify in comments)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned, specify in comments)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
Concomitant medication
Item
CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS
text
C2347852 (UMLS CUI [1])
AgentName
Item
Others, specify
text
AgentBeginDate
Item
Start Date
date
AgentEndDate
Item
Stop Date
date
Comments
Item
Comments
text
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