ID

11921

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

Lien

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

Mots-clés

Versions (4)
  1. 18/12/2014 18/12/2014 - Martin Dugas
  2. 02/06/2015 02/06/2015 -
  3. 03/06/2015 03/06/2015 -
  4. 22/08/2015 22/08/2015 - Martin Dugas
Téléchargé le

22 août 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
Modèle Commentaires :

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Treatment form Cervical Cancer SWOG S0227 NCT00057928

Anglais

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Type de données

text

SWOG Study No.
Description

SWOGStudyNo.

Type de données

text

Registration Step
Description

RegistrationStep

Type de données

text

Patient Initials (L, F M)
Description

PatientInitials

Type de données

text

Cycle #
Description

CourseIdentification

Type de données

float

Institution / Affiliate
Description

InstitutionName

Type de données

text

Physician (Groups other than SWOG)
Description

RegisteredInvestigator

Type de données

text

Group Name
Description

ParticipatingGroupName

Type de données

text

Study No.
Description

Particip.GroupProtocolNumber

Type de données

float

Pt. ID
Description

PatientStudyID,ParticipatingGroup

Type de données

text

Status
Description

Status

Date of Last Contact or Death
Description

DeathDate/LastContactDate

Type de données

date

Vital Status
Description

Patient'sVitalStatus

Type de données

text

First Cycle Of Treatment
Description

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Description

CourseBeginDate

Type de données

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)
Description

Cycleenddate

Type de données

text

Weight (First day of this cycle)
Description

PatientWeight

Type de données

float

Body surface area
Description

BSA: First day of this cycle

Type de données

float

Unités de mesure
  • 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
Description

DoseModification(Change)

Type de données

text

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

AgentTotalDose(percourse)

Type de données

float

CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS
Description

CONCOMITANTMEDICATIONS/MEDICALINTERVENTIONS

Type de données

text

Alias
UMLS CUI [1]
C2347852
Others, specify
Description

AgentName

Type de données

text

Start Date
Description

AgentBeginDate

Type de données

date

Stop Date
Description

AgentEndDate

Type de données

date

Comments
Description

Comments

Type de données

text

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Similar models

No Instruction available.

1 Formulaires
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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