ID

11921

Beschrijving

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

Trefwoorden

Versies (4)
  1. 18-12-14 18-12-14 - Martin Dugas
  2. 02-06-15 02-06-15 -
  3. 03-06-15 03-06-15 -
  4. 22-08-15 22-08-15 - Martin Dugas
Geüploaded op

22 augustus 2015

DOI

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Licentie

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

Engels

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient ID
Beschrijving

SWOGPatientID

Datatype

text

SWOG Study No.
Beschrijving

SWOGStudyNo.

Datatype

text

Registration Step
Beschrijving

RegistrationStep

Datatype

text

Patient Initials (L, F M)
Beschrijving

PatientInitials

Datatype

text

Cycle #
Beschrijving

CourseIdentification

Datatype

float

Institution / Affiliate
Beschrijving

InstitutionName

Datatype

text

Physician (Groups other than SWOG)
Beschrijving

RegisteredInvestigator

Datatype

text

Group Name
Beschrijving

ParticipatingGroupName

Datatype

text

Study No.
Beschrijving

Particip.GroupProtocolNumber

Datatype

float

Pt. ID
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Status
Beschrijving

Status

Date of Last Contact or Death
Beschrijving

DeathDate/LastContactDate

Datatype

date

Vital Status
Beschrijving

Patient'sVitalStatus

Datatype

text

First Cycle Of Treatment
Beschrijving

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Beschrijving

CourseBeginDate

Datatype

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)
Beschrijving

Cycleenddate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

Body surface area
Beschrijving

BSA: First day of this cycle

Datatype

float

Maateenheden
  • 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
Beschrijving

DoseModification(Change)

Datatype

text

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

AgentTotalDose(percourse)

Datatype

float

CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS
Beschrijving

CONCOMITANTMEDICATIONS/MEDICALINTERVENTIONS

Datatype

text

Alias
UMLS CUI [1]
C2347852
Others, specify
Beschrijving

AgentName

Datatype

text

Start Date
Beschrijving

AgentBeginDate

Datatype

date

Stop Date
Beschrijving

AgentEndDate

Datatype

date

Comments
Beschrijving

Comments

Datatype

text

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Similar models

No Instruction available.

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