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ID
11921
Descrição
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
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Versões (4)
- 18/12/2014 18/12/2014 - Martin Dugas
- 02/06/2015 02/06/2015 -
- 03/06/2015 03/06/2015 -
- 22/08/2015 22/08/2015 - Martin Dugas
Transferido a
22 de agosto de 2015
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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Treatment form Cervical Cancer SWOG S0227 NCT00057928
No Instruction available.
- StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
Similar models
No Instruction available.
- StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
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
DeathDate/LastContactDate
Item
Date of Last Contact or Death
date
CL Item
Alive (Alive)
CL Item
Dead (Dead)
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])
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI [1])
Item
Were there any dose modifications or additions/omissions to protocol treatment
text
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
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