ID

11921

Beskrivning

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

Länk

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

Nyckelord

Versioner (4)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-06-02 2015-06-02 -
  3. 2015-06-03 2015-06-03 -
  4. 2015-08-22 2015-08-22 - Martin Dugas
Uppladdad den

22 augusti 2015

DOI

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Licens

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

Engelsk

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Patient Initials (L, F M)
Beskrivning

PatientInitials

Datatyp

text

Cycle #
Beskrivning

CourseIdentification

Datatyp

float

Institution / Affiliate
Beskrivning

InstitutionName

Datatyp

text

Physician (Groups other than SWOG)
Beskrivning

RegisteredInvestigator

Datatyp

text

Group Name
Beskrivning

ParticipatingGroupName

Datatyp

text

Study No.
Beskrivning

Particip.GroupProtocolNumber

Datatyp

float

Pt. ID
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Status
Beskrivning

Status

Date of Last Contact or Death
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Vital Status
Beskrivning

Patient'sVitalStatus

Datatyp

text

First Cycle Of Treatment
Beskrivning

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Beskrivning

CourseBeginDate

Datatyp

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)
Beskrivning

Cycleenddate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

float

Body surface area
Beskrivning

BSA: First day of this cycle

Datatyp

float

Måttenheter
  • 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
Beskrivning

DoseModification(Change)

Datatyp

text

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

AgentTotalDose(percourse)

Datatyp

float

CONCOMITANT MEDICATIONS / MEDICAL INTERVENTIONS
Beskrivning

CONCOMITANTMEDICATIONS/MEDICALINTERVENTIONS

Datatyp

text

Alias
UMLS CUI [1]
C2347852
Others, specify
Beskrivning

AgentName

Datatyp

text

Start Date
Beskrivning

AgentBeginDate

Datatyp

date

Stop Date
Beskrivning

AgentEndDate

Datatyp

date

Comments
Beskrivning

Comments

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM (S0227)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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