ID

1211

Description

GOG Solid Tumor Evaluation Form Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ABA3C0AB-9AF2-247A-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ABA3C0AB-9AF2-247A-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 8/27/12 8/27/12 -
  2. 6/24/17 6/24/17 - Martin Dugas
Uploaded on

August 27, 2012

DOI

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License

Creative Commons BY-NC 3.0
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Cervical Cancer NCT00064077 Response - GOG Solid Tumor Evaluation Form - 2059416v3.0

English

FORM D2M

1 forms  
  1. StudyEvent: GOG Solid Tumor Evaluation Form
    1. FORM D2M
Header Module
Description

Header Module

Date form originally completed (m d y)
Description

FormCompletionDate,Original

Data type

date

Date form amended (m d y)
Description

FormCompletionDate,Amended

Data type

date

Person amending form, last name
Description

ResponsiblePersonReportingChangeLastName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Name, Last
Description

PatientName,Last

Data type

text

Patient Name, First
Description

PatientName,First

Data type

text

Patient Study ID
Description

PatientStudyID

Data type

text

Person Completing Form, Last Name
Description

PersonCompletingForm,LastName

Data type

text

Target Lesion(s) Evaluation
Description

Target Lesion(s) Evaluation

Lesion Number (unnamed)
Description

Lesion,ReferenceNumber

Data type

double

Site of Lesion
Description

Lesion,AnatomicSite

Data type

text

Date of Evaluation (m d y)
Description

AssessmentDate

Data type

date

Method of Evaluation (coded values)
Description

AssessmentType

Data type

text

If Other, specify (Method of Eval)
Description

AssessmentType,Specify

Data type

text

Longest Diameter of Lesion(s) (cm)
Description

Lesion,TumorDiameter

Data type

double

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Sum of longest diameters of all target lesions
Description

Lesion,Diameter,LongestSum

Data type

double

Non-target Lesion(s) Evaluation
Description

Non-target Lesion(s) Evaluation

Are there any nontarget lesions?
Description

NontargetLesionInd

Data type

text

Lesion Number (unnamed)
Description

Lesion,ReferenceNumber

Data type

double

Site of Lesion
Description

Lesion,AnatomicSite

Data type

text

Date of Evaluation (m d y)
Description

AssessmentDate

Data type

date

Method of Evaluation (coded values)
Description

AssessmentType

Data type

text

If Other, specify (Method of Eval)
Description

AssessmentType,Specify

Data type

text

Follow-Up Status of Lesion(s)
Description

Lesion,Follow-upStatus

Data type

text

New Target Lesion(s) At Follow-up Evaluation
Description

New Target Lesion(s) At Follow-up Evaluation

Was the appearance of any new lesions documented since the baseline evaluation?
Description

NewLesionInd

Data type

text

Lesion Number (unnamed)
Description

Lesion,ReferenceNumber

Data type

double

Site of Lesion
Description

Lesion,AnatomicSite

Data type

text

Date of Evaluation (m d y)
Description

AssessmentDate

Data type

date

Method of Evaluation (coded values)
Description

AssessmentType

Data type

text

If Other, specify (Method of Eval)
Description

AssessmentType,Specify

Data type

text

Overall Response
Description

Overall Response

Overall response status at this assessment (check one)
Description

OverallTumorResponse

Data type

text

Response confirmed date (m d y)
Description

ResponseConfirmedDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
Comments
Description

Comments

COMMENTS
Description

Comments

Data type

text

Footer Module
Description

Footer Module

Participating Group Code
Description

ParticipatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Participating Group Protocol Number
Description

ParticipatingGroupProtocolNumber

Data type

double

Participating Patient Study ID
Description

PatientParticipatingIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Ccrr Module For Gog Solid Tumor Evaluation Form
Description

Ccrr Module For Gog Solid Tumor Evaluation Form

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Similar models

FORM D2M

1 forms
  1. StudyEvent: GOG Solid Tumor Evaluation Form
    1. FORM D2M
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
FormCompletionDate,Original
Item
Date form originally completed (m d y)
date
FormCompletionDate,Amended
Item
Date form amended (m d y)
date
ResponsiblePersonReportingChangeLastName
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientStudyID
Item
Patient Study ID
text
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
Item Group
Target Lesion(s) Evaluation
Item
Lesion Number (unnamed)
double
CL.8
Code List
Lesion Number (unnamed)
CL Item
1 (1)
CL Item
2 (2)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
CL.9
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Lesion,TumorDiameter
Item
Longest Diameter of Lesion(s) (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Lesion,Diameter,LongestSum
Item
Sum of longest diameters of all target lesions
double
Item Group
Non-target Lesion(s) Evaluation
Item
Are there any nontarget lesions?
text
CL.3
Code List
Are there any nontarget lesions?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Lesion Number (unnamed)
double
CL.8
Code List
Lesion Number (unnamed)
CL Item
1 (1)
CL Item
2 (2)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
CL.9
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Item
Follow-Up Status of Lesion(s)
text
CL.6
Code List
Follow-Up Status of Lesion(s)
CL Item
Present (Present)
CL Item
Absent (Absent)
CL Item
Unequivocal Progression (Unequivocal Progression)
CL Item
Complete Response (CR)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Stable Disease Or Unchanged (Stable)
Item Group
New Target Lesion(s) At Follow-up Evaluation
Item
Was the appearance of any new lesions documented since the baseline evaluation?
text
CL.7
Code List
Was the appearance of any new lesions documented since the baseline evaluation?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Lesion Number (unnamed)
double
CL.8
Code List
Lesion Number (unnamed)
CL Item
1 (1)
CL Item
2 (2)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
CL.9
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Item Group
Overall Response
Item
Overall response status at this assessment (check one)
text
CL.10
Code List
Overall response status at this assessment (check one)
CL Item
Complete Response (CR)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Partial Response (PR)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (SD)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Null (Insufficient evaluation to determine response status)
ResponseConfirmedDate
Item
Response confirmed date (m d y)
date
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
Item Group
Comments
Comments
Item
COMMENTS
text
Item Group
Footer Module
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
ParticipatingGroupProtocolNumber
Item
Participating Group Protocol Number
double
PatientParticipatingIdentifierNumber
Item
Participating Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item Group
Ccrr Module For Gog Solid Tumor Evaluation Form
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