ID

1291

Description

ECOG 3200 On-Study Form Combination Chemotherapy With or Without Bevacizumab Compared With Bevacizumab Alone in Treating Patients With Advanced or Metastatic Colorectal Cancer That Has Been Previously Treated Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1706D40-4AAF-6AB7-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1706D40-4AAF-6AB7-E034-080020C9C0E0

Keywords

  1. 8/27/12 8/27/12 -
  2. 5/23/15 5/23/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

August 27, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Colorectal Cancer NCT00025337 On-Study - ECOG 3200 On-Study Form - 2036496v3.0

No Instruction available.

  1. StudyEvent: ECOG 3200 On-Study Form
    1. No Instruction available.
Unnamed1
Description

Unnamed1

Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Step No.
Description

StepNo.

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Primary Site Ind
Description

PrimarySiteInd

Data type

text

Regional Lymph Node(s) Ind
Description

RegionalLymphNode(s)Ind

Data type

text

Distant Lymph Node(s) Ind
Description

DistantLymphNode(s)Ind

Data type

text

Lung Site Ind
Description

LungSiteInd

Data type

text

Liver Site Ind
Description

LiverSiteInd

Data type

text

Other Abdominal Ind
Description

OtherAbdominalInd

Data type

text

Bone Site Ind
Description

BoneSiteInd

Data type

text

Brain Site Ind
Description

BrainSiteInd

Data type

text

Distant Skin/Subcutaneous Tissue Ind
Description

DistantSkin/SubcutaneousTissueInd

Data type

text

Other Site Ind
Description

OtherSiteInd

Data type

text

Other Site Name
Description

OtherSiteName

Data type

text

Advanced Disease Registration Status
Description

AdvancedDiseaseRegistrationStatus

Data type

text

Prior Surgery Ind
Description

PriorSurgeryInd

Data type

text

Prior Adjuvant Chemotherapy Ind
Description

PriorAdjuvantChemotherapyInd

Data type

text

Prior Adjuvant Immunotherapy Ind
Description

PriorAdjuvantImmunotherapyInd

Data type

text

Prior RT Ind
Description

PriorRTInd

Data type

text

Sites of prior RT
Description

SitesofpriorRT

Data type

text

Prior RT End Date
Description

PriorRTEndDate

Data type

date

Performance Status
Description

PerformanceStatus

Data type

text

Date CEA obtained
Description

CarcinoembryonicAntigenSpecimenCollectionDate

Data type

text

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25159
UMLS 2011AA ObjectClass
C0007082
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
CEA
Description

CEA

Data type

text

CEA ULN
Description

LaboratoryProcedureCarcinoembryonicAntigenOutcomeUpperLimitNormalValue

Data type

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25159
UMLS 2011AA Property
C0007082
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain
C25706
UMLS 2011AA ValueDomain
C1519815
CTC Code
Description

CTCCode

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

Similar models

No Instruction available.

  1. StudyEvent: ECOG 3200 On-Study Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed1
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
StepNo.
Item
Step No.
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
PrimarySiteInd
Item
Primary Site Ind
text
RegionalLymphNode(s)Ind
Item
Regional Lymph Node(s) Ind
text
DistantLymphNode(s)Ind
Item
Distant Lymph Node(s) Ind
text
LungSiteInd
Item
Lung Site Ind
text
LiverSiteInd
Item
Liver Site Ind
text
OtherAbdominalInd
Item
Other Abdominal Ind
text
BoneSiteInd
Item
Bone Site Ind
text
BrainSiteInd
Item
Brain Site Ind
text
DistantSkin/SubcutaneousTissueInd
Item
Distant Skin/Subcutaneous Tissue Ind
text
OtherSiteInd
Item
Other Site Ind
text
OtherSiteName
Item
Other Site Name
text
AdvancedDiseaseRegistrationStatus
Item
Advanced Disease Registration Status
text
PriorSurgeryInd
Item
Prior Surgery Ind
text
PriorAdjuvantChemotherapyInd
Item
Prior Adjuvant Chemotherapy Ind
text
PriorAdjuvantImmunotherapyInd
Item
Prior Adjuvant Immunotherapy Ind
text
PriorRTInd
Item
Prior RT Ind
text
SitesofpriorRT
Item
Sites of prior RT
text
PriorRTEndDate
Item
Prior RT End Date
date
PerformanceStatus
Item
Performance Status
text
CarcinoembryonicAntigenSpecimenCollectionDate
Item
Date CEA obtained
text
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25159 (NCI Thesaurus ObjectClass)
C0007082 (UMLS 2011AA ObjectClass)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
CEA
Item
CEA
text
LaboratoryProcedureCarcinoembryonicAntigenOutcomeUpperLimitNormalValue
Item
CEA ULN
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25159 (NCI Thesaurus Property)
C0007082 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
CTCCode
Item
CTC Code
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text

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