ID

1291

Beschrijving

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

Trefwoorden

Versies (3)
  1. 27-08-12 27-08-12 -
  2. 23-05-15 23-05-15 -
  3. 03-06-15 03-06-15 -
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27 augustus 2012

DOI

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Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00025337 On-Study - ECOG 3200 On-Study Form - 2036496v3.0

Engels

No Instruction available.

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

Unnamed1

Date of data transfer
Beschrijving

Dateofdatatransfer

Datatype

text

Transfer Method
Beschrijving

TransferMethod

Datatype

text

Specify other transfer method
Beschrijving

Specifyothertransfermethod

Datatype

text

Step No.
Beschrijving

StepNo.

Datatype

text

Patient Name
Beschrijving

PatientName

Datatype

text

Particip. Group Protocol Number
Beschrijving

Particip.GroupProtocolNumber

Datatype

double

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Institution Name
Beschrijving

InstitutionName

Datatype

text

Affiliate Name
Beschrijving

AffiliateName

Datatype

text

Amended Data Ind
Beschrijving

AmendedDataInd

Datatype

text

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

AmendedDataInd

Datatype

text

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

PrimarySiteInd

Datatype

text

Regional Lymph Node(s) Ind
Beschrijving

RegionalLymphNode(s)Ind

Datatype

text

Distant Lymph Node(s) Ind
Beschrijving

DistantLymphNode(s)Ind

Datatype

text

Lung Site Ind
Beschrijving

LungSiteInd

Datatype

text

Liver Site Ind
Beschrijving

LiverSiteInd

Datatype

text

Other Abdominal Ind
Beschrijving

OtherAbdominalInd

Datatype

text

Bone Site Ind
Beschrijving

BoneSiteInd

Datatype

text

Brain Site Ind
Beschrijving

BrainSiteInd

Datatype

text

Distant Skin/Subcutaneous Tissue Ind
Beschrijving

DistantSkin/SubcutaneousTissueInd

Datatype

text

Other Site Ind
Beschrijving

OtherSiteInd

Datatype

text

Other Site Name
Beschrijving

OtherSiteName

Datatype

text

Advanced Disease Registration Status
Beschrijving

AdvancedDiseaseRegistrationStatus

Datatype

text

Prior Surgery Ind
Beschrijving

PriorSurgeryInd

Datatype

text

Prior Adjuvant Chemotherapy Ind
Beschrijving

PriorAdjuvantChemotherapyInd

Datatype

text

Prior Adjuvant Immunotherapy Ind
Beschrijving

PriorAdjuvantImmunotherapyInd

Datatype

text

Prior RT Ind
Beschrijving

PriorRTInd

Datatype

text

Sites of prior RT
Beschrijving

SitesofpriorRT

Datatype

text

Prior RT End Date
Beschrijving

PriorRTEndDate

Datatype

date

Performance Status
Beschrijving

PerformanceStatus

Datatype

text

Date CEA obtained
Beschrijving

CarcinoembryonicAntigenSpecimenCollectionDate

Datatype

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
Beschrijving

CEA

Datatype

text

CEA ULN
Beschrijving

LaboratoryProcedureCarcinoembryonicAntigenOutcomeUpperLimitNormalValue

Datatype

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
Beschrijving

CTCCode

Datatype

text

CTC Adverse Event Term
Beschrijving

CTCAdverseEventTerm

Datatype

text

CTC Adverse Event Grade
Beschrijving

CTCAdverseEventGrade

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Comments2
Beschrijving

Comments2

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: ECOG 3200 On-Study Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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