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Information:
Fel:
ID
1330
Beskrivning
CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL) Fluorouracil and Leucovorin Plus Either Irinotecan or Oxaliplatin With or Without Cetuximab in Treating Patients With Previously Untreated Metastatic Adenocarcinoma of the Colon or Rectum Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BFD6186C-9F1B-3753-E034-0003BA12F5E7
Länk
Nyckelord
Versioner (2)
- 2012-08-27 2012-08-27 -
- 2017-07-14 2017-07-14 - Martin Dugas
Uppladdad den
27 augusti 2012
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0
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Colorectal Cancer NCT00077233 Toxicity - CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL) - 2170988v3.0
No Instruction available.
- StudyEvent: CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL)
Similar models
No Instruction available.
- StudyEvent: CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL)
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
MarkwithanXiftherearenone
Item
Mark with an X if there are none
text
MedDRA
Item
MedDRA
text
CL Item
Rash/desquamation (Rash/desquamation)
CL Item
Pruritus (Pruritus)
CL Item
Erithema multiforme (Erithema multiforme)
CL Item
Nail changes (Nail changes)
CL Item
Dry skin (Dry skin)
CL Item
Other, specify (Other, specify)
Other,specify
Item
Other, specify
text
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
Dose held (Dose held)
CL Item
Dose reduced (Dose reduced)
CL Item
Drug discontinued (Drug discontinued)
Adverseeventonsetdate
Item
Adverse event onset date
text
Adverseeventenddate
Item
Adverse event end date
text
IfongoingmarkwithanX
Item
If ongoing mark with an X
text
Completedby
Item
Completed by
text
Dateformoriginallycompleted
Item
Date form originally completed
text
Item Group
Ccrr Module For Calgb: 80203 Dermatology Specific Quality-of-life Questionnaire (dsql)
PatientInitials
Item
Patient Initials
text
PatientHospitalNo.
Item
Patient Hospital No.
text
Institution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroup
Item
Participating Group
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
CALGBStudyNo.
Item
CALGB Study No.
text
CALGBPatientID
Item
CALGB Patient ID
text
From
Item
From
text
To
Item
To
text
CL Item
Yes (Yes)