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Error:
ID
1381
Descripción
CALGB: FACT/GOG NEUROTOXICITY SUBSCALE 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=BFC4A282-B374-0499-E034-0003BA12F5E7
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Versiones (2)
- 27/8/12 27/8/12 -
- 14/7/17 14/7/17 - Martin Dugas
Subido en
27 de agosto de 2012
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0
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Colorectal Cancer NCT00077233 Toxicity - CALGB: FACT/GOG NEUROTOXICITY SUBSCALE - 2170915v3.0
PATIENT INSTRUCTIONS: By marking one box per line with an X, indicating how true each statement has been for you during the past 7 days.
- StudyEvent: CALGB: FACT/GOG NEUROTOXICITY SUBSCALE
Similar models
PATIENT INSTRUCTIONS: By marking one box per line with an X, indicating how true each statement has been for you during the past 7 days.
- StudyEvent: CALGB: FACT/GOG NEUROTOXICITY SUBSCALE
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
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
InterviewerorCRA
Item
Interviewer or CRA
text
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7 Day (7 Day)
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30 Day (30 Day)
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A little bit (A little bit)
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Somewhat (Somewhat)
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A little bit (A little bit)
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Somewhat (Somewhat)
CL Item
Quite a bit (Quite a bit)
CL Item
Very much (Very much)
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A little bit (A little bit)
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Somewhat (Somewhat)
CL Item
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A little bit (A little bit)
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Somewhat (Somewhat)
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A little bit (A little bit)
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Somewhat (Somewhat)
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Somewhat (Somewhat)
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A little bit (A little bit)
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Very much (Very much)
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A little bit (A little bit)
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Somewhat (Somewhat)
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Item
I have trouble feeling the shape of small objects when they are in my hand.
text
CL Item
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A little bit (A little bit)
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Somewhat (Somewhat)
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Somewhat (Somewhat)
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CL Item
Very much (Very much)