ID

1419

Descripción

CALGB: 80203 CHANGES IN FUNCTION FORM-Rev 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=BFC578AC-199D-0418-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BFC578AC-199D-0418-E034-0003BA12F5E7

Palabras clave

Versiones (2)
  1. 27/8/12 27/8/12 -
  2. 14/7/17 14/7/17 - Martin Dugas
Subido en

27 de agosto de 2012

DOI

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Licencia

Creative Commons BY-NC 3.0
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Colorectal Cancer NCT00077233 Quality of Life - CALGB: 80203 CHANGES IN FUNCTION FORM-Rev - 2088973v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: CALGB: 80203 CHANGES IN FUNCTION FORM-Rev
    1. No Instruction available.
Ccrr Module For Calgb: 80203 Changes In Function Form-rev
Descripción

Ccrr Module For Calgb: 80203 Changes In Function Form-rev

Patient Initials
Descripción

PatientInitials

Tipo de datos

text

Patient Hospital No.
Descripción

PatientHospitalNo.

Tipo de datos

text

Institution/Affiliate
Descripción

Institution/Affiliate

Tipo de datos

text

Participating Group
Descripción

ParticipatingGroup

Tipo de datos

text

Participating Group Protocol No.
Descripción

ParticipatingGroupProtocolNo.

Tipo de datos

text

Participating Group Patient ID
Descripción

ParticipatingGroupPatientID

Tipo de datos

text

Interviewer or CRA
Descripción

InterviewerorCRA

Tipo de datos

text

Assessment Number
Descripción

AssessmentNumber

Tipo de datos

text

Has your physical condition gotten
Descripción

Hasyourphysicalconditiongotten

Tipo de datos

text

Has your emotional state gotten
Descripción

Hasyouremotionalstategotten

Tipo de datos

text

Has your ability to enjoy social life gotten
Descripción

Hasyourabilitytoenjoysociallifegotten

Tipo de datos

text

Has your overall quality of life gotten
Descripción

Hasyouroverallqualityoflifegotten

Tipo de datos

text

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: CALGB: 80203 CHANGES IN FUNCTION FORM-Rev
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Ccrr Module For Calgb: 80203 Changes In Function Form-rev
Item
Patient Initials
text
CL.1
Code List
Patient Initials
CL Item
Last (Last)
CL Item
First (First)
CL Item
Middle (Middle)
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
Item
Assessment Number
text
CL.2
Code List
Assessment Number
CL Item
7 Day (7 Day)
CL Item
30 Day (30 Day)
Item
Has your physical condition gotten
text
CL.3
Code List
Has your physical condition gotten
CL Item
Very much worse (Very much worse)
CL Item
Moderatly worse (Moderatly worse)
CL Item
A little worse (A little worse)
CL Item
About the same (About the same)
CL Item
A little better (A little better)
CL Item
Moderatly better (Moderatly better)
CL Item
Very much better (Very much better)
Item
Has your emotional state gotten
text
CL.4
Code List
Has your emotional state gotten
CL Item
Very much worse (Very much worse)
CL Item
Moderatly worse (Moderatly worse)
CL Item
A little worse (A little worse)
CL Item
About the same (About the same)
CL Item
A little better (A little better)
CL Item
Moderatly better (Moderatly better)
CL Item
Very much better (Very much better)
Item
Has your ability to enjoy social life gotten
text
CL.5
Code List
Has your ability to enjoy social life gotten
CL Item
Very much worse (Very much worse)
CL Item
Moderatly worse (Moderatly worse)
CL Item
A little worse (A little worse)
CL Item
About the same (About the same)
CL Item
A little better (A little better)
CL Item
Moderatly better (Moderatly better)
CL Item
Very much better (Very much better)
Item
Has your overall quality of life gotten
text
CL.6
Code List
Has your overall quality of life gotten
CL Item
Very much worse (Very much worse)
CL Item
Moderatly worse (Moderatly worse)
CL Item
A little worse (A little worse)
CL Item
About the same (About the same)
CL Item
A little better (A little better)
CL Item
Moderatly better (Moderatly better)
CL Item
Very much better (Very much better)
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