ID

1419

Description

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

Lien

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

Mots-clés

Versions (2)
  1. 27/08/2012 27/08/2012 -
  2. 14/07/2017 14/07/2017 - Martin Dugas
Téléchargé le

27 août 2012

DOI

Pour une demande vous connecter.

Licence

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

Anglais

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

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

Patient Initials
Description

PatientInitials

Type de données

text

Patient Hospital No.
Description

PatientHospitalNo.

Type de données

text

Institution/Affiliate
Description

Institution/Affiliate

Type de données

text

Participating Group
Description

ParticipatingGroup

Type de données

text

Participating Group Protocol No.
Description

ParticipatingGroupProtocolNo.

Type de données

text

Participating Group Patient ID
Description

ParticipatingGroupPatientID

Type de données

text

Interviewer or CRA
Description

InterviewerorCRA

Type de données

text

Assessment Number
Description

AssessmentNumber

Type de données

text

Has your physical condition gotten
Description

Hasyourphysicalconditiongotten

Type de données

text

Has your emotional state gotten
Description

Hasyouremotionalstategotten

Type de données

text

Has your ability to enjoy social life gotten
Description

Hasyourabilitytoenjoysociallifegotten

Type de données

text

Has your overall quality of life gotten
Description

Hasyouroverallqualityoflifegotten

Type de données

text

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Similar models

No Instruction available.

1 Formulaires
  1. StudyEvent: CALGB: 80203 CHANGES IN FUNCTION FORM-Rev
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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