ID

2125

Beschrijving

E4599 Long-Term Follow-up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A13401E7-87EA-64C7-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A13401E7-87EA-64C7-E034-080020C9C0E0

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 12-12-14 12-12-14 - Martin Dugas
Geüploaded op

19 september 2012

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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Lung Cancer null Follow-Up - E4599 Long-Term Follow-up Form - 2036056v3.0

No Instruction available.

  1. StudyEvent: E4599 Long-Term Follow-up Form
    1. No Instruction available.
Unnamed
Beschrijving

Unnamed

Date of data transfer
Beschrijving

Dateofdatatransfer

Datatype

text

Transfer Method
Beschrijving

TransferMethod

Datatype

text

Specify other transfer method
Beschrijving

Specifyothertransfermethod

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
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

Interval Report From Date
Beschrijving

IntervalReportFromDate

Datatype

date

Interval Report To Date
Beschrijving

IntervalReportToDate

Datatype

date

Patient's Vital Status
Beschrijving

Patient'sVitalStatus

Datatype

text

Death Reason
Beschrijving

DeathReason

Datatype

text

Death Date/Last Contact Date
Beschrijving

DeathDate/LastContactDate

Datatype

date

Death Reason, Specify
Beschrijving

DeathReason,Specify

Datatype

text

Cancer Follow-up Status Ind
Beschrijving

CancerFollow-upStatusInd

Datatype

text

Cancer Follow-up Status Date
Beschrijving

CancerFollow-upStatusDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Progression Ind
Beschrijving

ProgressionInd

Datatype

text

Progression Date
Beschrijving

ProgressionDate

Datatype

date

Formal Progressive Disease Diagnosis
Beschrijving

FormalProgressiveDiseaseDiagnosis

Datatype

text

Progression Site
Beschrijving

ProgressionSite

Datatype

text

New Primary Cancer Ind
Beschrijving

NewPrimaryCancerInd

Datatype

text

New Primary Site
Beschrijving

NewPrimarySite

Datatype

text

Late Adverse Event Ind
Beschrijving

LateAdverseEventInd

Datatype

text

Non protocol therapy prior to first progression
Beschrijving

Nonprotocoltherapypriortofirstprogression

Datatype

text

Second line therapy
Beschrijving

Secondlinetherapy

Datatype

text

Type of Second Line Therapy
Beschrijving

TypeofSecondLineTherapy

Datatype

text

Type of Second Line Chemotherapy
Beschrijving

TypeofSecondLineChemotherapy

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Comments2
Beschrijving

Comments2

Datatype

text

New Primary Cancer Date
Beschrijving

NewPrimaryCancerDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Non-Protocol Therapy Date, First
Beschrijving

Non-ProtocolTherapyDate,First

Datatype

date

Similar models

No Instruction available.

  1. StudyEvent: E4599 Long-Term Follow-up Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
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
IntervalReportFromDate
Item
Interval Report From Date
date
IntervalReportToDate
Item
Interval Report To Date
date
Patient'sVitalStatus
Item
Patient's Vital Status
text
DeathReason
Item
Death Reason
text
DeathDate/LastContactDate
Item
Death Date/Last Contact Date
date
DeathReason,Specify
Item
Death Reason, Specify
text
CancerFollow-upStatusInd
Item
Cancer Follow-up Status Ind
text
CancerFollow-upStatusDate
Item
Cancer Follow-up Status Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
ProgressionInd
Item
Progression Ind
text
ProgressionDate
Item
Progression Date
date
FormalProgressiveDiseaseDiagnosis
Item
Formal Progressive Disease Diagnosis
text
ProgressionSite
Item
Progression Site
text
NewPrimaryCancerInd
Item
New Primary Cancer Ind
text
NewPrimarySite
Item
New Primary Site
text
LateAdverseEventInd
Item
Late Adverse Event Ind
text
Nonprotocoltherapypriortofirstprogression
Item
Non protocol therapy prior to first progression
text
Secondlinetherapy
Item
Second line therapy
text
TypeofSecondLineTherapy
Item
Type of Second Line Therapy
text
TypeofSecondLineChemotherapy
Item
Type of Second Line Chemotherapy
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
NewPrimaryCancerDate
Item
New Primary Cancer Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date

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