ID

2157

Descripción

QF RTOG Phase III-Multiple Brain Mets Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA4A0B-63F5-6417-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA4A0B-63F5-6417-E034-0003BA12F5E7

Palabras clave

  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
Subido en

19 de septiembre de 2012

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy

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    Lung Cancer NCT00096265 Quality of Life - QF RTOG Phase III-Multiple Brain Mets - 2277089v3.0

    No Instruction available.

    1. StudyEvent: QF RTOG Phase III-Multiple Brain Mets
      1. No Instruction available.
    Header
    Descripción

    Header

    [RTOG Study No.]
    Descripción

    ProtocolRTOGIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C19778
    UMLS 2011AA Property
    C1514695
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Case #
    Descripción

    Case#

    Tipo de datos

    text

    Institution
    Descripción

    InstitutionName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus ValueDomain
    C21541
    UMLS 2011AA ValueDomain
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Institution No.
    Descripción

    InstitutionIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participant's Initials
    Descripción

    PatientInitialsName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25536
    UMLS 2011AA Property
    C1555582
    Participant's I.D. No.
    Descripción

    PatientCoordinatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25462
    UMLS 2011AA Property
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Date Form Completed
    Descripción

    FormCompleteDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus ValueDomain
    C25367
    Module 1
    Descripción

    Module 1

    Mobility (Please circle one statement in each group below which best describes your health today.)
    Descripción

    QOLMobilityAssessmentStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Metathesaurus Property
    C0449580
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    Descripción

    QOLSelf-careStatusType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    Descripción

    QOLPhyscialActivityAssessmentStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property
    C17708
    UMLS 2011AA Property
    C0026606
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    Descripción

    QOLPainAssessmentStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property
    C3303
    UMLS 2011AA Property
    C0030193
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    Descripción

    QOLAnxietyAssessmentStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property
    C26696
    UMLS 2011AA Property
    C0003467
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Module 2
    Descripción

    Module 2

    Date
    Descripción

    ResponsiblePersonSignatureDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass
    C25657
    UMLS 2011AA ObjectClass
    C1273518
    NCI Thesaurus Property
    C25678
    UMLS 2011AA Property
    C1519316
    Your own health state today
    Descripción

    Yourownhealthstatetoday

    Tipo de datos

    text

    Patient's signature
    Descripción

    Patient'ssignature

    Tipo de datos

    text

    Similar models

    No Instruction available.

    1. StudyEvent: QF RTOG Phase III-Multiple Brain Mets
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Header
    Item
    [RTOG Study No.]
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C19778 (NCI Thesaurus Property)
    C1514695 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Code List
    [RTOG Study No.]
    CL Item
    RTOG Study 0320 (RTOG Study 0320)
    Case#
    Item
    Case #
    text
    InstitutionName
    Item
    Institution
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C21541 (NCI Thesaurus ValueDomain)
    C0018704 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    InstitutionIdentifierNumber
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientInitialsName
    Item
    Participant's Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25536 (NCI Thesaurus Property)
    C1555582 (UMLS 2011AA Property)
    PatientCoordinatingIdentifierNumber
    Item
    Participant's I.D. No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus Property)
    C0700114 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    FormCompleteDate
    Item
    Date Form Completed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus ValueDomain)
    Item Group
    Module 1
    Item
    Mobility (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C0449580 (NCI Metathesaurus Property)
    Code List
    Mobility (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems In Walking About (I have no problems in walking about)
    CL Item
    I Have Some Problems In Walking About (I have some problems in walking about)
    CL Item
    I Am Confined To Bed (I am confined to bed)
    Item
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems With Self-care (I have no problems with self-care)
    CL Item
    I Have Some Problems Washing Or Dressing Myself (I have some problems washing or dressing myself)
    CL Item
    I Am Unable To Wash Or Dress Myself (I am unable to wash or dress myself)
    Item
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C17708 (NCI Thesaurus Property)
    C0026606 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems With Performing My Usual Activities (I have no problems with performing my usual activities)
    CL Item
    I Have Some Problems With Performing My Usual Activities (I have some problems with performing my usual activities)
    CL Item
    I Am Unable To Perform My Usual Activities (I am unable to perform my usual activities)
    Item
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property)
    C0030193 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Pain Or Discomfort (I have no pain or discomfort)
    CL Item
    I Have Moderate Pain Or Discomfort (I have moderate pain or discomfort)
    CL Item
    I Have Extreme Pain Or Discomfort (I have extreme pain or discomfort)
    Item
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus Property)
    C0003467 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Am Not Anxious Or Depressed (I am not anxious or depressed)
    CL Item
    I Am Moderately Anxious Or Depressed (I am moderately anxious or depressed)
    CL Item
    I Am Extremely Anxious Or Depressed (I am extremely anxious or depressed)
    Item Group
    Module 2
    ResponsiblePersonSignatureDate
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass)
    C1273518 (UMLS 2011AA ObjectClass)
    C25678 (NCI Thesaurus Property)
    C1519316 (UMLS 2011AA Property)
    Yourownhealthstatetoday
    Item
    Your own health state today
    text
    Patient'ssignature
    Item
    Patient's signature
    text

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