ID

2245

Beschrijving

RTOG-0412 A5: Demographic Data Form - version 2 Cisplatin and Docetaxel With or Without Radiation Therapy in Treating Patients Who Are Undergoing Surgery for Newly Diagnosed Stage III Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E499E60B-975C-4FA9-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E499E60B-975C-4FA9-E034-0003BA3F9857

Trefwoorden

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19 september 2012

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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Lung Cancer NCT00113386 Demographic - RTOG-0412 A5: Demographic Data Form - version 2 - 2292933v3.0

model
Details

Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

1 Formulieren

StudyEvent: RTOG-0412 A5: Demographic Data Form - version 2
1. Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

Name

Type

Description | Question | Decode (Coded Value)

Datatype

Alias

Unnamed MODULE

Item Group

Unnamed Module

ProtocolRTOGIdentifierNumber

Item

RTOG Study

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)

Case#

Item

Case #

text

InstitutionName

Item

Institution Name

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)

PatientRadiationTherapyOncologyGroupIdentifierNumber

Item

RTOG Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

FormCompletionDate

Item

Date Completed (INSTRUCTIONS: Submit this form at patient's entry on study. Complete the information by filling in boxes or blanks as requested. See separate page for instructions)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

ResponsiblePersonDescriptionType

Item

Who completed this form? (Check one box)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.1

Code List

Who completed this form? (Check one box)

CL Item

Self (Self)

C25200 (NCI Thesaurus)
C0036588 (UMLS 2011AA)

CL Item

Staff (Staff)

CL Item

Other Person (Other person)

CL Item

Not Applicable, No Items Completed (Not applicable, no items completed)

PatientRaceCategory

Item

Race (Check one box only)

text

C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)

CL.2

Code List

Race (Check one box only)

CL Item

A Person Having Origins In Any Of The Original Peoples Of Europe, The Middle East, Or North Africa. (White, not Hispanic origin)

C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)

CL Item

Hispanic (Hispanic)

CL Item

A Person Having Origins In Any Of The Black Racial Groups Of Africa. Terms Such As "haitian" Or "negro" Can Be Used In Addition To "black Or African American." (Black, not Hispanic origin)

C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)

CL Item

A Person Having Origins In Any Of The Original Peoples Of Hawaii, Guam, Samoa, Or Other Pacific Islands (Native Hawaiian or other Pacific Islander)

CL Item

A Person Having Origins In Any Of The Original Peoples Of The Far East, Southeast Asia, Or The Indian Subcontinent Including, For Example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, And Vietnam. (Asian)

C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)

CL Item

A Person Having Origins In Any Of The Original Peoples Of North And South America (including Central America), And Who Maintains Tribal Affiliation Or Community Attachment (Native American / Alaskan Nation)

CL Item

Other (Other)

CL Item

Patient Is Unsure Of Their Race (Unknown / I prefer not to answer)

PatientEthnicityCategory

Item

Additional Race/Ethnicity (If you consider yourself multiracial, check all additional categories that apply in this question Do not include what you reported in 2A.)

text

C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29933 (NCI Thesaurus Property)

CL.3

Code List

Additional Race/Ethnicity (If you consider yourself multiracial, check all additional categories that apply in this question Do not include what you reported in 2A.)

CL Item

White, not Hispanic origin (White, not Hispanic origin)

CL Item

Hispanic (Hispanic)

CL Item

Black, not Hispanic origin (Black, not Hispanic origin)

CL Item

Native Hawaiian or other Pacific Islander (Native Hawaiian or other Pacific Islander)

CL Item

Asian (Asian)

CL Item

Native American / Alaskan Nation (Native American / Alaskan Nation)

CL Item

Patient Is Unsure Of Their Ethnicity (Unknown / I prefer not to answer)

CL Item

A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race (HISPANIC OR LATINO)

CL Item

Patient Refused Or Data Not Available (Not reported)

CL Item

A Person Not Meeting The Definition For Hispanic Or Latino. (NOT HISPANIC OR LATINO)

C41222 (NCI Thesaurus)
C1518424 (UMLS 2011AA)

PersonHighestEducationType

Item

Highest school grade completed (Check one box)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C16529 (NCI Thesaurus Property)
C0013622 (UMLS 2011AA Property)
C25525 (NCI Thesaurus Property)
C1522410 (UMLS 2011AA Property)

CL.4

Code List

Highest school grade completed (Check one box)

CL Item

8th Or Less (8th or less)

CL Item

9 - 11th Grade (9 - 11th Grade)

CL Item

High School Graduate / Ged (High school graduate / GED)

CL Item

Vocational / Technical School (Vocational / technical school)

CL Item

Associate Degree / Some College (Associate degree / some college)

CL Item

Bachelor's Degree (Bachelor's degree)

C39327 (NCI Thesaurus)
C1511035 (UMLS 2011AA)

CL Item

Advanced Degree (Advanced degree)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CL Item

I Prefer Not To Answer (I prefer not to answer)

PersonHighestEducationSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C16529 (NCI Thesaurus Property)
C0013622 (UMLS 2011AA Property)
C25525 (NCI Thesaurus Property)
C1522410 (UMLS 2011AA Property)

PersonPediatricReligionName

Item

Religion during childhood (Check one box)

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C39299 (NCI Thesaurus Property)
C0231335 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C17085 (NCI Thesaurus Property)
C0035039 (UMLS 2011AA Property)

CL.5

Code List

Religion during childhood (Check one box)

CL Item

Protestant (Protestant)

CL Item

Catholic (Catholic)

CL Item

Jewish (Jewish)

C0178443 (NCI Metathesaurus)

CL Item

Morman/latter Day Saints (Mormon/Latter Day Saints)

CL Item

Muslim / Islam (Muslim / Islam)

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Other, Specify (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CL Item

I Prefer Not To Answer (I prefer not to answer)

PersonPediatricReligionSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C39299 (NCI Thesaurus Property)
C0231335 (UMLS 2011AA Property)
C17085 (NCI Thesaurus Property)
C0035039 (UMLS 2011AA Property)

MaritalStatusCategory

Item

Marital status (Check one box)

text

C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)

CL.6

Code List

Marital status (Check one box)

CL Item

Married (Married)

C0555047 (NCI Metathesaurus)

CL Item

Widowed (Widowed)

C51775 (NCI Thesaurus)
C0206275 (UMLS 2011AA)

CL Item

Single (Single)

CL Item

Divorced (Divorced/Separated)

C0086170 (NCI Metathesaurus)

CL Item

Living As Married (Living as married)

CL Item

I Prefer Not To Answer (I prefer not to answer)

PatientBirthCountryType

Item

Where were you born? (Check one box)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25464 (NCI Thesaurus Property)
C0454664 (UMLS 2011AA Property)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)

CL.7

Code List

Where were you born? (Check one box)

CL Item

Usa (USA)

CL Item

Other Country (Other country)

PatientBirthStateSpecify

Item

USA, specify the 2 letter State code (e.g. NY)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C30010 (NCI Thesaurus Property)
C1301808 (UMLS 2011AA Property)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)

PatientBirthCountrySpecify

Item

Other country, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25464 (NCI Thesaurus Property)
C0454664 (UMLS 2011AA Property)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)

PatientLongestDurationResidenceType

Item

Where did you live the longest (Check one box)

text

C0030705 (NCI Metathesaurus ObjectClass)
C25558 (NCI Thesaurus Property)
C1522425 (UMLS 2011AA Property)
C25330 (NCI Thesaurus Property)
C0449238 (UMLS 2011AA Property)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.8

Code List

Where did you live the longest (Check one box)

CL Item

Usa (USA)

CL Item

Other Country (Other country)

PatientStateLongestDurationResidenceCode

Item

USA, specify the 2 letter State code (e.g. NY)

text

C0030705 (NCI Metathesaurus ObjectClass)
C25558 (NCI Thesaurus Property)
C1522425 (UMLS 2011AA Property)
C30010 (NCI Thesaurus Property)
C1301808 (UMLS 2011AA Property)
C25330 (NCI Thesaurus Property)
C0449238 (UMLS 2011AA Property)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C30010 (NCI Thesaurus ValueDomain)
C1301808 (UMLS 2011AA ValueDomain)

PatientCountryLongestDurationResidenceName

Item

Other country, specify (Cigarette History?)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25558 (NCI Thesaurus Property)
C1522425 (UMLS 2011AA Property)
C25464 (NCI Thesaurus Property)
C0454664 (UMLS 2011AA Property)
C25330 (NCI Thesaurus Property)
C0449238 (UMLS 2011AA Property)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)
C25464 (NCI Thesaurus ValueDomain)
C0454664 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)

SmokingHistoryInd-3

Item

Smoked at least 100 cigarette (5 packs) during lifetime

text

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)

CL.9

Code List

Smoked at least 100 cigarette (5 packs) during lifetime

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

Yes, Currently Smoke (Yes, currently smoke)

AgeBeganSmokinginYears

Item

Age began smoking cigarettes

double

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C18270 (NCI Thesaurus Property)
C0700219 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25150 (NCI Thesaurus ValueDomain)
C0001779 (UMLS 2011AA ValueDomain)

Numberofyearssmokedcigarettes

Item

Number of years smoked cigarettes

text

Averagenumberofcigarettessmokedperday

Item

Average number of cigarettes smoked per day

double

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)

PatientSmokingCessationAgeYear

Item

If quit, age stopped smoking completely

double

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0085134 (NCI Metathesaurus Property)

OtherDiseaseDiagnosisType

Item

If you have had any of the illnesses listed below, please check yes for those that apply (= Yes 2)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)

CL.10

Code List

If you have had any of the illnesses listed below, please check yes for those that apply (= Yes 2)

CL Item

Heart Problems (Heart problems)

CL Item

Lung Problems (Lung problems)

CL Item

High Blood Pressure (High blood pressure)

CL Item

Bleeding Problems (Bleeding problems)

CL Item

Circulation Problems (Circulation problems)

CL Item

Liver Problems (Liver problems)

CL Item

Diabetes Or Sugar In Urine (Diabetes or sugar in urine)

CL Item

Kidney/urine Problems (Kidney/urine problems)

CL Item

Stroke (Stroke)

CL Item

Thyroid Problems (Thyroid problems)

CL Item

Seizure (Seizure)

C2962 (NCI Thesaurus)
C0036572 (UMLS 2011AA)

CL Item

Hiv/aids (HIV/AIDS)

CL Item

Frequent Infections (Frequent infections)

CL Item

Psychological Problems (Psychological problems)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

OtherDiseaseDiagnosisSpecify

Item

Specify other

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)

FamilyRelativeType

Item

How many of the following family members (living and dead) do you have (Include only those who are blood-related.)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25173 (NCI Thesaurus ObjectClass)
C0015576 (UMLS 2011AA ObjectClass)
C21480 (NCI Thesaurus Property)
C0080103 (UMLS 2011AA Property)

CL.11

Code List

How many of the following family members (living and dead) do you have (Include only those who are blood-related.)

CL Item

Brothers (Brothers)

CL Item

Sisters (Sisters)

C0337514 (NCI Metathesaurus)

CL Item

Daughters (Daughters)

CL Item

Sons (Sons)

PatientAdoptedInd-3

Item

Are you adopted (Check one)

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25290 (NCI Thesaurus Property)
C0425382 (UMLS 2011AA Property)

CL.12

Code List

Are you adopted (Check one)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

RelativeFamilyCancerHistoryType

Item

Blood relative with cancer (= yes 2)

text

C25173 (NCI Thesaurus ObjectClass)
C0015576 (UMLS 2011AA ObjectClass)
C21480 (NCI Thesaurus ObjectClass)
C0080103 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.13

Code List

Blood relative with cancer (= yes 2)

CL Item

Father (Father)

C25174 (NCI Thesaurus)
C0015671 (UMLS 2011AA)

CL Item

Mother (Mother)

C25189 (NCI Thesaurus)
C0026591 (UMLS 2011AA)

CL Item

Brother #1 (Brother #1)

CL Item

Brother #2 (Brother #2)

CL Item

Brother #3 (Brother #3)

CL Item

Brother #4 (Brother #4)

CL Item

Sister #1 (Sister #1)

CL Item

Sister #2 (Sister #2)

CL Item

Sister #3 (Sister #3)

CL Item

Sister #4 (Sister #4)

CL Item

Child #1 (Child #1)

CL Item

Child #2 (Child #2)

CL Item

Child #3 (Child #3)

CL Item

Child #4 (Child #4)

PersonFirstCancerDiagnosisAgeYearCount

Item

Age when first cancer diagnosed

double

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)

CancerSiteType

Item

Type of cancer (= yes 2)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)

CL.14

Code List

Type of cancer (= yes 2)

CL Item

Lung (Lung)

C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)

CL Item

Breast (Breast)

C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)

CL Item

Colon (Colon)

C12382 (NCI Thesaurus)
C0009368 (UMLS 2011AA)

CL Item

Prostate (Prostate)

C12410 (NCI Thesaurus)
C0033572 (UMLS 2011AA)

CL Item

Head & Neck (Head & Neck)

CL Item

Non Melanoma Skin (Non Melanoma Skin)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CancerSiteSpecify

Item

specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)

CancerPreventionTrialKnowledgeDocumentedInd-2

Item

Have you ever heard of Cancer Prevention Trials (Check one box)

text

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus Property)
C1301725 (UMLS 2011AA Property)
C0376554 (NCI Metathesaurus Property)

CL.15

Code List

Have you ever heard of Cancer Prevention Trials (Check one box)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CancerPreventionTrialParticipationScale

Item

How likely would you be to volunteer to participate in Cancer Prevention Trials (The numbers below allow you to rate your answer between 1 - never and 10 - extremely likely. Circle the number below that best describes your choice.)

text

C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)

CL.16

Code List

CL Item

1 (1)

CL Item

3 (3)

CL Item

4 (4)

CL Item

5 (5)

CL Item

6 (6)

CL Item

7 (7)

CL Item

8 (8)

CL Item

9 (9)

CL Item

10 (10)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

Other,specify

Item

Other, specify

text

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Model Commentaren :

Itemgroep Commentaren voor :

Item Commentaren voor :

Lung Cancer NCT00113386 Demographic - RTOG-0412 A5: Demographic Data Form - version 2 - 2292933v3.0

Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

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Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving