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23121

Beschreibung

Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix GOG Treatment Completion Form 2059221v3.0 https://clinicaltrials.gov/ct2/show/NCT00064077

Link

https://clinicaltrials.gov/ct2/show/NCT00064077

Stichworte

Versionen (2)
  1. 27.08.12 27.08.12 -
  2. 24.06.17 24.06.17 - Martin Dugas
Hochgeladen am

24. Juni 2017

DOI

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Lizenz

Creative Commons BY 4.0
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    Cervical Cancer Cisplatin NCT00064077 GOG

    Englisch

    FORM Q0

    1 Formulare  
    1. StudyEvent: GOG Treatment Completion Form
      1. FORM Q0
    Header Module
    Beschreibung

    Header Module

    Alias
    UMLS CUI-1
    C1320722
    Date form originally completed
    Beschreibung

    Form Completion Date

    Datentyp

    date

    Maßeinheiten
    • m d y
    Alias
    UMLS CUI [1]
    C1549507
    m d y
    Date form amended
    Beschreibung

    Form Amendment Date

    Datentyp

    date

    Maßeinheiten
    • m d y
    Alias
    UMLS CUI [1,1]
    C0680532
    UMLS CUI [1,2]
    C0011008
    m d y
    Patient Name, Last
    Beschreibung

    Patient Lastname

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C1301584
    Patient Name, First
    Beschreibung

    Patient Firstname

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0421447
    Patient Study ID
    Beschreibung

    Patient Study ID

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C2348585
    Participating Group Code
    Beschreibung

    Participating Clinical Study Organization

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI [1]
    C2347449
    Participating Group Protocol Number
    Beschreibung

    Participating Group Protocol Number

    Datentyp

    text

    Alias
    UMLS CUI [1,1]
    C3274381
    UMLS CUI [1,2]
    C2347449
    Participating Patient Study ID
    Beschreibung

    Patient Identifier Number

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    UMLS CUI [1,1]
    C2348585
    UMLS CUI [1,2]
    C2347449
    Person amending form, last name
    Beschreibung

    Responsible Person Reporting Change

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus Property
    C25364
    UMLS CUI [1,1]
    C0680532
    UMLS CUI [1,2]
    C1547383
    Person Completing Form, Last Name
    Beschreibung

    Person Completing Form

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C3258039
    COMMENTS
    Beschreibung

    Comments

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0947611
    Treatment Schedule
    Beschreibung

    Treatment Schedule

    Alias
    UMLS CUI-1
    C0040808
    Total number of cycles given
    Beschreibung

    Total Course Number

    Datentyp

    integer

    Alias
    UMLS CUI [1]
    C2045831
    Last date (any modality of) protocol therapy was given
    Beschreibung

    Treatment End Date

    Datentyp

    date

    Maßeinheiten
    • m d y
    Alias
    UMLS CUI [1]
    C1531784
    m d y
    Off-treatment Reason
    Beschreibung

    Off-treatment Reason

    Alias
    UMLS CUI-1
    C1518544
    UMLS CUI-2
    C0566251
    Reason treatment ended (check only one)
    Beschreibung

    Off Treatment Reason

    Datentyp

    integer

    Alias
    UMLS CUI [1,1]
    C1518544
    UMLS CUI [1,2]
    C0566251
    Specify toxicity (unnamed)
    Beschreibung

    Toxicity

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0013221
    Specify reason (unnamed)
    Beschreibung

    Reason Off-Treatment

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25638
    NCI Thesaurus ObjectClass-2
    C25601
    NCI Metathesaurus Property
    C0030705
    NCI Thesaurus Property
    C41341
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI [1,1]
    C1518544
    UMLS CUI [1,2]
    C0566251
    Specify disease
    Beschreibung

    Complicating Disease

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0544688
    Will patient receive further treatment?
    Beschreibung

    Further Treatment

    Datentyp

    boolean

    Alias
    UMLS CUI [1,1]
    C0087111
    UMLS CUI [1,2]
    C1517331
    Specify further treatment
    Beschreibung

    Further Treatment, specify

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25519
    NCI Thesaurus Property
    C25382
    UMLS CUI [1,1]
    C0087111
    UMLS CUI [1,2]
    C1517331
    Zum Seitenanfang zurückkehren

    Ähnliche Modelle

    FORM Q0

    1 Formulare
    1. StudyEvent: GOG Treatment Completion Form
      1. FORM Q0
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header Module
    C1320722 (UMLS CUI-1)
    Form Completion Date
    Item
    Date form originally completed
    date
    C1549507 (UMLS CUI [1])
    Form Amendment Date
    Item
    Date form amended
    date
    C0680532 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Patient Lastname
    Item
    Patient Name, Last
    text
    C1301584 (UMLS CUI [1])
    Patient Firstname
    Item
    Patient Name, First
    text
    C0421447 (UMLS CUI [1])
    Patient Study ID
    Item
    Patient Study ID
    text
    C2348585 (UMLS CUI [1])
    Participating Clinical Study Organization
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI [1])
    Participating Group Protocol Number
    Item
    Participating Group Protocol Number
    text
    C3274381 (UMLS CUI [1,1])
    C2347449 (UMLS CUI [1,2])
    Patient Identifier Number
    Item
    Participating Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    C2348585 (UMLS CUI [1,1])
    C2347449 (UMLS CUI [1,2])
    Responsible Person Reporting Change
    Item
    Person amending form, last name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0680532 (UMLS CUI [1,1])
    C1547383 (UMLS CUI [1,2])
    Person Completing Form
    Item
    Person Completing Form, Last Name
    text
    C3258039 (UMLS CUI [1])
    Comments
    Item
    COMMENTS
    text
    C0947611 (UMLS CUI [1])
    Item Group
    Treatment Schedule
    C0040808 (UMLS CUI-1)
    Total Course Number
    Item
    Total number of cycles given
    integer
    C2045831 (UMLS CUI [1])
    Treatment End Date
    Item
    Last date (any modality of) protocol therapy was given
    date
    C1531784 (UMLS CUI [1])
    Item Group
    Off-treatment Reason
    C1518544 (UMLS CUI-1)
    C0566251 (UMLS CUI-2)
    Item
    Reason treatment ended (check only one)
    integer
    C1518544 (UMLS CUI [1,1])
    C0566251 (UMLS CUI [1,2])
    CL.1
    Code List
    Reason treatment ended (check only one)
    CL Item
    Routine completion of planned protocol treatment (1)
    C0040808 (UMLS CUI-1)
    C0205197 (UMLS CUI-2)
    CL Item
    Disease progression, relapse during active treatment (2)
    C0242656 (UMLS CUI-1)
    CL Item
    Toxicity/side effects/complications (3)
    C0877248 (UMLS CUI-1)
    CL Item
    Patient withdrawal or refusal for reason other than toxicity (4)
    C0040809 (UMLS CUI-1)
    CL Item
    Death after beginning protocol therapy (5)
    C0011065 (UMLS CUI-1)
    CL Item
    Patient off-treatment for other complicating disease (6)
    C0009566 (UMLS CUI-1)
    CL Item
    Other (7)
    C0205394 (UMLS CUI-1)
    Toxicity
    Item
    Specify toxicity (unnamed)
    text
    C0013221 (UMLS CUI [1])
    Reason Off-Treatment
    Item
    Specify reason (unnamed)
    text
    C25638 (NCI Thesaurus ObjectClass)
    C25601 (NCI Thesaurus ObjectClass-2)
    C0030705 (NCI Metathesaurus Property)
    C41341 (NCI Thesaurus Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI [1,1])
    C0566251 (UMLS CUI [1,2])
    Complicating Disease
    Item
    Specify disease
    text
    C0544688 (UMLS CUI [1])
    Further Treatment
    Item
    Will patient receive further treatment?
    boolean
    C0087111 (UMLS CUI [1,1])
    C1517331 (UMLS CUI [1,2])
    Further Treatment, specify
    Item
    Specify further treatment
    text
    C25685 (NCI Thesaurus ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25519 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C0087111 (UMLS CUI [1,1])
    C1517331 (UMLS CUI [1,2])
    Zum Seitenanfang zurückkehren 

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