Follow-Up Form - 2059334v3.0 Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix


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  1. 8/27/12
  2. 6/25/17
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June 25, 2017

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Creative Commons BY 4.0
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Cervical Cancer Cisplatin NCT00064077 GOG


  1. StudyEvent: GOG Follow-Up Form
    1. FORM Q
Header Module
Vital Status
Patient´s vital status
Primary cause of death
Was patient unable to be contacted for current scheduled follow-up?
Notice Of Progression
Has the patient been diagnosed with a new progression?
m d y
What was the method used to determine progression?
Ca125 And Other Biomarkers
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
m d y
Late Adverse Event
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >/= 3), long term toxicity that has not been previously reported?
m d y
CTC adverse event attribution category
Non-protocol Therapy
Is the patient receiving any non-protocol cancer therapy not previously reported?
m d y

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