Form Completion Date
Item
Form completion date, original
date
C1549507 (UMLS CUI [1])
Form Completion Date, amended
Item
Date form amended
date
C0680532 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Responsible Person Reporting Change LastName
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])
Last Name
Item
Patient Name, Last
text
C1301584 (UMLS CUI [1])
First Name
Item
Patient Name, First
text
C1443235 (UMLS CUI [1])
Patient Study ID
Item
Patient Study ID
text
C2348585 (UMLS CUI [1])
Person Completing Form, LastName
Item
Person Completing Form, Last Name
text
C1550483 (UMLS CUI [1,1])
C1301584 (UMLS CUI [1,2])
Participating Group Code
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C2986314 (UMLS CUI [1])
Study Number Participating Group
Item
Participating Group Protocol Number
text
C3274381 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
Patient Participating 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])
Comments
Item
COMMENTS
text
C0947611 (UMLS CUI [1])
Item
Patient´s vital status
integer
C1148433 (UMLS CUI [1])
Code List
Patient´s vital status
CL Item
Alive (1)
C2584946 (UMLS CUI-1)
CL Item
Dead (0)
C0011065 (UMLS CUI-1)
Item
Primary cause of death
integer
C0007465 (UMLS CUI [1])
Code List
Primary cause of death
CL Item
Due To This Disease (1)
C3699404 (UMLS CUI-1)
CL Item
Unknown (2)
C0439673 (UMLS CUI-1)
CL Item
Due To Protocol Treatment (3)
C0678226 (UMLS CUI-1)
C0040808 (UMLS CUI-2)
CL Item
Due To Other Cause (4)
C3262234 (UMLS CUI-1)
Death Reason, Specify
Item
Death due to other cause (specify)
text
C0007465 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Last Contact Date
Item
Date of last contact or death
date
C0585085 (UMLS CUI [1])
Lost to Follow-Up
Item
Was patient unable to be contacted for current scheduled follow-up?
boolean
C1302313 (UMLS CUI [1])
New Progression
Item
Has the patient been diagnosed with a new progression?
boolean
C3641258 (UMLS CUI [1])
Progression Date
Item
Date of progression (recurrence)
date
C0242656 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Progression Site
Item
Site(s) of progression
text
C0242656 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Item
What was the method used to determine progression?
integer
C2911685 (UMLS CUI [1])
Code List
What was the method used to determine progression?
CL Item
Histology (1)
C0019638 (UMLS CUI-1)
CL Item
Radiographic (2)
C0444708 (UMLS CUI-1)
CL Item
Physical Exam (3)
C0031809 (UMLS CUI-1)
CL Item
Tumor Markers (4)
C0041365 (UMLS CUI-1)
Tumormarker name
Item
Tumormarker name
text
C0041365 (UMLS CUI [1,1])
C1705313 (UMLS CUI [1,2])
Tumor Marker Value
Item
Tumor Marker Value
float
C25367 (NCI Thesaurus Property)
C17220 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0041365 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Tumormarker date
Item
Date of tumormarke (e.g. CA125)
date
C0041365 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
New Primary Cancer
Item
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
boolean
C0751623 (UMLS CUI [1])
New Primary Cancer Date
Item
Date of diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0751623 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
New Primary Site
Item
Site(s) of new primary
text
C0751623 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Late Adverse Event
Item
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?
boolean
C0877248 (UMLS CUI [1,1])
C0205087 (UMLS CUI [1,2])
Late Adverse Event Term
Item
Adverse event term
text
C0877248 (UMLS CUI [1,1])
C0205087 (UMLS CUI [1,2])
Late Adverse Event Grade
Item
Late adverse event grade
text
C0877248 (UMLS CUI [1,1])
C0205087 (UMLS CUI [1,2])
C0441800 (UMLS CUI [1,3])
Late Adverse Event Onset Date
Item
Late Adverse Event Onset Date
date
C0877248 (UMLS CUI [1,1])
C0205087 (UMLS CUI [1,2])
C0574845 (UMLS CUI [1,3])
Item
CTC adverse event attribution category
integer
C1706735 (UMLS CUI [1])
Code List
CTC adverse event attribution category
CL Item
Unrelated (1)
C0445356 (UMLS CUI-1)
CL Item
Unlikely (2)
C0750558 (UMLS CUI-1)
CL Item
Possibly (3)
C0332149 (UMLS CUI-1)
CL Item
Probably (4)
C0750492 (UMLS CUI-1)
CL Item
Definitely (5)
C1704787 (UMLS CUI-1)
Non-Protocol Therapy
Item
Is the patient receiving any non-protocol cancer therapy not previously reported?
boolean
C1518384 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Other Non-Protocol Therapy
Item
Name of other non-protocol therapy
text
C1518384 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Non-Protocol Therapy Date, First
Item
Date of first non-protocol therapy
date
C1518384 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Additional Therapy Reason
Item
Additional therapy reason
text
C1706712 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])