ID

23124

Description

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

Lien

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

Mots-clés

  1. 27/08/2012 27/08/2012 -
  2. 25/06/2017 25/06/2017 - Martin Dugas
Téléchargé le

25 juin 2017

DOI

Pour une demande vous connecter.

Licence

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
Description

Header Module

Alias
UMLS CUI-1
C1320722
Form completion date, original
Description

Form Completion Date

Type de données

date

Alias
UMLS CUI [1]
C1549507
Date form amended
Description

Form Completion Date, amended

Type de données

date

Alias
UMLS CUI [1,1]
C0680532
UMLS CUI [1,2]
C0011008
Person amending form, last name
Description

Responsible Person Reporting Change LastName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25364
UMLS CUI [1,1]
C0680532
UMLS CUI [1,2]
C1547383
Patient Name, Last
Description

Last Name

Type de données

text

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

First Name

Type de données

text

Alias
UMLS CUI [1]
C1443235
Patient Study ID
Description

Patient Study ID

Type de données

text

Alias
UMLS CUI [1]
C2348585
Person Completing Form, Last Name
Description

Person Completing Form, LastName

Type de données

text

Alias
UMLS CUI [1,1]
C1550483
UMLS CUI [1,2]
C1301584
Participating Group Code
Description

Participating Group Code

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI [1]
C2986314
Participating Group Protocol Number
Description

Study Number Participating Group

Type de données

text

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

Patient Participating Identifier Number

Type de données

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
COMMENTS
Description

Comments

Type de données

text

Alias
UMLS CUI [1]
C0947611
Vital Status
Description

Vital Status

Alias
UMLS CUI-1
C1148433
Patient´s vital status
Description

Vital Status

Type de données

integer

Alias
UMLS CUI [1]
C1148433
Primary cause of death
Description

Death Reason

Type de données

integer

Alias
UMLS CUI [1]
C0007465
Death due to other cause (specify)
Description

Death Reason, Specify

Type de données

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1521902
Date of last contact or death
Description

Last Contact Date

Type de données

date

Alias
UMLS CUI [1]
C0585085
Was patient unable to be contacted for current scheduled follow-up?
Description

Lost to Follow-Up

Type de données

boolean

Alias
UMLS CUI [1]
C1302313
Notice Of Progression
Description

Notice Of Progression

Alias
UMLS CUI-1
C0242656
Has the patient been diagnosed with a new progression?
Description

New Progression

Type de données

boolean

Alias
UMLS CUI [1]
C3641258
Date of progression (recurrence)
Description

Progression Date

Type de données

date

Unités de mesure
  • m d y
Alias
UMLS CUI [1,1]
C0242656
UMLS CUI [1,2]
C0011008
m d y
Site(s) of progression
Description

Progression Site

Type de données

text

Alias
UMLS CUI [1,1]
C0242656
UMLS CUI [1,2]
C1515974
What was the method used to determine progression?
Description

Progression Assessment Method

Type de données

integer

Alias
UMLS CUI [1]
C2911685
Ca125 And Other Biomarkers
Description

Ca125 And Other Biomarkers

Alias
UMLS CUI-1
C0005516
Tumormarker name
Description

Tumormarker name

Type de données

text

Alias
UMLS CUI [1,1]
C0041365
UMLS CUI [1,2]
C1705313
Tumor Marker Value
Description

Tumor Marker Value

Type de données

float

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C17220
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1,1]
C0041365
UMLS CUI [1,2]
C1522609
Date of tumormarke (e.g. CA125)
Description

Tumormarker date

Type de données

date

Alias
UMLS CUI [1,1]
C0041365
UMLS CUI [1,2]
C0011008
Notice Of New Primary
Description

Notice Of New Primary

Alias
UMLS CUI-1
C0751623
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Description

New Primary Cancer

Type de données

boolean

Alias
UMLS CUI [1]
C0751623
Date of diagnosis
Description

New Primary Cancer Date

Type de données

date

Unités de mesure
  • m d y
Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI [1,1]
C0751623
UMLS CUI [1,2]
C0011008
m d y
Site(s) of new primary
Description

New Primary Site

Type de données

text

Alias
UMLS CUI [1,1]
C0751623
UMLS CUI [1,2]
C1515974
Late Adverse Event
Description

Late Adverse Event

Alias
UMLS CUI-1
C0877248
UMLS CUI-2
C0205087
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?
Description

Late Adverse Event

Type de données

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0205087
Adverse event term
Description

Late Adverse Event Term

Type de données

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0205087
Late adverse event grade
Description

Late Adverse Event Grade

Type de données

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0205087
UMLS CUI [1,3]
C0441800
Late Adverse Event Onset Date
Description

Late Adverse Event Onset Date

Type de données

date

Unités de mesure
  • m d y
Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0205087
UMLS CUI [1,3]
C0574845
m d y
CTC adverse event attribution category
Description

CTC Adverse Event Attribution Code

Type de données

integer

Alias
UMLS CUI [1]
C1706735
Non-protocol Therapy
Description

Non-protocol Therapy

Alias
UMLS CUI-1
C1518384
UMLS CUI-2
C0087111
Is the patient receiving any non-protocol cancer therapy not previously reported?
Description

Non-Protocol Therapy

Type de données

boolean

Alias
UMLS CUI [1,1]
C1518384
UMLS CUI [1,2]
C0087111
Name of other non-protocol therapy
Description

Other Non-Protocol Therapy

Type de données

text

Alias
UMLS CUI [1,1]
C1518384
UMLS CUI [1,2]
C0087111
Date of first non-protocol therapy
Description

Non-Protocol Therapy Date, First

Type de données

date

Unités de mesure
  • m d y
Alias
UMLS CUI [1,1]
C1518384
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C0808070
m d y
Additional therapy reason
Description

Additional Therapy Reason

Type de données

text

Alias
UMLS CUI [1,1]
C1706712
UMLS CUI [1,2]
C0566251

Similar models

  1. StudyEvent: GOG Follow-Up Form
    1. FORM Q
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
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 Group
Vital Status
C1148433 (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])
Item Group
Notice Of Progression
C0242656 (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)
Item Group
Ca125 And Other Biomarkers
C0005516 (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])
Item Group
Notice Of New Primary
C0751623 (UMLS CUI-1)
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])
Item Group
Late Adverse Event
C0877248 (UMLS CUI-1)
C0205087 (UMLS CUI-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)
Item Group
Non-protocol Therapy
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
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])

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