ID

23299

Beskrivning

RTOG-0617 HP: Radiation Therapy Oncology Group Phase III High-dose Vs Standard-dose Conformal XRT with Chemotherapy Health Utility Measurement Euro (EQ - 5D) High-Dose or Standard-Dose Radiation Therapy and Chemotherapy With or Without Cetuximab in Treating Patients With Newly Diagnosed Stage III Non-Small Cell Lung Cancer That Cannot Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=24E6B80C-368A-3843-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=24E6B80C-368A-3843-E044-0003BA3F9857

Nyckelord

2017-07-02 2017-07-02 -

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2 juli 2017

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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RTOG-0617 HP: Radiation Therapy Oncology Group Phase III High-dose Vs Standard-dose Conformal XRT with Chemotherapy Health Utility Measurement Euro (EQ - 5D)

model
Detaljer

No Instruction available.

1 Formulär

StudyEvent: RTOG-0617 HP: Radiation Therapy Oncology Group Phase III High-dose Vs Standard-dose Conformal XRT with Chemotherapy Health Utility Measurement Euro (EQ - 5D)
1. No Instruction available.

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

Unnamed MODULE 1

Item Group

Unnamed Module 1

ProtocolRTOGIdentifierNumber

Item

RTOG Study No.

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-2)
C0600091 (UMLS 2011AA Property-2)

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Item

Case #

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)

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-2)
C0018704 (UMLS 2011AA ValueDomain-2)
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

Patient 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-2)
C0600091 (UMLS 2011AA Property-2)

DataAmendedInd-3

Item

Amended data

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)

CL.1

Code List

Amended data

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus-3)
C1705108 (UMLS 2011AA-4)

Unamed Module 2

Item Group

Unamed Module 2

AssessmentPeriodType

Item

Time point

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)

CL.2

Code List

Time point

CL Item

At Completion Of Chemoradiation (At completion of chemoradiation)

CL Item

Pretreatment (Pretreatment)

CL Item

Three Months From Baseline (Three months from baseline)

CL Item

Twelve Months From Baseline (Twelve months from baseline)

CL Item

Twenty-four Months From Baseline (Twenty-four months from baseline)

PatientQuestionnaireCompleteInd-2

Item

Was patient questionnaire completed

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property-2)
C0034394 (UMLS 2011AA Property-2)

QualityofLifeCompleteAssessmentDate

Item

Date patient questionnaire completed

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)

PatientIncompleteQuestionnaireReason

Item

Reason Questionnaire was not Completed

text

C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)

CL.4

Code List

Reason Questionnaire was not Completed

CL Item

Not Applicable, Questionnaire Was Completed (Not applicable, questionnaire was completed)

CL Item

Patient Refused Due To Illness (Patient refused due to illness)

CL Item

Patient Refused For Other Reason (Patient refused for other reason)

CL Item

Patient Unable To Be Contacted (Patient unable to be contacted)

CL Item

Institution Error (Institutional error)

CL Item

Tool Not Availalble In Patient's Language (Tool not availalble in patient's language)

CL Item

Other Reason (Other reason)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PatientRefuseIncompleteQuestionnaireSpecify

Item

Patient refused for other reason, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C49161 (NCI Thesaurus Property-2)
C1705116 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

PatientIncompleteQuestionnaireOtherSpecify

Item

Other reason, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)

PatientQuestionnaireCompleteMethodofCollectionType

Item

Specify method of completion

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property-2)
C0034394 (UMLS 2011AA Property-2)

CL.5

Code List

Specify method of completion

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

At Appointment (At appointment)

CL Item

By Mail (By mail)

CL Item

By Telephone (By telephone)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PatientQuestionnaireAssistanceInd

Item

Did the patient require any assistance in completing the questionnaire?

boolean

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)

PatientQuestionnaireAssistancePersonCategory

Item

Specify the person who assisted the patient

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus ValueDomain-2)
C0683312 (UMLS 2011AA ValueDomain-2)

CL.7

Code List

Specify the person who assisted the patient

CL Item

Staff Member (Staff member)

CL Item

Family (Family)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

PatientQuestionnaireAssistanceType

Item

Extent of assistance given

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)

CL.8

Code List

Extent of assistance given

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

CL Item

Read Items To Patient (Read items to patient)

CL Item

Interpreted Items For Patient (Interpreted items for patient)

CL Item

Marked Items Per Patient's Response (Marked items per patient's response)

CL Item

Combination Of Above (Combination of above)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

PatientQuestionnaireAssistanceCombinedSpecify

Item

Combination of above, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25454 (NCI Thesaurus ValueDomain-2)
C0205195 (UMLS 2011AA ValueDomain-2)

PatientQuestionnaireAssistanceOtherSpecify

Item

Other, specify

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)

ResearchCommentsText

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

ResponsiblePersonSignatureText

Item

Signature of Person Completing This Form

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)

FormOriginalCompleteDate

Item

Date Form Originally Completed

date

C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property-2)
C0205313 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)

Health Utility Measurement

Item Group

Unamed Module 2

EQ-5D Questionnaire

Item

EQ-5D Questionnaire

text

C2733251 (UMLS CUI [1])

Unnamed MODULE 3

Item Group

Unnamed Module 3

PatientHealthScore

Item

Your own health state today

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25178 (NCI Thesaurus Property)
C0018684 (UMLS 2011AA Property)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)

PatientSeriousSicknessInd-2

Item

HAVE YOU EXPERIENCED SERIOUS ILLNESS In yourself?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C54035 (NCI Thesaurus Property)
C0205404 (UMLS 2011AA Property)
C0221423 (NCI Metathesaurus Property)

ImmediateSeriousSicknessInd-2

Item

HAVE YOU EXPERIENCED SERIOUS ILLNESS In your family?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C54035 (NCI Thesaurus Property)
C0205404 (UMLS 2011AA Property)
CL282488 (NCI Metathesaurus ObjectClass)
C0221423 (NCI Metathesaurus Property)

CareAssistantPatientSeriousSicknessInd-2

Item

HAVE YOU EXPERIENCED SERIOUS ILLNESS In caring for others?

boolean

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
CL259930 (NCI Metathesaurus ObjectClass)
C54035 (NCI Thesaurus Property)
C0205404 (UMLS 2011AA Property)
C0221423 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)

PatientAgeYearCount

Item

WHAT IS YOUR AGE IN YEARS?

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)

SmokingCurrentUseInd-3

Item

ARE YOU A current smoker

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C0449865 (NCI Metathesaurus Property)

SmokingUseInd-3

Item

ARE YOU An ex-smoker

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)

NoSmokingHistoryInd-2

Item

ARE YOU A never smoker

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ObjectClass)
C1298908 (UMLS 2011AA ObjectClass)
C17934 (NCI Thesaurus ObjectClass-2)
C0453996 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)

SocialWorkHistoryInd-2

Item

DO YOU NOW, OR DID YOU EVER, WORK IN HEALTH OR SOCIAL SERVICES?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C17142 (NCI Thesaurus ObjectClass)
C0037441 (UMLS 2011AA ObjectClass)

SocialWorkHistoryRoleSpecify

Item

IF SO, IN WHAT CAPACITY?

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C17142 (NCI Thesaurus ObjectClass)
C0037441 (UMLS 2011AA ObjectClass)
C25199 (NCI Thesaurus ValueDomain-2)
C0035820 (UMLS 2011AA ValueDomain-2)

Occupationstatus

Item

WHICH OF THE FOLLOWING BEST DESCRIBES YOUR MAIN ACTIVITY?

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25193 (NCI Thesaurus Property)
C0028811 (UMLS 2011AA Property)
C25193 (NCI Thesaurus ValueDomain-2)
C0028811 (UMLS 2011AA ValueDomain-2)

CL.21

Code List

WHICH OF THE FOLLOWING BEST DESCRIBES YOUR MAIN ACTIVITY?

CL Item

Employed (In employment or self employment)

CL Item

Retired (Retired)

CL Item

Homemaker (Housework)

C75560 (NCI Thesaurus)
C0555052 (UMLS 2011AA)

CL Item

Student (Student)

CL Item

Unemployed (Seeking work)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

ContinuedEducationMinimumAgeatLeavingSchoolInd-2

Item

Did your education continue after the minimum school leaving age?

boolean

C16529 (NCI Thesaurus ObjectClass)
C0013622 (UMLS 2011AA ObjectClass)
C0750536 (NCI Metathesaurus ObjectClass)
C25570 (NCI Thesaurus Property)
C1524031 (UMLS 2011AA Property)
CL238333 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)

PatientEducationalStatusInd-2

Item

Do you have a degree or equivalent professional qualification?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0013658 (NCI Metathesaurus Property)

QualityofLifePatientAddressPostalCode

Item

IF YOU KNOW YOUR POSTCODE, WOULD YOU PLEASE WRITE IT HERE

text

C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus ObjectClass-2)
C0030705 (UMLS 2011AA ObjectClass-2)
C1442065 (NCI Metathesaurus ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)

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Nyckelord

Versioner (1)

Uppladdad den

DOI

Licens

Modellkommentarer :

Itemgroup-kommentar för :

Item-kommentar för :

RTOG-0617 HP: Radiation Therapy Oncology Group Phase III High-dose Vs Standard-dose Conformal XRT with Chemotherapy Health Utility Measurement Euro (EQ - 5D)

No Instruction available.

Beskrivning

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