ID

2331

Descrição

Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA0178-CF14-0F96-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA0178-CF14-0F96-E034-0003BA12F5E7

Palavras-chave

Versões (3)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 03/07/2015 03/07/2015 -
Transferido a

19 de setembro de 2012

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Follow-Up - Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up - 2038060v3.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up
    1. No Instruction available.
Unnamed 1
Descrição

Unnamed 1

SWOG Patient No
Descrição

SWOGPatientID

Tipo de dados

text

SWOG Study No.
Descrição

SWOGStudyNo.

Tipo de dados

text

Registration Step
Descrição

RegistrationStep

Tipo de dados

text

Patient Initials (L, F M)
Descrição

PatientInitialsName

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution/Member
Descrição

MainMemberInstitution/Affiliate

Tipo de dados

text

Physician (Groups other than SWOG)
Descrição

TreatingPhysician

Tipo de dados

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass
C25705
UMLS 2011AA ObjectClass
C1522326
Group Name
Descrição

ParticipatingGroupName

Tipo de dados

text

Study No.
Descrição

StudyNo.

Tipo de dados

text

Pt. No
Descrição

Pt.ID

Tipo de dados

text

Vital Status
Descrição

Vital Status

Vital Status
Descrição

Patient'sVitalStatus

Tipo de dados

text

Date of last contact or death
Descrição

DeathDate/LastContactDate

Tipo de dados

date

Disease Follow-up Status
Descrição

Disease Follow-up Status

Has the patient been assessed for this cancer since submission of the last form?
Descrição

CancerFollow-upStatusInd

Tipo de dados

text

Date of assessment
Descrição

CancerFollow-upStatusDate

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Notice Of First Relapse Or Progression
Descrição

Notice Of First Relapse Or Progression

Has the patient had a first relapse or progression of this cancer that has not been previously reported?
Descrição

ProgressionInd

Tipo de dados

text

Date of Relapse
Descrição

ProgressionDate

Tipo de dados

date

Site(s) of relapse
Descrição

Sites(progressionorrelapse)

Tipo de dados

text

Notice Of New Primary
Descrição

Notice Of New Primary

Has a new malignant neoplasm or myelodysplastic syndrome (MDS) been diagnosed since the last form?
Descrição

Hasanewprimarycancerofmyelodysplasticsyndrome(MDS)beendiagnosedthathasnotbeenpreviouslyreported?

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Date of new primary
Descrição

NewPrimaryCancerDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Specify new primary site
Descrição

NewPrimarySite

Tipo de dados

text

Non-protocol Treatment
Descrição

Non-protocol Treatment

Has the patient received any (non-protocol) cancer treatment since submission of the last S0201 Adjuvant Melanoma Follow-up Form?
Descrição

Non-ProtocolTherapyInd

Tipo de dados

text

Surgery?
Descrição

Non-protocolSurgeryPerformedInd-3

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus ObjectClass
C25590
UMLS 2011AA ObjectClass
C1518384
Date (surgery)
Descrição

SurgeryDate

Tipo de dados

date

Specify (surgery
Descrição

Non-ProtocolSurgeryType

Tipo de dados

text

Systemic therapy?
Descrição

Non-ProtocolChemotherapyInd

Tipo de dados

text

Date (systemic therapy)
Descrição

ChemotherapyBeginDate

Tipo de dados

date

Specify agents, dose, schedule
Descrição

Non-ProtocolChemotherapyAdministeredSpecify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass
C25590
UMLS 2011AA ObjectClass
C1518384
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Radiation Therapy?
Descrição

Non-ProtocolRTInd

Tipo de dados

text

Date (RT)
Descrição

RTBeginDate

Tipo de dados

date

Specify (RT)
Descrição

Non-ProtocolRTType

Tipo de dados

text

Other therapy?
Descrição

OtherTherapyInd

Tipo de dados

text

Specify (other therapy)
Descrição

OtherTherapyName

Tipo de dados

text

Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up
Descrição

Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up

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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient No
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitialsName
Item
Patient Initials (L, F M)
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)
MainMemberInstitution/Affiliate
Item
Institution/Member
text
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
ParticipatingGroupName
Item
Group Name
text
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. No
text
Item Group
Vital Status
Item
Vital Status
text
CL.1
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
DeathDate/LastContactDate
Item
Date of last contact or death
date
Item Group
Disease Follow-up Status
Item
Has the patient been assessed for this cancer since submission of the last form?
text
CL.2
Code List
Has the patient been assessed for this cancer since submission of the last form?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CancerFollow-upStatusDate
Item
Date of assessment
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Notice Of First Relapse Or Progression
Item
Has the patient had a first relapse or progression of this cancer that has not been previously reported?
text
CL.3
Code List
Has the patient had a first relapse or progression of this cancer that has not been previously reported?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ProgressionDate
Item
Date of Relapse
date
Item
Site(s) of relapse
text
CL.4
Code List
Site(s) of relapse
CL Item
Local Recurrence (local-recurrence)
CL Item
In-transit Recurrence (in-transit recurrence)
CL Item
Regional Recurrence (regional recurrence)
CL Item
Distant Metastasis (distant metastasis)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
Item Group
Notice Of New Primary
Item
Has a new malignant neoplasm or myelodysplastic syndrome (MDS) been diagnosed since the last form?
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.5
Code List
Has a new malignant neoplasm or myelodysplastic syndrome (MDS) been diagnosed since the last form?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
NewPrimaryCancerDate
Item
Date of new primary
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
Specify new primary site
text
Item Group
Non-protocol Treatment
Item
Has the patient received any (non-protocol) cancer treatment since submission of the last S0201 Adjuvant Melanoma Follow-up Form?
text
CL.6
Code List
Has the patient received any (non-protocol) cancer treatment since submission of the last S0201 Adjuvant Melanoma Follow-up Form?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Surgery?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass)
C1518384 (UMLS 2011AA ObjectClass)
CL.7
Code List
Surgery?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SurgeryDate
Item
Date (surgery)
date
Non-ProtocolSurgeryType
Item
Specify (surgery
text
Item
Systemic therapy?
text
CL.8
Code List
Systemic therapy?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ChemotherapyBeginDate
Item
Date (systemic therapy)
date
Non-ProtocolChemotherapyAdministeredSpecify
Item
Specify agents, dose, schedule
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
Item
Radiation Therapy?
text
CL.9
Code List
Radiation Therapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
RTBeginDate
Item
Date (RT)
date
Non-ProtocolRTType
Item
Specify (RT)
text
Item
Other therapy?
text
CL.10
Code List
Other therapy?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
OtherTherapyName
Item
Specify (other therapy)
text
Item Group
Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Follow Up
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