Information:
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ID
25168
Description
CALGB 50901 Off-Treatment Form Ofatumumab in Treating Patients With Previously Untreated Stage II, Stage III, or Stage IV Follicular Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9F3C69B5-BEE4-AEDA-E040-BB89AD436BFE
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 8/28/17 8/28/17 -
Uploaded on
August 28, 2017
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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CALGB 50901 Off-Treatment Form
No Instruction available.
- StudyEvent: CALGB 50901 Off-Treatment Form
Similar models
No Instruction available.
- StudyEvent: CALGB 50901 Off-Treatment Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Treatment Schedule (oral Antiandrogen)
C0040808 (UMLS CUI-1)
C0002842 (UMLS CUI-2)
C0024301 (UMLS CUI-3)
C0002842 (UMLS CUI-2)
C0024301 (UMLS CUI-3)
Date of Last Dose
Item
Date of Last Dose of Protocol Systemic Therapy
date
C25488 (NCI Thesaurus ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C25320 (NCI Thesaurus Property)
C13310 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C25551 (NCI Thesaurus ObjectClass-2)
C25320 (NCI Thesaurus Property)
C13310 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Reason Treatment Ended
integer
C25638 (NCI Thesaurus ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C1518544 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C25601 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C1518544 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
CL Item
Treatment Completed Per Protocol Criteria (1)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (2)
CL Item
Patient Withdrawal Or Refusal Before Beginning Protocol Therapy (3)
CL Item
Adverse Event/side Effects/complications (4)
CL Item
Disease Progression, Relapse During Active Treatment (5)
CL Item
Disease Progression Before Active Treatment (6)
CL Item
Alternative Therapy (7)
CL Item
Patient Off-treatment For Other Complicating Disease (8)
CL Item
Death On Study (9)
CL Item
Other (10)
Adverse event/side effects/complications
Item
Adverse event/side effects/complications specify
text
C25685 (NCI Thesaurus ValueDomain)
C25638 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C25601 (NCI Thesaurus ObjectClass)
C0877248 (UMLS CUI [1])
C0001688 (UMLS CUI [2])
C0009566 (UMLS CUI [3])
C1518544 (UMLS CUI [4])
C25638 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C25601 (NCI Thesaurus ObjectClass)
C0877248 (UMLS CUI [1])
C0001688 (UMLS CUI [2])
C0009566 (UMLS CUI [3])
C1518544 (UMLS CUI [4])
Off-TreatmentConditionSpecify
Item
Patient off-treatment for other complicating disease, specify
text
C25685 (NCI Thesaurus ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C25457 (NCI Thesaurus Property)
C0348080 (UMLS CUI [1,1])
C1518544 (UMLS CUI [1,2])
C25601 (NCI Thesaurus ObjectClass)
C25457 (NCI Thesaurus Property)
C0348080 (UMLS CUI [1,1])
C1518544 (UMLS CUI [1,2])
Off Treatment Reason, specify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C1518544 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C25601 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C1518544 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])