ID

2564

Description

Southwest Oncology Group Advanced Non-Small Cell Lung Carcinoma Prestudy Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A508BD48-3F65-74B8-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A508BD48-3F65-74B8-E034-080020C9C0E0

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
  4. 9/20/21 9/20/21 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Pre-Study - Southwest Oncology Group Advanced Non-Small Cell Lung Carcinoma Prestudy Form - 2042376v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group Advanced Non-Small Cell Lung Carcinoma Prestudy Form
    1. No Instruction available.
Unnamed 1
Description

Unnamed 1

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

Patient Initials (L, F M)
Description

PatientInitialsName

Data type

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/Affiliate
Description

MainMemberInstitution/Affiliate

Data type

text

Physician
Description

RegisteredInvestigator

Data type

text

Group Name
Description

GroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Study No.
Description

StudyNo.

Data type

text

Pt. ID
Description

Pt.ID

Data type

text

Patient And Disease Description
Description

Patient And Disease Description

Weight Loss Prior Six Months
Description

WeightLossPriorSixMonths

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3445
UMLS 2011AA Property
C0043096
Histologic Type
Description

HistologicType

Data type

text

Combined/mixed,specify
Description

Combined/mixed,specify

Data type

text

Type of Disease
Description

AdvancedDiseaseRegistrationStatus

Data type

text

Metastatic Involvement
Description

MetastaticInvolvement

Data type

text

Stage
Description

StageGrouping

Data type

text

Pleural Effusion
Description

PleuralEffusionInd

Data type

text

If Yes, Malignant
Description

PleuralEffusion,MalignantInd

Data type

text

Current Laboratory Values
Description

Current Laboratory Values

Albumin
Description

Lab,Chemistry,Albumin

Data type

double

LDH
Description

Lab,Chemistry,LactateDehydrogenase

Data type

double

LDH ULN
Description

LDHULN

Data type

text

Prior Treatment Related To This Cancer
Description

Prior Treatment Related To This Cancer

Prior Surgery
Description

PriorSurgeryInd

Data type

text

Prior Radiation Therapy
Description

PRIORRADIATIONTHERAPY

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Comments
Description

Comments

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group Advanced Non-small Cell Lung Carcinoma Prestudy Form
Description

Ccrr Module For Southwest Oncology Group Advanced Non-small Cell Lung Carcinoma Prestudy Form

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No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group Advanced Non-Small Cell Lung Carcinoma Prestudy Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
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/Affiliate
text
RegisteredInvestigator
Item
Physician
text
GroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Patient And Disease Description
Item
Weight Loss Prior Six Months
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3445 (NCI Thesaurus Property)
C0043096 (UMLS 2011AA Property)
CL.1
Code List
Weight Loss Prior Six Months
CL Item
<5% Of Body Weight (< 5%)
CL Item
5 To <10% Of Body Weight (5 - < 10%)
CL Item
10 To <20% Of Body Weight (10 - <20%)
CL Item
> Or = 20% Of Body Weight (? 20%)
Item
Histologic Type
text
CL.2
Code List
Histologic Type
CL Item
Squamous Cell Carcinoma (Squamous cell carcinoma)
C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)
CL Item
Adenocarcinoma (Adenocarcinoma)
C2852 (NCI Thesaurus)
C0001418 (UMLS 2011AA)
CL Item
Large Cell Undifferentiated (Large Cell undifferentiated)
CL Item
Bronchoalveolar Carcinoma (bac) (Bronchioloalveolar carcinoma (BAC))
CL Item
Non-small Cell Lung Cancer (nsclc), Nos (Non Small Cell Lung Cancer, NOS)
CL Item
Combined/mixed, Specify Subcategories (Combined/mixed,specify)
Combined/mixed,specify
Item
Combined/mixed,specify
text
Item
Type of Disease
text
CL.3
Code List
Type of Disease
CL Item
Initial Diagnosis (New Diagnosis)
CL Item
Recurrence (Recurrent)
Item
Metastatic Involvement
text
CL.4
Code List
Metastatic Involvement
CL Item
Single Lesion In Single Site Or Organ (Single lesion in single site or organ)
CL Item
Multiple Lesions In Single Site Or Organ (Multiple lesions in single site or organ)
CL Item
Multiple Lesions In Multiple Organs (Multiple lesions in multiple organs)
Item
Stage
text
CL.5
Code List
Stage
CL Item
Iiib (not Recurrent) (IIB)
CL Item
Iv (not Recurrent) (IV)
Item
Pleural Effusion
text
CL.6
Code List
Pleural Effusion
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
If Yes, Malignant
text
CL.7
Code List
If Yes, Malignant
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Current Laboratory Values
Lab,Chemistry,Albumin
Item
Albumin
double
Lab,Chemistry,LactateDehydrogenase
Item
LDH
double
LDHULN
Item
LDH ULN
text
Item Group
Prior Treatment Related To This Cancer
Item
Prior Surgery
text
CL.8
Code List
Prior Surgery
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Radiation Therapy
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.9
Code List
Prior Radiation Therapy
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Advanced Non-small Cell Lung Carcinoma Prestudy Form
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