Anglais

Cancer Report Form Repeating form GSK study Chronic Coronary Heart Disease NCT00799903

1 Formulaires  
1. Diagnosis of a new, recurrence of, or metastatic cancer
Description

1. Diagnosis of a new, recurrence of, or metastatic cancer

Diagnosis of a new, recurrence of, or metastatic cancer
Description

Cancer diagnosis

Type de données

integer

2. New cancer details
Description

2. New cancer details

Date of diagnosis
Description

Date of diagnosis new cancer

Type de données

date

Site
Description

Site new cancer

Type de données

integer

Other site
Description

Other site new cancer

Type de données

boolean

Other site, specify
Description

Other site new cancer specification

Type de données

text

Was the pathology report obtained for the source documentation?
Description

pathology report new cancer

Type de données

boolean

3. Recurrence of cancer details
Description

3. Recurrence of cancer details

Date of recurrence
Description

Date of recurrence

Type de données

date

Site
Description

Site recurrence

Type de données

integer

Other site
Description

Other site recurrence

Type de données

boolean

Other site, specify
Description

Other site recurrence specification

Type de données

text

Was the pathology report obtained for the source documentation?
Description

pathology report recurrence

Type de données

boolean

Was the pathology report for primary diagnosis obtained for the source documentation?
Description

pathology report primary diagnosis recurrence

Type de données

boolean

4. Metastatic cancer details
Description

4. Metastatic cancer details

Date of diagnosis of metastasis
Description

Date of diagnosis of metastasis

Type de données

date

Site
Description

Site of metastasis

Type de données

integer

Other site
Description

Other site metastasis

Type de données

boolean

Other site, specify
Description

Other site specification

Type de données

text

Was the pathology report obtained for the source documentation?
Description

pathology report metastasis

Type de données

boolean

Date of diagnosis of primary site
Description

Date of diagnosis primary site

Type de données

date

Primary site
Description

Primary site metastasis

Type de données

integer

Other primary site
Description

Other primary site

Type de données

boolean

Other primary site, specify
Description

Other primary site specification

Type de données

text

Was the pathology report for primary diagnosis obtained for the source documentation?
Description

pathology report primary diagnosis metastasis

Type de données

boolean

5. Was the subject hospitalised related to this diagnosis?
Description

5. Was the subject hospitalised related to this diagnosis?

Was the subject hospitalised related to this diagnosis?
Description

Hospitalisation related to diagnosis

Type de données

boolean

Retour au début de la page

Similar models

Cancer Report Form Repeating form GSK study Chronic Coronary Heart Disease NCT00799903

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
1. Diagnosis of a new, recurrence of, or metastatic cancer
Item
Diagnosis of a new, recurrence of, or metastatic cancer
integer
Cancer diagnosis
Code List
Diagnosis of a new, recurrence of, or metastatic cancer
CL Item
New cancer (1)
CL Item
Recurrence of cancer (2)
CL Item
Metastatic cancer (3)
Item Group
2. New cancer details
Date of diagnosis new cancer
Item
Date of diagnosis
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site new cancer
Item
Other site
boolean
Other site new cancer specification
Item
Other site, specify
text
pathology report new cancer
Item
Was the pathology report obtained for the source documentation?
boolean
Item Group
3. Recurrence of cancer details
Date of recurrence
Item
Date of recurrence
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site recurrence
Item
Other site
boolean
Other site recurrence specification
Item
Other site, specify
text
pathology report recurrence
Item
Was the pathology report obtained for the source documentation?
boolean
pathology report primary diagnosis recurrence
Item
Was the pathology report for primary diagnosis obtained for the source documentation?
boolean
Item Group
4. Metastatic cancer details
Date of diagnosis of metastasis
Item
Date of diagnosis of metastasis
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site metastasis
Item
Other site
boolean
Other site specification
Item
Other site, specify
text
pathology report metastasis
Item
Was the pathology report obtained for the source documentation?
boolean
Date of diagnosis primary site
Item
Date of diagnosis of primary site
date
Item
Primary site
integer
Site new cancer
Code List
Primary site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other primary site
Item
Other primary site
boolean
Other primary site specification
Item
Other primary site, specify
text
pathology report primary diagnosis metastasis
Item
Was the pathology report for primary diagnosis obtained for the source documentation?
boolean
Item Group
5. Was the subject hospitalised related to this diagnosis?
Hospitalisation related to diagnosis
Item
Was the subject hospitalised related to this diagnosis?
boolean
Retour au début de la page