0 Evaluaciones
ID

2711

Descripción

Southwest Oncology Group S0421 Cover Sheet for Patient Completed Questionnaires: Step 1 Randomization Form Docetaxel and Prednisone With or Without Atrasentan in Treating Patients With Stage IV Prostate Cancer and Bone Metastases That Did Not Respond to Previous Hormone Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F15B4D3C-6774-37C6-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F15B4D3C-6774-37C6-E034-0003BA3F9857

Palabras clave

Versiones (4)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 9/1/15 9/1/15 - Martin Dugas
  4. 5/7/15 5/7/15 -
Subido en

19 de septiembre de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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    Metastatic Cancer NCT00134056 Quality of Life - Southwest Oncology Group S0421 Cover Sheet for Patient Completed Questionnaires: Step 1 Randomization Form - 2305535v3.0

    Inglés

    No Instruction available.

    1 formularios  
    1. StudyEvent: Southwest Oncology Group S0421 Cover Sheet for Patient Completed Questionnaires: Step 1 Randomization Form
      1. No Instruction available.
    Unnamed 1
    Descripción

    Unnamed 1

    SWOG Patient ID
    Descripción

    PatientSouthwestOncologyGroupIdentifierNumber

    Tipo de datos

    double

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus Property
    C25699 (undefined)
    UMLS 2011AA Property
    C1519429 (SWOG)
    LOINC
    LA4458-1
    SWOG Study No.
    Descripción

    ProtocolSWOGIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS 2011AA ObjectClass
    C1507394 (Clinical trial protocol document)
    LOINC
    LP33258-2
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus Property
    C25699 (undefined)
    UMLS 2011AA Property
    C1519429 (SWOG)
    LOINC
    LA4458-1
    Registration Step
    Descripción

    RegistrationStepNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C25646 (undefined)
    UMLS 2011AA ObjectClass
    C1514821 (Registration)
    NCI Thesaurus Property
    C16154 (undefined)
    UMLS 2011AA Property
    C1704379 (Treatment Step)
    NCI Thesaurus ValueDomain
    C16154 (undefined)
    UMLS 2011AA ValueDomain
    C1704379 (Treatment Step)
    Patient Initials (L, F M)
    Descripción

    PatientInitialsName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C25536 (undefined)
    UMLS 2011AA Property
    C1555582 (Initial (abbreviation))
    Institution/Affiliate
    Descripción

    CombinedInstitutionName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454 (undefined)
    UMLS 2011AA ObjectClass
    C0205195 (Combined)
    SNOMED
    89780004
    LOINC
    LA30596-3
    NCI Thesaurus ObjectClass
    C21541 (undefined)
    UMLS 2011AA ObjectClass
    C0018704 (Health care facility)
    SNOMED
    257622000
    LOINC
    LA30302-6
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    NCI Thesaurus ValueDomain
    C21541 (undefined)
    UMLS 2011AA ValueDomain
    C0018704 (Health care facility)
    SNOMED
    257622000
    LOINC
    LA30302-6
    Physician
    Descripción

    RegisteredInvestigatorName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus ObjectClass
    C17089 (undefined)
    UMLS 2011AA ObjectClass
    C0035173 (Research Personnel)
    SNOMED
    769038007
    LOINC
    LA23773-7
    NCI Thesaurus ObjectClass
    C25644 (undefined)
    Date form completed
    Descripción

    FormCompleteDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ObjectClass
    C40988 (undefined)
    UMLS 2011AA ObjectClass
    C1516308 (Case Report Form)
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus ValueDomain
    C25367 (undefined)
    Participating Group Name
    Descripción

    ParticipatingGroupName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    NCI Thesaurus ObjectClass
    C25608 (undefined)
    UMLS 2011AA ObjectClass
    C0679823 (Participation)
    NCI Thesaurus ObjectClass
    C17005 (undefined)
    UMLS 2011AA ObjectClass
    C1257890 (Population Group)
    SNOMED
    389109008
    LOINC
    LA12078-4
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Participating Study No.
    Descripción

    ProtocolParticipatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS 2011AA ObjectClass
    C1507394 (Clinical trial protocol document)
    LOINC
    LP33258-2
    NCI Thesaurus Property
    C25608 (undefined)
    UMLS 2011AA Property
    C0679823 (Participation)
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Participating Patient ID
    Descripción

    PatientParticipatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C25608 (undefined)
    UMLS 2011AA Property
    C0679823 (Participation)
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Planned Assessment
    Descripción

    PlannedAssessmentPeriodType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284 (undefined)
    UMLS 2011AA ValueDomain
    C0332307 (Type - attribute)
    SNOMED
    261664005
    NCI Thesaurus ObjectClass
    C20989 (undefined)
    UMLS 2011AA ObjectClass
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C25616 (undefined)
    UMLS 2011AA Property
    C1948053 (Period (temporal qualifier))
    SNOMED
    272117007
    Was the symptom questionnaire completed? (required every cycle and end of treatment [beginning of Week 37])
    Descripción

    SymptomQuestionnaireCompleteInd-2

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38147 (undefined)
    UMLS 2011AA ValueDomain
    C1512698 (Yes or No Response)
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus ObjectClass
    C17048 (undefined)
    UMLS 2011AA ObjectClass
    C0034394 (Questionnaires)
    NCI Thesaurus ObjectClass
    C4876 (undefined)
    UMLS 2011AA ObjectClass
    C1457887 (Symptoms)
    LOINC
    MTHU021540
    Was the Pain Medication Log completed? (required every cycle and end of treatment [beginning of Week 37])
    Descripción

    PainPersonalLogCompleteInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148 (undefined)
    UMLS 2011AA ValueDomain
    C1512699 (Yes, No, or Unknown Response)
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus ObjectClass
    C3303 (undefined)
    UMLS 2011AA ObjectClass
    C0030193 (Pain)
    SNOMED
    22253000
    LOINC
    MTHU029813
    NCI Metathesaurus ObjectClass
    C0872075 (personal log/diary)
    Was the FACT-P completed? (required Prestudy, Cycles 4[week 10], 7[week 19], 10[week 28], and end of treatment [beginning of Week 37])
    Descripción

    CancerTherapyFunctionalAssessmentQuestionnaireCompleteInd-2

    Tipo de datos

    text

    Alias
    NCI Metathesaurus ObjectClass
    C0920425 (cancer treatment)
    NCI Metathesaurus ObjectClass
    C0278372 (Functional assessment)
    SNOMED
    12894003
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus Property
    C17048 (undefined)
    UMLS 2011AA Property
    C0034394 (Questionnaires)
    NCI Thesaurus ValueDomain
    C38147 (undefined)
    UMLS 2011AA ValueDomain
    C1512698 (Yes or No Response)
    Did the patient require any assistance in completing the questionnaire? (If completed,)
    Descripción

    PatientQuestionnaireAssistanceInd

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C17048 (undefined)
    UMLS 2011AA Property
    C0034394 (Questionnaires)
    NCI Metathesaurus Property
    C0018896 (Helping Behavior)
    Describe (If yes,)
    Descripción

    PatientQuestionnaireAssistanceOtherSpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C17048 (undefined)
    UMLS 2011AA Property
    C0034394 (Questionnaires)
    NCI Metathesaurus Property
    C0018896 (Helping Behavior)
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    UMLS 2011AA ValueDomain
    C1521902 (To specify)
    NCI Thesaurus ValueDomain
    C17649 (undefined)
    UMLS 2011AA ValueDomain
    C0205394 (Other)
    SNOMED
    74964007
    LOINC
    LP21049-9
    Method of questionnaire administration
    Descripción

    PatientQuestionnaireAdministeredMethodType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus ObjectClass
    C17048 (undefined)
    UMLS 2011AA ObjectClass
    C0034394 (Questionnaires)
    NCI Thesaurus Property
    C16847 (undefined)
    UMLS 2011AA Property
    C0449851 (Techniques)
    SNOMED
    272394005
    NCI Thesaurus Property
    C25382 (undefined)
    UMLS 2011AA Property
    C1521801 (Having administered)
    NCI Thesaurus ValueDomain
    C25284 (undefined)
    UMLS 2011AA ValueDomain
    C0332307 (Type - attribute)
    SNOMED
    261664005
    Other (please specify)
    Descripción

    PatientQuestionnaireAdministeredMethodSpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus ObjectClass
    C17048 (undefined)
    UMLS 2011AA ObjectClass
    C0034394 (Questionnaires)
    NCI Thesaurus Property
    C16847 (undefined)
    UMLS 2011AA Property
    C0449851 (Techniques)
    SNOMED
    272394005
    NCI Thesaurus Property
    C25382 (undefined)
    UMLS 2011AA Property
    C1521801 (Having administered)
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    UMLS 2011AA ValueDomain
    C1521902 (To specify)
    If not completed, please give reason (select one)
    Descripción

    PatientIncompleteQuestionnaireReason

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638 (undefined)
    UMLS 2011AA ValueDomain
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Metathesaurus Property
    C0034394 (Questionnaires)
    Unnamed 3
    Descripción

    Unnamed 3

    Person completing form, last name
    Descripción

    ResponsiblePersonLastName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190 (undefined)
    UMLS 2011AA ObjectClass
    C0027361 (Persons)
    SNOMED
    125676002
    NCI Thesaurus ObjectClass
    C25657 (undefined)
    UMLS 2011AA ObjectClass
    C1273518 (Responsible to (attribute))
    SNOMED
    394851003
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus Property
    C25551 (undefined)
    UMLS 2011AA Property
    C1517741 (Last)
    LOINC
    LP200101-6
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    Person completing form, phone
    Descripción

    ResponsiblePersonPhoneNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C25190 (undefined)
    UMLS 2011AA ObjectClass
    C0027361 (Persons)
    SNOMED
    125676002
    NCI Thesaurus ObjectClass
    C25657 (undefined)
    UMLS 2011AA ObjectClass
    C1273518 (Responsible to (attribute))
    SNOMED
    394851003
    NCI Thesaurus Property
    C25395 (undefined)
    UMLS 2011AA Property
    C0039457 (Telephone)
    SNOMED
    359993007
    LOINC
    LA26664-5
    Comments
    Descripción

    Comments

    Comments
    Descripción

    ResearchCommentsText

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    UMLS 2011AA Property
    C0282411 (Published Comment)
    LOINC
    MTHU018874
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    Similar models

    No Instruction available.

    1 formularios
    1. StudyEvent: Southwest Oncology Group S0421 Cover Sheet for Patient Completed Questionnaires: Step 1 Randomization Form
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Unnamed 1
    PatientSouthwestOncologyGroupIdentifierNumber
    Item
    SWOG Patient ID
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25699 (NCI Thesaurus Property)
    C1519429 (UMLS 2011AA Property)
    ProtocolSWOGIdentifierNumber
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25699 (NCI Thesaurus Property)
    C1519429 (UMLS 2011AA Property)
    RegistrationStepNumber
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25646 (NCI Thesaurus ObjectClass)
    C1514821 (UMLS 2011AA ObjectClass)
    C16154 (NCI Thesaurus Property)
    C1704379 (UMLS 2011AA Property)
    C16154 (NCI Thesaurus ValueDomain)
    C1704379 (UMLS 2011AA ValueDomain)
    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)
    CombinedInstitutionName
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C0205195 (UMLS 2011AA ObjectClass)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ValueDomain)
    C0018704 (UMLS 2011AA ValueDomain)
    RegisteredInvestigatorName
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C17089 (NCI Thesaurus ObjectClass)
    C0035173 (UMLS 2011AA ObjectClass)
    C25644 (NCI Thesaurus ObjectClass)
    FormCompleteDate
    Item
    Date form completed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus ValueDomain)
    ParticipatingGroupName
    Item
    Participating Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ProtocolParticipatingIdentifierNumber
    Item
    Participating Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientParticipatingIdentifierNumber
    Item
    Participating Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Item
    Planned Assessment
    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.1
    Code List
    Planned Assessment
    CL Item
    Prestudy (Prestudy)
    CL Item
    Week 4 (Week 4)
    CL Item
    Week 7 (Week 7)
    CL Item
    Week 10 (Week 10)
    CL Item
    Week 13 (Week 13)
    CL Item
    Week 16 (Week 16)
    CL Item
    Week 19 (Week 19)
    CL Item
    Week 22 (Week 22)
    CL Item
    Week 25 (Week 25)
    CL Item
    Week 28 (Week 28)
    CL Item
    Week 31 (Week 31)
    CL Item
    Week 34 (Week 34)
    CL Item
    Week 37 (Week 37)
    Item
    Was the symptom questionnaire completed? (required every cycle and end of treatment [beginning of Week 37])
    text
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C17048 (NCI Thesaurus ObjectClass)
    C0034394 (UMLS 2011AA ObjectClass)
    C4876 (NCI Thesaurus ObjectClass)
    C1457887 (UMLS 2011AA ObjectClass)
    CL.2
    Code List
    Was the symptom questionnaire completed? (required every cycle and end of treatment [beginning of Week 37])
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Was the Pain Medication Log completed? (required every cycle and end of treatment [beginning of Week 37])
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus ObjectClass)
    C0030193 (UMLS 2011AA ObjectClass)
    C0872075 (NCI Metathesaurus ObjectClass)
    CL.3
    Code List
    Was the Pain Medication Log completed? (required every cycle and end of treatment [beginning of Week 37])
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Was the FACT-P completed? (required Prestudy, Cycles 4[week 10], 7[week 19], 10[week 28], and end of treatment [beginning of Week 37])
    text
    C0920425 (NCI Metathesaurus ObjectClass)
    C0278372 (NCI Metathesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C17048 (NCI Thesaurus Property)
    C0034394 (UMLS 2011AA Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Was the FACT-P completed? (required Prestudy, Cycles 4[week 10], 7[week 19], 10[week 28], and end of treatment [beginning of Week 37])
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Did the patient require any assistance in completing the questionnaire? (If completed,)
    text
    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)
    CL.5
    Code List
    Did the patient require any assistance in completing the questionnaire? (If completed,)
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    PatientQuestionnaireAssistanceOtherSpecify
    Item
    Describe (If yes,)
    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)
    C0205394 (UMLS 2011AA ValueDomain)
    Item
    Method of questionnaire administration
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus ObjectClass)
    C0034394 (UMLS 2011AA ObjectClass)
    C16847 (NCI Thesaurus Property)
    C0449851 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.6
    Code List
    Method of questionnaire administration
    CL Item
    In The Clinic (in the clinic)
    CL Item
    By Telephone (by telephone)
    CL Item
    Other (other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientQuestionnaireAdministeredMethodSpecify
    Item
    Other (please specify)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C17048 (NCI Thesaurus ObjectClass)
    C0034394 (UMLS 2011AA ObjectClass)
    C16847 (NCI Thesaurus Property)
    C0449851 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Item
    If not completed, please give reason (select one)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0034394 (NCI Metathesaurus Property)
    CL.7
    Code List
    If not completed, please give reason (select one)
    CL Item
    Illness/deteriorating Health (illness/deteriorating health)
    CL Item
    Not Illness Related (not illness related)
    CL Item
    Institution Error (institution error)
    CL Item
    Death (death)
    C28554 (NCI Thesaurus)
    C0011065 (UMLS 2011AA)
    CL Item
    Other (other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Item Group
    Unnamed 3
    ResponsiblePersonLastName
    Item
    Person completing form, last name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass)
    C1273518 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25551 (NCI Thesaurus Property)
    C1517741 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    ResponsiblePersonPhoneNumber
    Item
    Person completing form, phone
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass)
    C1273518 (UMLS 2011AA ObjectClass)
    C25395 (NCI Thesaurus Property)
    C0039457 (UMLS 2011AA Property)
    Item Group
    Comments
    ResearchCommentsText
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0282411 (UMLS 2011AA Property)
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