Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
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Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
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Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
Prior Cancer Therapies (If patient received prior cancer therapy: Mark an X for each therapy received. For chemotherapies, specify number of regimens received. The number of regimens refers to the number of treatment courses, not the number of cycles received for a course of treatment. For example, a patient who received 3 cycles while on Treatment A and 6 cycles while on Treatment B has received 2 treatment regimens - Treatment A and Treatment B.)
Prior Cancer Therapies (If patient received prior cancer therapy: Mark an X for each therapy received. For chemotherapies, specify number of regimens received. The number of regimens refers to the number of treatment courses, not the number of cycles received for a course of treatment. For example, a patient who received 3 cycles while on Treatment A and 6 cycles while on Treatment B has received 2 treatment regimens - Treatment A and Treatment B.)
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No Previous Exposure To Drug (nos) (No prior therapy)
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Agents Administered To Control The Replication And/or Spread Of Viruses (Anti-retroviral therapy)
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Treatment With An Agent That Prevents Or Impairs The Translation Of The Genetic Message For Production Of A Specific Protein (Antisense)
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High Dose Chemotherapy Combined With Transplantation Of Bone Marrow Cells (Bone marrow transplant)
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Systemic Chemotherapy With A Regimen Containing Multiple Agents (Chemotherapy multiple agents systemic)
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Prior Therapy With Agents That Are Not Known To Cause Damage To Cycling Cells (Chemotherapy non-cytotoxic)
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Non-systemic Chemotherapy Treatment Or Chemotherapy Not Described By Chemotherapy Single Agent Systemic Or Multi-agent Systemic (Chemotherapy (NOS))
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Systemic Chemotherapy With A Single Agent Regimen (Chemotherapy single agent systemic)
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Treatment Of Human Disease By Gene Transfer (Gene transfer)
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Image Directed Local Therapy (Image Directed Local Therapy)
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Cancer Therapy Which Incorporates Hormonal Manipulation (Hormonal therapy)
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Drug And/or Immunotherapy (Drug and/or Immunotherapy)
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Anticancer Treatment With A Live, Replication-competent Virus (Oncolytic virotherapy)
I choose to take part in the Patient-Reported Outcomes Study and agree to complete the questionnaire once per month (consent question #1 - must be Yes for participation in 71102)
I choose to take part in the Patient-Reported Outcomes Study and agree to complete the questionnaire once per month (consent question #1 - must be Yes for participation in 71102)
My coded samples and related coded information may be used to learn about, prevent, find or treat my type of cancer. This may also include research on inherited traits (genes passed on in families) (consent question #2 - must be Yes for participation in 151109 and 61103)
My coded samples and related coded information may be used to learn about, prevent, find or treat my type of cancer. This may also include research on inherited traits (genes passed on in families) (consent question #2 - must be Yes for participation in 151109 and 61103)
My coded samples and related coded information may be kept for use in future research to learn about, prevent, find or treat any type of cancer. This may also include research on inherited traits (genes passed on in families) (consent question #3)
My coded samples and related coded information may be kept for use in future research to learn about, prevent, find or treat any type of cancer. This may also include research on inherited traits (genes passed on in families) (consent question #3)
My coded samples and related coded information may be kept for use in future research to learn about, prevent, find or treat other health problems (for example: diabetes, Alzheimer's disease, or heart disease). This may also include research on inherited traits (genes passed on in families) (consent question #4)
My coded samples and related coded information may be kept for use in future research to learn about, prevent, find or treat other health problems (for example: diabetes, Alzheimer's disease, or heart disease). This may also include research on inherited traits (genes passed on in families) (consent question #4)