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ID

3039

Descrizione

Summary Response/Progression Form for Solid Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D8883549-3CBC-0049-E034-0003BA12F5E7

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D8883549-3CBC-0049-E034-0003BA12F5E7

Keywords

versioni (2)
  1. 19/09/12 19/09/12 -
  2. 08/01/15 08/01/15 - Martin Dugas
Caricato su

19 settembre 2012

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy
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    Response - Summary Response/Progression Form for Solid Tumors - 2278235v3.0

    Inglese

    [Optional Form ? May be selected by specific disease committees where appropriate.]

    1 moduli  
    1. StudyEvent: Summary Response/Progression Form for Solid Tumors
      1. [Optional Form ? May be selected by specific disease committees where appropriate.]
    Crf Header
    Descrizione

    Crf Header

    Coordinating Group Protocol No.
    Descrizione

    ProtocolCoordinatingIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C25462
    UMLS 2011AA Property
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Coordinating Group Code
    Descrizione

    CoordinatingGroupIdentifierCode

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus ObjectClass
    C25462
    UMLS 2011AA ObjectClass
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Protocol Title
    Descrizione

    ProtocolTitleName

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C42774
    UMLS 2011AA Property
    C1705823
    Patient Study ID
    Descrizione

    PatientCoordinatingIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25462
    UMLS 2011AA Property
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Institution/Affiliate
    Descrizione

    CombinedInstitutionName

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS 2011AA ObjectClass
    C0205195
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ValueDomain
    C21541
    UMLS 2011AA ValueDomain
    C0018704
    Other Patient ID
    Descrizione

    PatientParticipatingIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participating Group Code
    Descrizione

    ParticipatingGroupIdentifierCode

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Patient Initials
    Descrizione

    PatientInitialsName

    Tipo di dati

    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
    Form Administration
    Descrizione

    Form Administration

    Reporting Period Start Date (mm dd yyyy)
    Descrizione

    TreatmentReportingPeriodBeginDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property
    C25651
    UMLS 2011AA Property
    C0700287
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25431
    UMLS 2011AA ValueDomain
    C0439659
    Reporting Period End Date (mm dd yyyy)
    Descrizione

    TreatmentReportingPeriodEndDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25651
    UMLS 2011AA Property
    C0700287
    Date of Last Clinical Assessment (mm dd yyyy)
    Descrizione

    CancerFollow-UpStatusDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C16033
    UMLS 2011AA Property
    C1522577
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25367
    Response Assessment
    Descrizione

    Response Assessment

    Has the patient achieved a response?
    Descrizione

    TumorResponseInd-3

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    NCI Thesaurus ValueDomain
    C25755
    UMLS 2011AA ValueDomain
    C0871261
    Partial Response (PR) First Observed Date (mm dd yyyy)
    Descrizione

    PartialResponseFirstObservedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS 2011AA ObjectClass
    C0871261
    NCI Thesaurus ObjectClass
    C25378
    UMLS 2011AA ObjectClass
    C0728938
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property
    C25599
    UMLS 2011AA Property
    C1441672
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25367
    Complete Response (CR) First Observed Date (mm dd yyyy)
    Descrizione

    CompleteResponseFirstObservedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS 2011AA ObjectClass
    C0871261
    NCI Thesaurus ObjectClass
    C25250
    UMLS 2011AA ObjectClass
    C0205197
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property
    C25599
    UMLS 2011AA Property
    C1441672
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25367
    Has the patient been diagnosed with a new progression? (during this reporting period not previously reported)
    Descrizione

    DiseaseNewProgressionInd-2

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C25586
    UMLS 2011AA Property
    C0205314
    NCI Thesaurus Property
    C25331
    NCI Thesaurus ObjectClass
    C2991
    UMLS 2011AA ObjectClass
    C0012634
    Progressive Disease (PD) Observed Date (mm dd yyyy)
    Descrizione

    ProgressionObservedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25367
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus Property
    C25599
    UMLS 2011AA Property
    C1441672
    Progressive Disease Documentation (Note: Record all anatomic sites of progression on the Follow-Up form for the specific disease being treated.)
    Descrizione

    ProgressionCriteriaType

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus Property
    C25466
    UMLS 2011AA Property
    C0243161
    Other specify
    Descrizione

    ProgressionCriteriaSpecify

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus Property
    C25466
    UMLS 2011AA Property
    C0243161
    Date Response Last Documented (mm dd yyyy)
    Descrizione

    ResponseLastDocumentedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS 2011AA ObjectClass
    C0871261
    NCI Thesaurus Property
    C25551
    UMLS 2011AA Property
    C1517741
    NCI Thesaurus Property
    C25356
    UMLS 2011AA Property
    C1301725
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain
    C25367
    Comments
    Descrizione

    Comments

    Comments
    Descrizione

    ResearchCommentsText

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    UMLS 2011AA Property
    C0282411
    Ritorna all'inizio della pagina

    Similar models

    [Optional Form ? May be selected by specific disease committees where appropriate.]

    1 moduli
    1. StudyEvent: Summary Response/Progression Form for Solid Tumors
      1. [Optional Form ? May be selected by specific disease committees where appropriate.]
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Crf Header
    ProtocolCoordinatingIdentifierNumber
    Item
    Coordinating Group Protocol No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus Property)
    C0700114 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    CoordinatingGroupIdentifierCode
    Item
    Coordinating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus ObjectClass)
    C0700114 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ProtocolTitleName
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C42774 (NCI Thesaurus Property)
    C1705823 (UMLS 2011AA Property)
    PatientCoordinatingIdentifierNumber
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus Property)
    C0700114 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (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)
    PatientParticipatingIdentifierNumber
    Item
    Other 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)
    ParticipatingGroupIdentifierCode
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (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)
    PatientInitialsName
    Item
    Patient Initials
    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)
    Item Group
    Form Administration
    TreatmentReportingPeriodBeginDate
    Item
    Reporting Period Start Date (mm dd yyyy)
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25651 (NCI Thesaurus Property)
    C0700287 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain)
    C0439659 (UMLS 2011AA ValueDomain)
    TreatmentReportingPeriodEndDate
    Item
    Reporting Period End Date (mm dd yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25651 (NCI Thesaurus Property)
    C0700287 (UMLS 2011AA Property)
    CancerFollow-UpStatusDate
    Item
    Date of Last Clinical Assessment (mm dd yyyy)
    date
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C16033 (NCI Thesaurus Property)
    C1522577 (UMLS 2011AA Property)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain)
    Item Group
    Response Assessment
    Item
    Has the patient achieved a response?
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    C25755 (NCI Thesaurus ValueDomain)
    C0871261 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Has the patient achieved a response?
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    PartialResponseFirstObservedDate
    Item
    Partial Response (PR) First Observed Date (mm dd yyyy)
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0871261 (UMLS 2011AA ObjectClass)
    C25378 (NCI Thesaurus ObjectClass)
    C0728938 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25599 (NCI Thesaurus Property)
    C1441672 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain)
    CompleteResponseFirstObservedDate
    Item
    Complete Response (CR) First Observed Date (mm dd yyyy)
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0871261 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus ObjectClass)
    C0205197 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25599 (NCI Thesaurus Property)
    C1441672 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain)
    Item
    Has the patient been diagnosed with a new progression? (during this reporting period not previously reported)
    text
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25586 (NCI Thesaurus Property)
    C0205314 (UMLS 2011AA Property)
    C25331 (NCI Thesaurus Property)
    C2991 (NCI Thesaurus ObjectClass)
    C0012634 (UMLS 2011AA ObjectClass)
    CL.2
    Code List
    Has the patient been diagnosed with a new progression? (during this reporting period not previously reported)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    ProgressionObservedDate
    Item
    Progressive Disease (PD) Observed Date (mm dd yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain)
    C25331 (NCI Thesaurus ObjectClass)
    C25599 (NCI Thesaurus Property)
    C1441672 (UMLS 2011AA Property)
    Item
    Progressive Disease Documentation (Note: Record all anatomic sites of progression on the Follow-Up form for the specific disease being treated.)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25331 (NCI Thesaurus ObjectClass)
    C25466 (NCI Thesaurus Property)
    C0243161 (UMLS 2011AA Property)
    CL.3
    Code List
    Progressive Disease Documentation (Note: Record all anatomic sites of progression on the Follow-Up form for the specific disease being treated.)
    CL Item
    Target Lesions (at Least A 20% Increase In The Sum Of Longest Diameters Of Target Lesions, Taking As Reference The Smallest Sum Recorded Since The Treatment Started) (Target Lesions)
    CL Item
    Nontarget Lesions (unequivocal Progression Of Existing Nontarget Lesions) (Nontarget Lesions)
    CL Item
    Progressive Disease Defined By New Lesions (Appearance of one or more new lesions)
    CL Item
    Other, Specify (Other)
    ProgressionCriteriaSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25331 (NCI Thesaurus ObjectClass)
    C25466 (NCI Thesaurus Property)
    C0243161 (UMLS 2011AA Property)
    ResponseLastDocumentedDate
    Item
    Date Response Last Documented (mm dd yyyy)
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0871261 (UMLS 2011AA ObjectClass)
    C25551 (NCI Thesaurus Property)
    C1517741 (UMLS 2011AA Property)
    C25356 (NCI Thesaurus Property)
    C1301725 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain)
    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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