ID
3096
Description
Breast Cancer - Advanced Disease On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE332B4F-910E-38FA-E034-0003BA12F5E7
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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On-Study - Breast Cancer - Advanced Disease On-Study Form - 2262184v3.0
No Instruction available.
- StudyEvent: Breast Cancer - Advanced Disease On-Study Form
Description
Breast: Form Administration
Description
ResponsiblePersonName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
DataAmendedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Description
Breast: Patient Characteristics
Description
PatientMenopauseCategory
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C3231
- UMLS 2011AA Property
- C0025320
- NCI Thesaurus ValueDomain
- C3231
- UMLS 2011AA ValueDomain
- C0025320
Description
Breast: Advanced Disease Description
Description
ERLevelTumorStatus
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C3262
- UMLS 2011AA ValueDomain
- C0027651
- NCI Thesaurus ObjectClass
- C17069
- UMLS 2011AA ObjectClass
- C0034804
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C25554
- UMLS 2011AA Property
- C0441889
Description
ERAssayPerformedTime
Data type
text
Alias
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ValueDomain
- C25207
- UMLS 2011AA ValueDomain
- C0040223
- NCI Thesaurus ObjectClass
- C17069
- UMLS 2011AA ObjectClass
- C0034804
- NCI Thesaurus ObjectClass
- C16341
- UMLS 2011AA ObjectClass
- C0005507
Description
PgRStatusType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C17075
- UMLS 2011AA ObjectClass
- C0034833
- NCI Metathesaurus Property
- C0678257
Description
TumorMarkerVisitCollectedType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ValueDomain
- C25452
- NCI Thesaurus ObjectClass
- C17220
- UMLS 2011AA ObjectClass
- C0041365
- NCI Thesaurus Property
- C25716
- UMLS 2011AA Property
- C0545082
Description
TumorMarkerVisitCollectedType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ValueDomain
- C25452
- NCI Thesaurus ObjectClass
- C17220
- UMLS 2011AA ObjectClass
- C0041365
- NCI Thesaurus Property
- C25716
- UMLS 2011AA Property
- C0545082
Description
PgRAssayPerformedTime
Data type
text
Alias
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ValueDomain
- C25207
- UMLS 2011AA ValueDomain
- C0040223
- NCI Thesaurus ObjectClass
- C17075
- UMLS 2011AA ObjectClass
- C0034833
- NCI Thesaurus ObjectClass
- C16341
- UMLS 2011AA ObjectClass
- C0005507
Description
FirstBiopsyPositiveDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15189
- UMLS 2011AA ObjectClass
- C0005558
- NCI Thesaurus ObjectClass
- C25509
- UMLS 2011AA ObjectClass
- C1279901
- NCI Thesaurus Property
- C25246
- UMLS 2011AA Property
- C1446409
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Description
DiseaseRecurrenceDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
- NCI Thesaurus Property
- C3352
- UMLS 2011AA Property
- C0034897
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
Description
Breast: Site(s) Of Progression
Description
ProgressionSite
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C25331
Description
OtherDiseaseSiteName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
Description
OtherDiseaseSiteName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
Description
Breast: Advanced Treatment - Prior Systemic Therapy
Description
AdjuvantHormonalTherapyPriorAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus ObjectClass
- C2140
- UMLS 2011AA ObjectClass
- C0001552
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
PriorHormonalTherapyMetastatic/RecurrentAdministreredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus Property
- C25567
- UMLS 2011AA Property
- C1513186
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
AdjuvantChemotherapyPriorAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C15632
- UMLS 2011AA ObjectClass
- C0392920
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
PriorChemotherapyMetastatic/RecurrentDiseaseAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15632
- UMLS 2011AA ObjectClass
- C0392920
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
PriorHDC/ASCTAdjuvantAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C38722
- UMLS 2011AA ObjectClass
- C1512429
- NCI Thesaurus Property
- C2140
- UMLS 2011AA Property
- C0001552
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
PriorHigh-DoseChemotherapywithStemCellSupportMetastaticRecurrentDiseaseAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C38722
- UMLS 2011AA ObjectClass
- C1512429
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
AdjuvantImmunotherapyPriorAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15262
- UMLS 2011AA ObjectClass
- C0021083
- NCI Thesaurus ObjectClass
- C2140
- UMLS 2011AA ObjectClass
- C0001552
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
PriorImmunotherapyMetastaticRecurrentDiseaseAdministeredInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15262
- UMLS 2011AA ObjectClass
- C0021083
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
AdjuvantTherapyOtherAdministeredPriorInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass
- C2140
- UMLS 2011AA ObjectClass
- C0001552
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ValueDomain
- C25629
- UMLS 2011AA ValueDomain
- C0332152
Description
PriorTherapyMetastaticRecurrentDiseaseAdministeredOtherInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus Property
- C38155
- UMLS 2011AA Property
- C0277556
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C17649
- UMLS 2011AA ValueDomain
- C0205394
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
Breast: Advanced Prior Treatment - Systemic Regimens
Description
PriorTreatmentRegimenName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
Description
PriorTreatmentRegimenBeginDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25431
- UMLS 2011AA ValueDomain
- C0439659
Description
PriorTreatmentRegimenEndDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
Description
PriorTreatmentRegimenText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
Similar models
No Instruction available.
- StudyEvent: Breast Cancer - Advanced Disease On-Study Form
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
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C0600091 (UMLS 2011AA Property)
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C25462 (NCI Thesaurus ObjectClass)
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C25462 (NCI Thesaurus Property)
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C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA 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)
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)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3231 (NCI Thesaurus Property)
C0025320 (UMLS 2011AA Property)
C3231 (NCI Thesaurus ValueDomain)
C0025320 (UMLS 2011AA ValueDomain)
C0027651 (UMLS 2011AA ValueDomain)
C17069 (NCI Thesaurus ObjectClass)
C0034804 (UMLS 2011AA ObjectClass)
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C0449438 (UMLS 2011AA ValueDomain)
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C0441889 (UMLS 2011AA Property)
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C0034804 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
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C17075 (NCI Thesaurus ObjectClass)
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C0262950 (UMLS 2011AA)
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C0024109 (UMLS 2011AA)
C0032225 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C1547383 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
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C0012634 (UMLS 2011AA ObjectClass)
C1547383 (UMLS 2011AA ValueDomain)
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C2140 (NCI Thesaurus ObjectClass)
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C1512429 (UMLS 2011AA ObjectClass)
C2140 (NCI Thesaurus Property)
C0001552 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0332152 (UMLS 2011AA ObjectClass)
C38722 (NCI Thesaurus ObjectClass)
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C0036525 (UMLS 2011AA Property)
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C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0021083 (UMLS 2011AA ObjectClass)
C2140 (NCI Thesaurus ObjectClass)
C0001552 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0021083 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C2140 (NCI Thesaurus ObjectClass)
C0001552 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ValueDomain)
C0332152 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)