ID

31434

Beskrivning

LOCALIZED PROSTATE CANCER DATA COLLECTION Version 2.0.5 Revised: April 7th , 2017 www.ichom.org ICHOM Localized Prostate Cancer Standard Set was made possible only through the support of the Movember Foundation, an organization changing the face of men’s health. Conditions: Localized prostate cancer Treatment Approaches: Active Surveillance | Watchful Waiting | Radical Prostatectomy* | External Beam Radiation Therapy* | Androgen Deprivation Therapy (ADT)* | Focal Therapy* | Other* * These should also be collected as salvage treatments where necessary This ODM-file contains Baseline Patient-reported Form. To be used at baseline, i.e., post-diagnosis, pre-treatment. Excluding the Patient Reported Outcome questionnaires (separate form, as asked at multiple timepoints). Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. TEST StudyFor example, VARIABLEID_BASE (baseline); VARIABLEID_6MO (6 month follow-up); VARIABLEID_1YR (1 year follow-up), etc. Survey used: Expanded Prostate Cancer Index Composite (EPIC-26): The EPIC-26 is free for all health care organizations, and a license is not needed. The scoring guide may be found at http://www.med.umich.edu/urology/research/EPIC/EPIC-26-Scoring-1.2007.pdf ; Wei J, Dunn R, Litwin M, Sandler H, and Sanda M. "Development and Validation of the Expanded Prostate Cancer Index Composite (EPIC) for Comprehensive Assessment of Health-Related Quality of Life in Men with Prostate Cancer", Urology. 56: 899-905, 2000. For registries choosing to implement the EPIC-CP rather than the EPIC-26, we recommend using the same variable IDs as the corresponding EPIC-26 questions. This means that only questions 2, 3, 4a, 4b, 4d, 4e, 5, 6e, 6b, 7, 8b, 9, 12, 13a, 13c, and 13d of the EPIC-26 are administered. Utilization of Sexual Medications/Devices: The Utilization of Sexual Medications/Devices is free for all health care organizations, and a license is not needed. Refer to http://dx.doi.org/10.1016/j.urology.2006.01.077 for more information European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ- PR25): The EORTC QLQ-PR25 is free for all health care organizations, but a license is needed for use. Therefore it will not be integrated in this Version of the questionnaire. For more information, please visit http://groups.eortc.be/qol/eortc-qlq-c30 .

Länk

www.ichom.org

Nyckelord

Versioner (2)
  1. 2018-08-21 2018-08-21 - Sarah Riepenhausen
  2. 2020-04-30 2020-04-30 - Sarah Riepenhausen
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ICHOM

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21 augusti 2018

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ICHOM Localized Prostate Cancer

Engelsk

Baseline Patient-reported Form

1 Formulär  
Patient ID
Beskrivning

Patient ID

Alias
UMLS CUI-1
C1269815
Indicate the patient's medical record number
Beskrivning

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical TYPE: Numerical RESPONSE OPTIONS: According to institution

Datatyp

integer

Alias
UMLS CUI [1]
C1269815
Patient Factors
Beskrivning

Patient Factors

Alias
UMLS CUI-1
C1955348
What is your date of birth?
Beskrivning

INCLUSION CRITERIA: All patients TIMING: Before treatment REPORTING SOURCE: Clinical or patient-reported TYPE: Date by DD/MM/YYYY RESPONSE OPTIONS: DD/MM/YYYY

Datatyp

date

Alias
UMLS CUI [1]
C0001779
UMLS CUI [2]
C0421451
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C1298908
Have you been told by a doctor that you have any of the following? 1 = Heart disease (for example angina, heart attack, or heart failure)
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0018799
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0020538
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C1306889
Have you been told by a doctor that you have any of the following? 4 = Lung disease (for example asthma, chronic bronchitis, or emphysema)
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0024115
Have you been told by a doctor that you have any of the following? 5 = Diabetes
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011849
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0022658
Have you been told by a doctor that you have any of the following? 7 = Liver disease
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0023895
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0038454
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (for example Parkinson’s disease or multiple sclerosis)
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0027765
Have you been told by a doctor that you have any of the following? 10 = Other cancer (within the last 5 years)
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C1707251
Have you been told by a doctor that you have any of the following? 11 = Depression
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011581
Have you been told by a doctor that you have any of the following? 12 = Arthritis
Beskrivning

INCLUSION CRITERIA: All patients Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) TIMING: Before treatment REPORTING SOURCE: patient-reported TYPE: Multiple Answer

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0003864
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Similar models

Baseline Patient-reported Form

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Patient ID
C1269815 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Item Group
Patient Factors
C1955348 (UMLS CUI-1)
Age
Item
What is your date of birth?
date
C0001779 (UMLS CUI [1])
C0421451 (UMLS CUI [2])
Comorbidities: No
Item
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
boolean
C0009488 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
Comorbidities: Heart Disease
Item
Have you been told by a doctor that you have any of the following? 1 = Heart disease (for example angina, heart attack, or heart failure)
boolean
C0009488 (UMLS CUI [1,1])
C0018799 (UMLS CUI [1,2])
Comorbidities: High blood pressure
Item
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
boolean
C0009488 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Comorbidities: leg pain when walking due to poor circulation
Item
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
boolean
C0009488 (UMLS CUI [1,1])
C1306889 (UMLS CUI [1,2])
Comorbidities: Lung Disease
Item
Have you been told by a doctor that you have any of the following? 4 = Lung disease (for example asthma, chronic bronchitis, or emphysema)
boolean
C0009488 (UMLS CUI [1,1])
C0024115 (UMLS CUI [1,2])
Comorbidities: Diabetes
Item
Have you been told by a doctor that you have any of the following? 5 = Diabetes
boolean
C0009488 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
Comorbidities: Kidney Disease
Item
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
boolean
C0009488 (UMLS CUI [1,1])
C0022658 (UMLS CUI [1,2])
Comorbidities: Liver Disease
Item
Have you been told by a doctor that you have any of the following? 7 = Liver disease
boolean
C0009488 (UMLS CUI [1,1])
C0023895 (UMLS CUI [1,2])
Comorbidities: Stroke
Item
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
boolean
C0009488 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
Comorbidities: Disease of the nervous system
Item
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (for example Parkinson’s disease or multiple sclerosis)
boolean
C0009488 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
Comorbidities: other cancer
Item
Have you been told by a doctor that you have any of the following? 10 = Other cancer (within the last 5 years)
boolean
C0009488 (UMLS CUI [1,1])
C1707251 (UMLS CUI [1,2])
Comorbidities: Depression
Item
Have you been told by a doctor that you have any of the following? 11 = Depression
boolean
C0009488 (UMLS CUI [1,1])
C0011581 (UMLS CUI [1,2])
Comorbidities: Arthritis
Item
Have you been told by a doctor that you have any of the following? 12 = Arthritis
boolean
C0009488 (UMLS CUI [1,1])
C0003864 (UMLS CUI [1,2])
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