ID

3146

Description

Record whether or not the patient has received any treatments for each of the prior therapy types listed that are related to the disease being studies by the protocol. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD101A85-7234-8273-E040-BB89AD4368A1

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD101A85-7234-8273-E040-BB89AD4368A1

Keywords

Versions (1)
  1. 9/19/12 9/19/12 -
Uploaded on

September 19, 2012

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Creative Commons BY-NC 3.0 Legacy
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Treatment - Prior Treatment Summary - 3279801v1.0

English

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1 forms  
  1. StudyEvent: Prior Treatment Summary
    1. No Instruction available.
Prior Treatment Summary
Description

Prior Treatment Summary

Visit Date (Enter the date the form was completed i.e. the date information was gathered.)
Description

FormCompletionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
Therapy Type (Name of the type of therapy. The appropriate list of therapy types is provided by CTMS.)
Description

PriorTherapyTypeTextCode

Data type

text

Alias
NCI Thesaurus ObjectClass
C16124
UMLS 2011AA ObjectClass
C1514463
NCI Thesaurus ObjectClass
C19992
UMLS 2011AA ObjectClass
C1516607
NCI Thesaurus Property
C25162
UMLS 2011AA Property
C0805701
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Any therapy? (Indicate whether or not the patient has received any prior treatment for the type of therapy listed.)
Description

PriorTherapyTypeIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus Property
C25180
UMLS 2011AA Property
C1522602
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Number of Prior Chemotherapy Regimens (Enter the number of prior regimes received for chemotherapies types of therapy. Do not use for other types of therapy..)
Description

PriorTreatmentRegimenCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
Date of Last Dose (Enter the date of the last dose of the most recent prior treatment regimen for each therapy type. Partial dates are acceptable when the day is not known. Leave it blank if the treatment is currently being received and "Ongoing" will be reported to CTMS or CDS.)
Description

StopDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C65125
UMLS 2011AA Property
C1947925
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Prior Treatment Summary
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Prior Treatment Summary
FormCompletionDate
Item
Visit Date (Enter the date the form was completed i.e. the date information was gathered.)
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)
Item
Therapy Type (Name of the type of therapy. The appropriate list of therapy types is provided by CTMS.)
text
C16124 (NCI Thesaurus ObjectClass)
C1514463 (UMLS 2011AA ObjectClass)
C19992 (NCI Thesaurus ObjectClass)
C1516607 (UMLS 2011AA ObjectClass)
C25162 (NCI Thesaurus Property)
C0805701 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
CL.1
Code List
Therapy Type (Name of the type of therapy. The appropriate list of therapy types is provided by CTMS.)
CL Item
Anti-retroviral Therapy (AR)
C16165 (NCI Thesaurus)
C0887947 (UMLS 2011AA)
CL Item
Antisense Therapy (AS)
C16236 (NCI Thesaurus)
C0935882 (UMLS 2011AA)
CL Item
Bone Marrow Transplantation (BM)
C15194 (NCI Thesaurus)
C0005961 (UMLS 2011AA)
CL Item
Biphosphonate Therapy (BP)
C443 (NCI Thesaurus)
C0012544 (UMLS 2011AA)
CL Item
Chemotherapy, Nos (C)
C15632 (NCI Thesaurus)
C0392920 (UMLS 2011AA)
C19594 (NCI Thesaurus)
C1518425 (UMLS 2011AA)
CL Item
Chemotherapy, Multiple Agents Systemic (CM)
C15632 (NCI Thesaurus)
C0392920 (UMLS 2011AA)
C13310 (NCI Thesaurus)
C0205373 (UMLS 2011AA)
C17648 (NCI Thesaurus)
C0439064 (UMLS 2011AA)
C1708 (NCI Thesaurus)
C0450442 (UMLS 2011AA)
CL Item
Single Agent Systemic Chemotherapy (CS)
C15756 (NCI Thesaurus)
C0854619 (UMLS 2011AA)
CL Item
Extensive Radiation (ER)
C16230 (NCI Thesaurus)
C1517030 (UMLS 2011AA)
CL Item
Gene Transfer (G)
C20185 (NCI Thesaurus)
C1517499 (UMLS 2011AA)
CL Item
Hormone Therapy (H)
C15445 (NCI Thesaurus)
C0279025 (UMLS 2011AA)
CL Item
Hematopoietic Stem Cell Transplantation (HE)
C12551 (NCI Thesaurus)
C0018956 (UMLS 2011AA)
C15342 (NCI Thesaurus)
C0029216 (UMLS 2011AA)
CL Item
Immunotherapy (I)
C15262 (NCI Thesaurus)
C0021083 (UMLS 2011AA)
CL Item
Image Directed Local Therapy (ID)
C15687 (NCI Thesaurus)
C1517925 (UMLS 2011AA)
C17369 (NCI Thesaurus)
C0079595 (UMLS 2011AA)
CL Item
Limited Radiation Therapy (LR)
C54225 (NCI Thesaurus)
C1711365 (UMLS 2011AA)
CL Item
No Prior Therapy (N)
C15903 (NCI Thesaurus)
C1518341 (UMLS 2011AA)
CL Item
Chemotherapy, Non-cytotoxic (NC)
CL Item
Oncolytic Virotherapy (OV)
CL Item
Prior Therapy (PT)
C16124 (NCI Thesaurus)
C1514463 (UMLS 2011AA)
CL Item
Radiation Therapy (R)
C15313 (NCI Thesaurus)
C1522449 (UMLS 2011AA)
CL Item
Surgery (S)
C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)
CL Item
Vaccine Therapy (V)
C15347 (NCI Thesaurus)
C0042209 (UMLS 2011AA)
Item
Any therapy? (Indicate whether or not the patient has received any prior treatment for the type of therapy listed.)
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25180 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.2
Code List
Any therapy? (Indicate whether or not the patient has received any prior treatment for the type of therapy listed.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
PriorTreatmentRegimenCount
Item
Number of Prior Chemotherapy Regimens (Enter the number of prior regimes received for chemotherapies types of therapy. Do not use for other types of therapy..)
double
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
StopDate
Item
Date of Last Dose (Enter the date of the last dose of the most recent prior treatment regimen for each therapy type. Partial dates are acceptable when the day is not known. Leave it blank if the treatment is currently being received and "Ongoing" will be reported to CTMS or CDS.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C65125 (NCI Thesaurus Property)
C1947925 (UMLS 2011AA Property)
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