ID

3213

Description

Prior Treatment History for Kaposi's Sarcoma - RKS01B Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE47CB4-3553-4ED5-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE47CB4-3553-4ED5-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

September 19, 2012

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License

Creative Commons BY-NC 3.0 Legacy
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Sarcoma, Kaposi xxx On-Study - Prior Treatment History for Kaposi's Sarcoma - RKS01B - 2267118v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Prior Treatment History for Kaposi's Sarcoma - RKS01B
    1. No Instruction available.
Ccrr Module For Prior Treatment History For Kaposi's Sarcoma - Rks01b
Description

Ccrr Module For Prior Treatment History For Kaposi's Sarcoma - Rks01b

Patient Initials
Description

PatientInitialsName

Data type

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
Study#
Description

ProtocolCoordinatingIdentifierNumber

Data type

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
Site#
Description

NCIInstitutionIdentifierCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C19202
UMLS 2011AA ObjectClass
C1513882
ID#
Description

PatientCoordinatingIdentifierNumber

Data type

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
Date of Visit
Description

LesionAssessmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25367
Has the patient received non-investigational systemic chemotherapy or immunotherapy for the treatment of Kaposi's Sarcoma?
Description

PriorChemotherapyAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Single Agents
Description

AgentName

Data type

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C1708
UMLS 2011AA ValueDomain
C0450442
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Unnamed
Description

CancerPriorTreatmentInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C15368
Best Response
Description

TumorResponseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Best Response
Description

TumorResponseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
Source
Description

ProgressionAssessmentSource

Data type

text

Source
Description

ProgressionAssessmentSource

Data type

text

If Other Source, specify
Description

IfOtherSource,specify

Data type

text

Has the patient received any systemic or topical therapy other than cytotoxic chemotherapy specified in section 1 for the treatment of Kaposi's Sarcoma?
Description

Hasthepatientreceivedanysystemicortopicaltherapyotherthancytotoxicchemotherapyspecifiedinsection1forthetreatmentofKaposi'sSarcoma?

Data type

text

Specify
Description

Specify

Data type

text

If Other Source, specify
Description

IfOtherSource,specify

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Prior Treatment History for Kaposi's Sarcoma - RKS01B
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Prior Treatment History For Kaposi's Sarcoma - Rks01b
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)
ProtocolCoordinatingIdentifierNumber
Item
Study#
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)
NCIInstitutionIdentifierCode
Item
Site#
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus ObjectClass)
C1513882 (UMLS 2011AA ObjectClass)
PatientCoordinatingIdentifierNumber
Item
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)
LesionAssessmentDate
Item
Date of Visit
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
Item
Has the patient received non-investigational systemic chemotherapy or immunotherapy for the treatment of Kaposi's Sarcoma?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.1
Code List
Has the patient received non-investigational systemic chemotherapy or immunotherapy for the treatment of Kaposi's Sarcoma?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Single Agents
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C0450442 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
CL.2
Code List
Single Agents
CL Item
Interferon (Interferon)
CL Item
Adriamycin (Adriamycin)
CL Item
Vincristine (Vincristine)
CL Item
Doxil (Doxil)
CL Item
Vinblastine (Vinblastine)
CL Item
Bleomycin (Bleomycin)
CL Item
Taxol (Taxol)
CL Item
Etoposide (Etoposide)
CL Item
DaunoXome (DaunoXome)
CL Item
Other single agent therapy (Other single agent therapy)
CL Item
Vincristine/vinblastine (Vincristine/vinblastine)
CL Item
Bleomycin/vincristine (Bleomycin/vincristine)
CL Item
Adrianmycin/bleomycin/vincristine (Adrianmycin/bleomycin/vincristine)
CL Item
Doxil/bleomycin/vincristine (Doxil/bleomycin/vincristine)
CL Item
Other combination therapy (Other combination therapy)
Item
Unnamed
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property)
CL.3
Code List
Unnamed
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Best Response
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
CL.7
Code List
Best Response
CL Item
Complete Response (Complete response)
CL Item
Complete Response (Clinical Complete Response)
CL Item
Partial Response (Partial Response)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (Stable Disease)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Partial Response (Progressive Disease)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
C18212 (NCI Thesaurus)
CL Item
N/A (Phase I Trial) (N/A (Phase I Trial))
CL Item
Unknown (Unknown)
Item
Best Response
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
CL.7
Code List
Best Response
CL Item
Complete Response (Complete response)
CL Item
Complete Response (Clinical Complete Response)
CL Item
Partial Response (Partial Response)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (Stable Disease)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Partial Response (Progressive Disease)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
C18212 (NCI Thesaurus)
CL Item
N/A (Phase I Trial) (N/A (Phase I Trial))
CL Item
Unknown (Unknown)
CL.8
Code List
Source
CL Item
Clinical Assessment (Clinical/Medical Record)
CL Item
Patient (Patient)
CL Item
Other (Other)
CL.8
Code List
Source
CL Item
Clinical Assessment (Clinical/Medical Record)
CL Item
Patient (Patient)
CL Item
Other (Other)
IfOtherSource,specify
Item
If Other Source, specify
text
Item
Has the patient received any systemic or topical therapy other than cytotoxic chemotherapy specified in section 1 for the treatment of Kaposi's Sarcoma?
text
CL.6
Code List
Has the patient received any systemic or topical therapy other than cytotoxic chemotherapy specified in section 1 for the treatment of Kaposi's Sarcoma?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Specify
Item
Specify
text
IfOtherSource,specify
Item
If Other Source, specify
text
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