ID

3225

Description

Off Treatment form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0E6C422B-7E9E-3C5E-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0E6C422B-7E9E-3C5E-E044-0003BA3F9857

Keywords

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

September 19, 2012

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License

Creative Commons BY-NC 3.0 Legacy
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Toxicity - OFF TREATMENT - 2453800v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: OFF TREATMENT
    1. No Instruction available.
Off Treatment
Description

Off Treatment

Treatment Phase End Date
Description

TreatmentPhaseEndDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus ObjectClass
C0087111
NCI Metathesaurus ObjectClass
C0205390
NCI Metathesaurus Property
C0205197
Reason off study
Description

OffStudyReasonCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C40450
UMLS 2011AA ObjectClass
C1518543
Off Study Followup Date
Description

OffStudyFollowupDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Off Study Other Reason
Description

OffStudyOtherReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C40450
UMLS 2011AA ObjectClass
C1518543
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C45255
UMLS 2011AA ValueDomain
C1708523
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus ValueDomain
C68805
UMLS 2011AA ValueDomain
C2350015
Off Study Other Reason
Description

OffStudyOtherReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C40450
UMLS 2011AA ObjectClass
C1518543
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C45255
UMLS 2011AA ValueDomain
C1708523
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus ValueDomain
C68805
UMLS 2011AA ValueDomain
C2350015
Response Assessment Type
Description

ResponseAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus Property
C25367
Best Response Date
Description

BestResponseDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus ObjectClass
C25432
UMLS 2011AA ObjectClass
C1522427
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus Property
C25279
UMLS 2011AA Property
C0332162
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Progression Date
Description

ProgressionDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17747
UMLS 2011AA ObjectClass
C0242656
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: OFF TREATMENT
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Off Treatment
TreatmentPhaseEndDate
Item
Treatment Phase End Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0087111 (NCI Metathesaurus ObjectClass)
C0205390 (NCI Metathesaurus ObjectClass)
C0205197 (NCI Metathesaurus Property)
Item
Reason off study
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C1518543 (UMLS 2011AA ObjectClass)
CL.1
Code List
Reason off study
CL Item
Patient Noncompliance (2)
C0376405 (NCI Metathesaurus)
CL Item
Withdrawal Of Informed Consent (3)
CL Item
Alternative Medicine (A)
C19936 (NCI Thesaurus)
C1515928 (UMLS 2011AA)
CL Item
Disease Progression Before Treatment (B)
CL Item
Study Complete (C)
CL Item
Death (D)
C26554 (NCI Thesaurus)
C1366479 (UMLS 2011AA)
CL Item
Late Adverse Events/side Effects (E)
CL Item
Cytogenetic Resistance (G)
CL Item
Follow-up Period Completed (H)
CL Item
Ineligible (I)
C40412 (NCI Thesaurus)
C1512714 (UMLS 2011AA)
CL Item
Lost To Follow-up (L)
C48227 (NCI Thesaurus)
C1302313 (UMLS 2011AA)
CL Item
Death During Follow-up Period (M)
CL Item
Not Treated (N)
CL Item
Other (O)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Disease Progression (P)
C17747 (NCI Thesaurus)
C0242656 (UMLS 2011AA)
CL Item
Refused Further Treatment (R)
CL Item
Complicating Disease (S)
C16457 (NCI Thesaurus)
C0009488 (UMLS 2011AA)
CL Item
Toxicity (T)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Not Treated - Other Reasons (U)
CL Item
Protocol Violation (V)
C48251 (NCI Thesaurus)
C1709750 (UMLS 2011AA)
CL Item
Refused Further Follow-up (W)
CL Item
Declined To Participate (X)
CL Item
No Treatment, Per Protocol Criteria (Z)
OffStudyFollowupDate
Item
Off Study Followup Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
OffStudyOtherReason
Item
Off Study Other Reason
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C1518543 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C45255 (NCI Thesaurus ValueDomain)
C1708523 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C68805 (NCI Thesaurus ValueDomain)
C2350015 (UMLS 2011AA ValueDomain)
OffStudyOtherReason
Item
Off Study Other Reason
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C1518543 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C45255 (NCI Thesaurus ValueDomain)
C1708523 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C68805 (NCI Thesaurus ValueDomain)
C2350015 (UMLS 2011AA ValueDomain)
Item
Response Assessment Type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
CL.2
Code List
Response Assessment Type
CL Item
Complete Response (CR)
CL Item
Complete Response Unconfirmed (CRU)
CL Item
Disease Unchanged (DU)
CL Item
Less Than Partial Response (MR)
CL Item
Not Assessed (NA)
CL Item
Not Evauable (NE)
CL Item
Not Applicable Per Protocol (NP)
CL Item
No Response (NR)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Partial Response (PR)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (SD)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Too Early (TE)
CL Item
Unknown (UK)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
BestResponseDate
Item
Best Response Date
date
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25432 (NCI Thesaurus ObjectClass)
C1522427 (UMLS 2011AA ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
ProgressionDate
Item
Progression Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
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