ID

3439

Beschrijving

RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire Higher-Dose Radiation Therapy or Standard Radiation Therapy in Treating Patients With Early-Stage Breast Cancer That Was Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9D7B30AD-FE61-0FB3-E040-BB89AD435271

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9D7B30AD-FE61-0FB3-E040-BB89AD435271

Trefwoorden

Versies (2)
  1. 20-09-12 20-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

20 september 2012

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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NCT01349322 Quality of Life - RTOG-1005 BQ: Radiation Therapy Oncology Group Phase III Whole Breast Irradiation for Early Stage Breast Cancer Patient Cosmesis Questionnaire - 3194282v1.0

Engels

INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

1 Formulieren  
Unnamed Module 1
Beschrijving

Unnamed Module 1

RTOG Study No.
Beschrijving

ProtocolRTOGIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C19778
UMLS 2011AA Property
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Case #
Beschrijving

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C19778
UMLS 2011AA ObjectClass
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C49152
UMLS 2011AA Property
C1706256
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Institution Name
Beschrijving

InstitutionName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Institution No.
Beschrijving

InstitutionIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Initials
Beschrijving

PatientInitialsName

Datatype

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
RTOG Patient ID
Beschrijving

PatientRadiationTherapyOncologyGroupIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C19778
UMLS 2011AA Property
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Are data amended
Beschrijving

DataAmendedInd-3

Datatype

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
Unamed Module 2
Beschrijving

Unamed Module 2

Time point
Beschrijving

AssessmentPeriodType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
Treatment Start Date
Beschrijving

TreatmentBeginDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25431
UMLS 2011AA Property
C0439659
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25431
UMLS 2011AA ValueDomain
C0439659
Was patient questionnaire completed
Beschrijving

PatientQuestionnaireCompleteInd-2

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
Date patient questionnaire completed
Beschrijving

QualityofLifeCompleteAssessmentDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C25367
Reason Questionnaire was not Completed (PATIENT)
Beschrijving

PatientIncompleteQuestionnaireReason

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus Property
C0034394
Patient refused for other reason, specify
Beschrijving

PatientRefuseIncompleteQuestionnaireSpecify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus Property
C0034394
NCI Thesaurus Property
C49160
UMLS 2011AA Property
C0205257
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other reason, specify
Beschrijving

PatientIncompleteQuestionnaireOtherSpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C17649
UMLS 2011AA ValueDomain
C0205394
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus Property
C0034394
Specify method of completion
Beschrijving

PatientQuestionnaireCompleteMethodofCollectionType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
Did the patient require any assistance in completing the questionnaire?
Beschrijving

PatientQuestionnaireAssistanceInd

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
Specify the person who assisted the patient
Beschrijving

PatientQuestionnaireAssistancePersonCategory

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
NCI Thesaurus ValueDomain
C25190
UMLS 2011AA ValueDomain
C0027361
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
Other, specify
Beschrijving

PatientQuestionnaireAssistancePersonSpecify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C25190
UMLS 2011AA ValueDomain
C0027361
Extent of the assistance
Beschrijving

PatientQuestionnaireAssistanceType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
Combination of above, specify
Beschrijving

PatientQuestionnaireAssistanceCombinedSpecify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C25454
UMLS 2011AA ValueDomain
C0205195
Other, specify
Beschrijving

PatientQuestionnaireAssistanceOtherSpecify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Metathesaurus Property
C0018896
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C17649
UMLS 2011AA ValueDomain
C0205394
Signature of Person Completing This Form
Beschrijving

ResponsiblePersonSignatureText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
Date Form Completed (MM DD YYYY)
Beschrijving

FormCompleteDate

Datatype

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
NCI Thesaurus ValueDomain
C25367
Difference Between Treated And Untreated Breast And Area
Beschrijving

Difference Between Treated And Untreated Breast And Area

Breast size
Beschrijving

BreastReconstructionComparisonSizeAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25681
UMLS 2011AA Property
C0456389
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast texture
Beschrijving

BreastReconstructionComparisonTextureAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C41144
UMLS 2011AA Property
C0449582
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Arm heaviness
Beschrijving

BreastReconstructionComparisonArmHeavyAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C68807
UMLS 2011AA Property
C0439539
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Nipple appearance
Beschrijving

BreastReconstructionComparisonNippleAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C12299
UMLS 2011AA Property
C0028109
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Should movement
Beschrijving

BreastReconstructionComparisonShoulderAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25203
UMLS 2011AA Property
C0037004
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Arm movement
Beschrijving

BreastReconstructionComparisonArmAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast pain
Beschrijving

BreastReconstructionComparisonPainAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
CTCAE Property
E11167
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Ability to lift objects
Beschrijving

BreastReconstructionComparisonLiftingAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C86567
UMLS 2011AA Property
C0206244
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Fit of shirt sleeve
Beschrijving

BreastReconstructionComparisonFitShoulderClothingAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25203
UMLS 2011AA Property
C0037004
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C70826
UMLS 2011AA Property
C2349186
NCI Thesaurus Property
C86930
UMLS 2011AA Property
C0009072
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast tenderness
Beschrijving

BreastReconstructionComparisonTendernessAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C75540
UMLS 2011AA Property
C0234233
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Shoulder stiffness
Beschrijving

BreastReconstructionComparisonShoulderJointStiffnessAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25203
UMLS 2011AA Property
C0037004
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C79603
UMLS 2011AA Property
C0162298
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast shape
Beschrijving

BreastReconstructionComparisonShapeAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C25677
UMLS 2011AA Property
C0332479
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast elevation
Beschrijving

BreastReconstructionComparisonElevationAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C25494
UMLS 2011AA Property
C0702240
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Scar tissue
Beschrijving

BreastReconstructionComparisonScarAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C34483
UMLS 2011AA Property
C2004491
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Shoulder pain
Beschrijving

BreastReconstructionComparisonShoulderPainAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property
C25203
UMLS 2011AA Property
C0037004
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Arm pain
Beschrijving

BreastReconstructionComparisonArmPainAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Arm swelling
Beschrijving

BreastReconstructionComparisonArmSwellingAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C3399
UMLS 2011AA Property
C0038999
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast swelling
Beschrijving

BreastReconstructionComparisonSwellingAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C3399
UMLS 2011AA Property
C0038999
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Arm stiffness
Beschrijving

BreastReconstructionComparisonArmJointStiffnessAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C79603
UMLS 2011AA Property
C0162298
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Fit of bra
Beschrijving

BreastReconstructionComparisonUndergarmentAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C86932
UMLS 2011AA Property
C0453880
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Breast sensitivity
Beschrijving

BreastReconstructionComparisonSensitivityAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C68816
UMLS 2011AA Property
C2349185
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Fit of clothing
Beschrijving

BreastReconstructionComparisonFitClothingAssessmentStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C25351
UMLS 2011AA ObjectClass
C0524865
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C49156
UMLS 2011AA Property
C1707455
NCI Thesaurus Property
C70826
UMLS 2011AA Property
C2349186
NCI Thesaurus Property
C86930
UMLS 2011AA Property
C0009072
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
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INSTRUCTIONS: This page must be completed by the medical staff (nurse, data manager, physician, etc.) Questionnaires for all time points are required even if submission time points deviate from the specified intervals. Only patient death or documented patient refusal will be an acceptable reason for omission of the QOL questionnaires. However, this page must be completed and submitted for every time point on the calendar regardless of whether the QOL questionnaire was completed. Every effort possible should be made to collect the data on time

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed Module 1
ProtocolRTOGIdentifierNumber
Item
RTOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass)
C1514695 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property)
C1706256 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
InstitutionIdentifierNumber
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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)
PatientRadiationTherapyOncologyGroupIdentifierNumber
Item
RTOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Are data amended
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unamed Module 2
Item
Time point
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
CL.2
Code List
Time point
CL Item
Pretreatment (Pretreatment)
CL Item
At End Of Rt (At end of RT)
CL Item
1 Month Post Rt Completion (1 month post RT Completion)
CL Item
6 Months Post Rt Completion (6 months post RT Completion)
CL Item
1 Year Post Rt Completion (1 year post RT Completion)
CL Item
2 Years Post Rt Completion (2 years post RT Completion)
CL Item
3 Years Post Rt Completion (3 years post RT Completion)
TreatmentBeginDate
Item
Treatment Start Date
date
C15368 (NCI Thesaurus ObjectClass)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
Item
Was patient questionnaire completed
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
CL.3
Code List
Was patient questionnaire completed
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
QualityofLifeCompleteAssessmentDate
Item
Date patient questionnaire completed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
Item
Reason Questionnaire was not Completed (PATIENT)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
CL.4
Code List
Reason Questionnaire was not Completed (PATIENT)
CL Item
Not Applicable, Questionnaire Was Completed (Not applicable, questionnaire was completed)
CL Item
Patient Refused Due To Illness (Patient refused due to illness)
CL Item
Patient Refused For Other Reason (Patient refused for other reason)
CL Item
Patient Unable To Be Contacted (Patient unable to be contacted)
CL Item
Institution Error (Institutional error)
CL Item
Tool Not Availalble In Patient's Language (Tool not available in patient's language)
CL Item
Other Reason (Other reason)
CL Item
Patient Withdrew Consent Prior/after (Patient withdrew consent prior/after)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientRefuseIncompleteQuestionnaireSpecify
Item
Patient refused for other reason, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
PatientIncompleteQuestionnaireOtherSpecify
Item
Other reason, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0034394 (NCI Metathesaurus Property)
Item
Specify method of completion
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
CL.5
Code List
Specify method of completion
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
At Appointment (At appointment)
CL Item
By Mail (By mail)
CL Item
By Telephone (By telephone)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Did the patient require any assistance in completing the questionnaire?
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
CL.6
Code List
Did the patient require any assistance in completing the questionnaire?
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown If Assistance Given (Unknown if assistance given)
Item
Specify the person who assisted the patient
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
CL.7
Code List
Specify the person who assisted the patient
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Staff Member (Staff member)
CL Item
Family (Family)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
PatientQuestionnaireAssistancePersonSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ValueDomain)
C0027361 (UMLS 2011AA ValueDomain)
Item
Extent of the assistance
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
CL.8
Code List
Extent of the assistance
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Read Items To Patient (Read items to patient)
CL Item
Interpreted Items For Patient (Interpreted items for patient)
CL Item
Marked Items Per Patient's Response (Marked items per patient's response)
CL Item
Combination Of Above (Combination of above)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientQuestionnaireAssistanceCombinedSpecify
Item
Combination of above, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25454 (NCI Thesaurus ValueDomain)
C0205195 (UMLS 2011AA ValueDomain)
PatientQuestionnaireAssistanceOtherSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
ResponsiblePersonSignatureText
Item
Signature of Person Completing This Form
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
FormCompleteDate
Item
Date Form Completed (MM DD YYYY)
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)
C25367 (NCI Thesaurus ValueDomain)
Item Group
Difference Between Treated And Untreated Breast And Area
Item
Breast size
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.9
Code List
Breast size
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast texture
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C41144 (NCI Thesaurus Property)
C0449582 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.10
Code List
Breast texture
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Arm heaviness
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C68807 (NCI Thesaurus Property)
C0439539 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.11
Code List
Arm heaviness
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Nipple appearance
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C12299 (NCI Thesaurus Property)
C0028109 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.12
Code List
Nipple appearance
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Should movement
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.13
Code List
Should movement
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Arm movement
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.14
Code List
Arm movement
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast pain
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
E11167 (CTCAE Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.15
Code List
Breast pain
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Ability to lift objects
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C86567 (NCI Thesaurus Property)
C0206244 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.16
Code List
Ability to lift objects
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Fit of shirt sleeve
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C70826 (NCI Thesaurus Property)
C2349186 (UMLS 2011AA Property)
C86930 (NCI Thesaurus Property)
C0009072 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.17
Code List
Fit of shirt sleeve
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast tenderness
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C75540 (NCI Thesaurus Property)
C0234233 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.18
Code List
Breast tenderness
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Shoulder stiffness
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C79603 (NCI Thesaurus Property)
C0162298 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.19
Code List
Shoulder stiffness
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast shape
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25677 (NCI Thesaurus Property)
C0332479 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.20
Code List
Breast shape
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast elevation
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25494 (NCI Thesaurus Property)
C0702240 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.21
Code List
Breast elevation
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Scar tissue
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C34483 (NCI Thesaurus Property)
C2004491 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.22
Code List
Scar tissue
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Shoulder pain
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25203 (NCI Thesaurus Property)
C0037004 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.23
Code List
Shoulder pain
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Arm pain
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.24
Code List
Arm pain
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Arm swelling
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.25
Code List
Arm swelling
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast swelling
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.26
Code List
Breast swelling
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Arm stiffness
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C79603 (NCI Thesaurus Property)
C0162298 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.27
Code List
Arm stiffness
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Fit of bra
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C86932 (NCI Thesaurus Property)
C0453880 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.28
Code List
Fit of bra
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Breast sensitivity
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C68816 (NCI Thesaurus Property)
C2349185 (UMLS 2011AA Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.29
Code List
Breast sensitivity
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
Item
Fit of clothing
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus ObjectClass)
C0524865 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C49156 (NCI Thesaurus Property)
C1707455 (UMLS 2011AA Property)
C70826 (NCI Thesaurus Property)
C2349186 (UMLS 2011AA Property)
C86930 (NCI Thesaurus Property)
C0009072 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.30
Code List
Fit of clothing
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Slight (Slight)
CL Item
Moderate (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
Large (Large)
C49508 (NCI Thesaurus)
C0549177 (UMLS 2011AA)
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