Head and Neck Cancer NCT00265941 Follow-Up Header Current Disease Status And Method Of Determination PATIENT'S VITAL STATUS PRIMARY CAUSE OF DEATH HAS THE PATIENT HAD A DOCUMENTED CLINICAL ASSESSMENT FOR THIS CANCER (SINCE SUBMISSION OF THE PREVIOUS FOLLOW-UP FORM) Primary tumor (Original study site) Nodal Disease Right Nodal Disease Left Method of Evaluation (see Q5 codetable) Disease Events Event (Event Codes: Primary Tumor site under study 11,12; Regional Disease including Lymph Nodes from site under study 21,22,23,24) Has the patient been diagnosed with first distant recurrence/progression? (SINCE SUBMISSION OF THE PREVIOUS FOLLOW-UP FORM) Site(s) of distant progression (S use codetable below) New primary cancer Has a new primary cancer or MDS been diagnosed that has not been previously reported? (MYELODYSPLASTIC SYNDROME SINCE SUBMISSION OF THE PREVIOUS FOLLOW-UP FORM) Site(s) of new primary (S USE CODETABLE FROM Q7) Non-Protocol Therapy Was any non-protocol therapy given (RELATED TO CANCER UNDER STUDY SINCE SUBMISSION OF THE PREVIOUS FOLLOW-UP FORM) Non-Protocol Surgery Non-Protocol Chemotherapy Non-Protocol Biologic Response Modifier Non-protocol radiation therapy to primary Non-protocol radiation therapy to nodes (right) Non-protocol radiation therapy to nodes (left) Non-protocol radiation therapy to other sites Other Non-Protocol Therapy Was any non-protocol supportive therapy given (Was any non-protocol supportive therapy given since submission of the previous follow-up form) Type of Supportive Care Given Swallowing and Tube Feeding Does the patient currently have swallowing problems How long have swallowing problems been present (IF YES,) Does the patient currently require tube feeding (12) Is patient dependent on tube feeding for >50% of nutritional support (If yes,) Was a feeding tube inserted during this reporting period (13) Was a feeding tube discontinued during this reporting period (14) Was a tracheostomy performed during this reporting period (15) Was use of a tracheostomy discontinued during this reporting period Protocol Specific Adverse Event Evaluation CTC Adverse Event Term CTC AE Attribution Code (A. Attribution to Protocol Treatment: See protocol sections 6&7 for definition of "protocol treatment" 1=unrelated; 2=unlikely; 3=possible; 4=probable; 5=definite) Serious adverse event report submitted (B. Adverse Event report submitted: 1=No; 2=Yes; 9=Unknown) Protocol Specific Adverse Event Evaluation New or continuing adverse events (Not reported in Q6) 
