Baseline - Clinical Form

Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Description

Supporting Definition: This number will not be shared with ICHOM. In the case patient-­‐level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-­‐linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution Inclusion Criteria: All patients Timing: On all forms Data Source: Administrative or clinical Type: Numerical Response Options: According to institution

Data type

integer

Alias
UMLS CUI [1]
C2348585
Demographic factors
Description

Demographic factors

Alias
UMLS CUI-1
C1704791
What is your date of birth?
Description

Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical or patient-­‐reported Type: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0421451
DD/MM/YYYY
Please indicate your sex at birth
Description

Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical or patient-­‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0079399
Baseline Clinical Factors
Description

Baseline Clinical Factors

Alias
UMLS CUI-1
C0449440
UMLS CUI-2
C1442488
Indicate the absolute value of FEV-1 at time of lung cancer diagnosis
Description

Inclusion Criteria: Patients undergoing surgery Timing: Baseline Data Source: Clinical Type: Numerical value Response Options: Numerical value in liters 999 = Unknown

Data type

float

Measurement units
  • L
Alias
UMLS CUI [1,1]
C0024119
UMLS CUI [1,2]
C0429706
L
Indicate the percentage predicted value of FEV-1 at time of lung cancer diagnosis
Description

Inclusion Criteria: Patients undergoing surgery Timing: Baseline Data Source: Clinical Type: Numerical value Response Options: Numerical value of 0‐100 999 = Unknown

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0024119
UMLS CUI [1,2]
C0086715
%
Baseline tumor factors
Description

Baseline tumor factors

Alias
UMLS CUI-1
C0475752
UMLS CUI-2
C1442488
Indicate how lung cancer was diagnosed
Description

Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C2911685
UMLS CUI [1,2]
C0332140
UMLS CUI [2,1]
C2911685
UMLS CUI [2,2]
C1521733
Indicate the lung cancer histology
Description

Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0019638
Indicate presence of ALK translocation
Description

Supporting Definition: If the test is not performed, unknown can be answered. Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0026882
UMLS CUI [1,2]
C0449438
UMLS CUI [1,3]
C0252409
UMLS CUI [1,4]
C0040715
Indicate presence of activating EGFR mutation
Description

Supporting Definition: If the test is not performed, unknown can be answered. Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0026882
UMLS CUI [1,2]
C0449438
UMLS CUI [1,3]
C2984891
Indicate the clinical tumor stage (per UICC / IASLC / AJCC 7th)
Description

Supporting Definition: Pathologic staging preferred, if available cT0: no primary tumor cT1: if not able to select T1a or T1b: Tumor ≤3 cm diameter, surrounded by lung or visceral pleura, without invasion more proximal than lobar bronchus cT1a: Tumor ≤2 cm in diameter cT1b: Tumor >2 cm but ≤3 cm in diameter cT2: if not able to select T2a or T2b: Tumor >3 cm but ≤7 cm, or tumor with any of the following features: Involves main bronchus, ≥2 cm distal to carina. Invades visceral pleura. Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung cT2a: Tumor >3 cm but ≤5 cm cT2b: Tumor >5 cm but ≤7 cm cT3: Tumor >7 cm or any of the following: Directly invades any of the following: chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium, main bronchus <2 cm from carina (without involvement of carina), Atelectasis or obstructive pneumonitis of the entire lung. Separate tumor nodules in the same lobe cT4: Tumor of any size that invades the mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or with separate tumor nodules in a different ipsilateral lobe cTX: Primary tumor cannot be assessed Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0205210
UMLS CUI [1,2]
C1300072
Indicate the clinical nodal stage (per UICC / IASLC / AJCC 7th)
Description

Supporting Definition: Pathologic staging preferred, if available cN0: No regional lymph node metastases cN1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension cN2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s) cN3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s) cNX: Regional lymph nodes were not assessed Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0456532
UMLS CUI [1,2]
C0205210
Indicate clinical metastatic stage (per UICC / IASLC / AJCC 7th)
Description

Supporting Definition: cM0: No distant metastasis cM1: Distant metastasis cM1a: Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodules or malignant pleural or pericardial effusion cM1b: Distant metastasis (in extrathoracic organs) cMX: Distant metastasis cannot be evaluated Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0456533
UMLS CUI [1,2]
C0205210
Indicate pathological metastatic stage (per UICC / IASLC / AJCC 7th)
Description

Supporting Definition: pM0: No distant metastasis pM1: Distant metastasis pM1a: Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodules or malignant pleural or pericardial effusion pM1b: Distant metastasis (in extrathoracic organs) pMX: Distant metastasis cannot be evaluated Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1521733
UMLS CUI [1,2]
C0036525
UMLS CUI [1,3]
C1300072
Degree of health
Description

Degree of health

Alias
UMLS CUI-1
C0018759
Q1 Perform: Change definition: Indicate the ECOG/WHO performance status
Description

Supporting Definition: ECOG / WHO scale: - PS = 0 normal activity level; -­ PS = 1 restricted with strenuous activity, but can do light activity; -­ PS = 2 active >/= 50% of day; -­ PS = 3 spends >50% of day in chair or bed; -­ PS = 4 totally confined to bed Inclusion Criteria: All patients Timing: Baseline 1 year post initiation of treatment Tracked ongoing annually for life (when hospital is able to track this ongoing) Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1520224

Similar models

Baseline - Clinical Form

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C2348585 (UMLS CUI [1])
Item Group
Demographic factors
C1704791 (UMLS CUI-1)
Date of birth
Item
What is your date of birth?
date
C0421451 (UMLS CUI [1])
Item
Please indicate your sex at birth
integer
C0079399 (UMLS CUI [1])
Code List
Please indicate your sex at birth
CL Item
Male (1)
C0086582 (UMLS CUI-1)
(Comment:en)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
(Comment:en)
CL Item
Undisclosed (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item Group
Baseline Clinical Factors
C0449440 (UMLS CUI-1)
C1442488 (UMLS CUI-2)
Pulmonary function at lung cancer diagnosis: Absolute value FEV-1
Item
Indicate the absolute value of FEV-1 at time of lung cancer diagnosis
float
C0024119 (UMLS CUI [1,1])
C0429706 (UMLS CUI [1,2])
Pulmonary function at lung cancer diagnosis: Percent predicted normal value
Item
Indicate the percentage predicted value of FEV-1 at time of lung cancer diagnosis
float
C0024119 (UMLS CUI [1,1])
C0086715 (UMLS CUI [1,2])
Item Group
Baseline tumor factors
C0475752 (UMLS CUI-1)
C1442488 (UMLS CUI-2)
Item
Indicate how lung cancer was diagnosed
integer
C2911685 (UMLS CUI [1,1])
C0332140 (UMLS CUI [1,2])
C2911685 (UMLS CUI [2,1])
C1521733 (UMLS CUI [2,2])
Code List
Indicate how lung cancer was diagnosed
CL Item
Clinical assessment (1)
C4534461 (UMLS CUI-1)
(Comment:en)
CL Item
Histological assessment (2)
C0449575 (UMLS CUI-1)
C1516048 (UMLS CUI-2)
(Comment:en)
CL Item
Cytological assessment (3)
C0205471 (UMLS CUI-1)
C1516048 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Indicate the lung cancer histology
integer
C0019638 (UMLS CUI [1])
Code List
Indicate the lung cancer histology
CL Item
Adenocarcinoma (1)
C0001418 (UMLS CUI-1)
(Comment:en)
CL Item
Adenocarcinoma with lepidic pattern (2)
C0001418 (UMLS CUI-1)
C1881368 (UMLS CUI-2)
(Comment:en)
CL Item
Invasive mucinous adenocarcinoma (3)
C0007130 (UMLS CUI-1)
C0205281 (UMLS CUI-2)
(Comment:en)
CL Item
Squamous cell carcinoma (4)
C0007137 (UMLS CUI-1)
(Comment:en)
CL Item
Small‐cell carcinoma (5)
C0262584 (UMLS CUI-1)
(Comment:en)
CL Item
Non-­small cell lung cancer (NSCLC) – favor adenocarcioma (6)
C0007131 (UMLS CUI-1)
C0001418 (UMLS CUI-2)
(Comment:en)
CL Item
NSCLC – favor squamous cell carcinoma (7)
C0007131 (UMLS CUI-1)
C0007137 (UMLS CUI-2)
(Comment:en)
CL Item
NSCLC with neuroendocrine (NE) morphology and positive NE markers; (8)
C0007131 (UMLS CUI-1)
C1709218 (UMLS CUI-2)
C1265996 (UMLS CUI-3)
C0332149 (UMLS CUI-4)
(Comment:en)
CL Item
NSCLC with NE morphology (negative NE markers) (9)
C0007131 (UMLS CUI-1)
C1709218 (UMLS CUI-2)
C1265996 (UMLS CUI-3)
C0205160 (UMLS CUI-4)
(Comment:en)
CL Item
NSCLC with spindle and/or giant cell carcinoma (10)
C0007131 (UMLS CUI-1)
C0682540 (UMLS CUI-2)
C0007097 (UMLS CUI-3)
C0206703 (UMLS CUI-4)
(Comment:en)
CL Item
NSCLC‐not otherwise specified (11)
C0007131 (UMLS CUI-1)
C1518425 (UMLS CUI-2)
(Comment:en)
CL Item
Atypical adenomatous hyperplasia (12)
C0334001 (UMLS CUI-1)
(Comment:en)
CL Item
Adenocarcinoma in situ (13)
C0001418 (UMLS CUI-1)
C0007099 (UMLS CUI-2)
(Comment:en)
CL Item
Minimally invasive adenocarcinoma (14)
C0001418 (UMLS CUI-1)
C1881856 (UMLS CUI-2)
(Comment:en)
CL Item
Carcinoid typical (NET grade 1) (15)
C0007095 (UMLS CUI-1)
(Comment:en)
CL Item
Carcinoid atypical (NET grade 2) (16)
C0007095 (UMLS CUI-1)
C0205182 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Indicate presence of ALK translocation
integer
C0026882 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
C0252409 (UMLS CUI [1,3])
C0040715 (UMLS CUI [1,4])
Code List
Indicate presence of ALK translocation
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Failed analysis (2)
C0231175 (UMLS CUI-1)
C0936012 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Indicate presence of activating EGFR mutation
integer
C0026882 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
C2984891 (UMLS CUI [1,3])
Code List
Indicate presence of activating EGFR mutation
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Failed analysis (2)
C0231175 (UMLS CUI-1)
C0936012 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Indicate the clinical tumor stage (per UICC / IASLC / AJCC 7th)
integer
C0205210 (UMLS CUI [1,1])
C1300072 (UMLS CUI [1,2])
Code List
Indicate the clinical tumor stage (per UICC / IASLC / AJCC 7th)
CL Item
c T0 (0)
C0475371 (UMLS CUI-1)
C1275863 (UMLS CUI-2)
(Comment:en)
CL Item
cT1 (1)
C0475372 (UMLS CUI-1)
C1275863 (UMLS CUI-2)
(Comment:en)
CL Item
cT1a (2)
C1275863 (UMLS CUI-1)
C0475383 (UMLS CUI-2)
(Comment:en)
CL Item
cT1b (3)
C1275863 (UMLS CUI-1)
C0475385 (UMLS CUI-2)
(Comment:en)
CL Item
cT2 (4)
C1275863 (UMLS CUI-1)
C0475373 (UMLS CUI-2)
(Comment:en)
CL Item
cT2a (5)
C1275863 (UMLS CUI-1)
C0475387 (UMLS CUI-2)
(Comment:en)
CL Item
cT2b (6)
C1275863 (UMLS CUI-1)
C0475388 (UMLS CUI-2)
(Comment:en)
CL Item
cT3 (7)
C0475374 (UMLS CUI-1)
C1275863 (UMLS CUI-2)
(Comment:en)
CL Item
cT4 (8)
C0475751 (UMLS CUI-1)
C1275863 (UMLS CUI-2)
(Comment:en)
CL Item
cTX (9)
C0332377 (UMLS CUI-1)
C1275863 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Indicate the clinical nodal stage (per UICC / IASLC / AJCC 7th)
integer
C0456532 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Code List
Indicate the clinical nodal stage (per UICC / IASLC / AJCC 7th)
CL Item
cN0 (0)
C1275865 (UMLS CUI-1)
C0441959 (UMLS CUI-2)
(Comment:en)
CL Item
cN1 (1)
C1275865 (UMLS CUI-1)
C0441962 (UMLS CUI-2)
(Comment:en)
CL Item
cN2 (2)
C1275865 (UMLS CUI-1)
C0441960 (UMLS CUI-2)
(Comment:en)
CL Item
cN3 (3)
C1275865 (UMLS CUI-1)
C0441961 (UMLS CUI-2)
(Comment:en)
CL Item
cNX (4)
C1275865 (UMLS CUI-1)
C0445085 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C1275865 (UMLS CUI-1)
C0439673 (UMLS CUI-2)
(Comment:en)
Item
Indicate clinical metastatic stage (per UICC / IASLC / AJCC 7th)
integer
C0456533 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Code List
Indicate clinical metastatic stage (per UICC / IASLC / AJCC 7th)
CL Item
cM0 (0)
C0445034 (UMLS CUI-1)
C1275856 (UMLS CUI-2)
(Comment:en)
CL Item
cM1 (1)
C0441971 (UMLS CUI-1)
C1275856 (UMLS CUI-2)
(Comment:en)
CL Item
cM1a (2)
C0445036 (UMLS CUI-1)
C1275856 (UMLS CUI-2)
(Comment:en)
CL Item
cM1b (3)
C0445064 (UMLS CUI-1)
C1275856 (UMLS CUI-2)
(Comment:en)
CL Item
cMX (4)
C0445039 (UMLS CUI-1)
C1275856 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C1275856 (UMLS CUI-1)
C0439673 (UMLS CUI-2)
(Comment:en)
Item
Indicate pathological metastatic stage (per UICC / IASLC / AJCC 7th)
integer
C1521733 (UMLS CUI [1,1])
C0036525 (UMLS CUI [1,2])
C1300072 (UMLS CUI [1,3])
Code List
Indicate pathological metastatic stage (per UICC / IASLC / AJCC 7th)
CL Item
pM0 (0)
C0332402 (UMLS CUI-1)
(Comment:en)
CL Item
pM1 (1)
C0456957 (UMLS CUI-1)
(Comment:en)
CL Item
pM1a (2)
C2733084 (UMLS CUI-1)
(Comment:en)
CL Item
pM1b (3)
C2733110 (UMLS CUI-1)
(Comment:en)
CL Item
pMX (4)
C0332404 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item Group
Degree of health
C0018759 (UMLS CUI-1)
Item
Q1 Perform: Change definition: Indicate the ECOG/WHO performance status
integer
C1520224 (UMLS CUI [1])
Code List
Q1 Perform: Change definition: Indicate the ECOG/WHO performance status
CL Item
0 (0)
C1828078 (UMLS CUI-1)
(Comment:en)
CL Item
1 (1)
C1827388 (UMLS CUI-1)
(Comment:en)
CL Item
2 (2)
C1828242 (UMLS CUI-1)
(Comment:en)
CL Item
3 (3)
C1827126 (UMLS CUI-1)
(Comment:en)
CL Item
4 (4)
C1827528 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
C1520224 (UMLS CUI-2)
(Comment:en)