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Yearly Follow-up contact; Anti Cancer Therapy (Report Final and Annex Report 2 Final)

1 forms  
Adminstrative
Description

Adminstrative

Alias
UMLS CUI-1
C1320722
Patient Number
Description

Patient Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Yearly Follow-up - Check for Follow-up contact
Description

Yearly Follow-up - Check for Follow-up contact

Alias
UMLS CUI-1
C1522577
UMLS CUI-2
C0332158
Is the patient still alive?
Description

Yes → Date of contact No → Please complete the Death Form. Please complete the Study Conclusion Unknown → Please specify the reason

Data type

text

Alias
UMLS CUI [1]
C2584946
If patient ist alive, enter date of contact
Description

If patient ist alive, enter date of contact

Data type

date

Alias
UMLS CUI [1,1]
C2584946
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C1705415
If unknown if patient is still alive, please specify reason
Description

If unknown if patient is still alive, please specify reason

Data type

text

Alias
UMLS CUI [1]
C2584946
UMLS CUI [2]
C0439673
UMLS CUI [3,1]
C0392360
UMLS CUI [3,2]
C2348235
If other reason, please specify
Description

If other reason, please specify

Data type

text

Alias
UMLS CUI [1,1]
C3840932
UMLS CUI [1,2]
C2348235
End of yearly Follow-up contact
Description

End of yearly Follow-up contact

Alias
UMLS CUI-1
C1522577
UMLS CUI-2
C0332158
UMLS CUI-3
C0444930
Is it the last Yearly Follow-up contact for this patient?
Description

Yes → Please complete the Study Conclusion. No → Please schedule the next Yearly Follow-up contact.

Data type

boolean

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C0332158
Anti-cancer therapy(ies) following last study treatment administration
Description

Anti-cancer therapy(ies) following last study treatment administration

Alias
UMLS CUI-1
C0920425
UMLS CUI-2
C3469597
UMLS CUI-3
C0304229
UMLS CUI-4
C1517741
Has the patient received any anti-cancer therapy(ies) following last study treatment administration?
Description

Yes → Please record any subsequent treatment the patient received

Data type

boolean

Alias
UMLS CUI [1]
C0920425
UMLS CUI [2,1]
C3469597
UMLS CUI [2,2]
C0304229
UMLS CUI [3]
C1517741
Subsequent treatment
Description

Subsequent treatment

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0332282
Type of therapy
Description

Type of therapy

Data type

text

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0087111
Specify
Description

Specify

Data type

text

Alias
UMLS CUI [1]
C2348235
Date of First Treatment administration/ surgery
Description

Date of First Treatment administration/ surgery

Data type

date

Alias
UMLS CUI [1,1]
C3469597
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C0205435
UMLS CUI [1,4]
C0011008
UMLS CUI [2,1]
C0543467
UMLS CUI [2,2]
C0205435
UMLS CUI [2,3]
C0011008
Date of last Treatment administration (Not applicable for surgery)
Description

Date of last Treatment administration (Not applicable for surgery)

Data type

date

Alias
UMLS CUI [1,1]
C3469597
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C1517741
UMLS CUI [1,4]
C0011008
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Similar models

Yearly Follow-up contact; Anti Cancer Therapy (Report Final and Annex Report 2 Final)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Adminstrative
C1320722 (UMLS CUI-1)
Patient Number
Item
Patient Number
text
C2348585 (UMLS CUI [1])
Item Group
Yearly Follow-up - Check for Follow-up contact
C1522577 (UMLS CUI-1)
C0332158 (UMLS CUI-2)
Item
Is the patient still alive?
text
C2584946 (UMLS CUI [1])
Is the patient still alive?
Code List
Is the patient still alive?
CL Item
Yes (Y)
CL Item
No (N)
CL Item
Unknown (U)
If patient ist alive, enter date of contact
Item
If patient ist alive, enter date of contact
date
C2584946 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1705415 (UMLS CUI [1,3])
Item
If unknown if patient is still alive, please specify reason
text
C2584946 (UMLS CUI [1])
C0439673 (UMLS CUI [2])
C0392360 (UMLS CUI [3,1])
C2348235 (UMLS CUI [3,2])
If unknown if patient is still alive, please specify reason
Code List
If unknown if patient is still alive, please specify reason
CL Item
Lost to follow-up  (LFU)
CL Item
Consent withdrawal  (CWS)
CL Item
Other, please specify (OTH)
If other reason, please specify
Item
If other reason, please specify
text
C3840932 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
End of yearly Follow-up contact
C1522577 (UMLS CUI-1)
C0332158 (UMLS CUI-2)
C0444930 (UMLS CUI-3)
Is it the last Yearly Follow-up contact for this patient?
Item
Is it the last Yearly Follow-up contact for this patient?
boolean
C1522577 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0332158 (UMLS CUI [1,3])
Item Group
Anti-cancer therapy(ies) following last study treatment administration
C0920425 (UMLS CUI-1)
C3469597 (UMLS CUI-2)
C0304229 (UMLS CUI-3)
C1517741 (UMLS CUI-4)
Has the patient received any anti-cancer therapy(ies) following last study treatment administration?
Item
Has the patient received any anti-cancer therapy(ies) following last study treatment administration?
boolean
C0920425 (UMLS CUI [1])
C3469597 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C1517741 (UMLS CUI [3])
Item Group
Subsequent treatment
C0087111 (UMLS CUI-1)
C0332282 (UMLS CUI-2)
Item
Type of therapy
text
C0332307 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Type of therapy
Code List
Type of therapy
CL Item
Surgery  (S)
CL Item
Biological response modifier (B)
CL Item
Chemotherapy  (C)
CL Item
Hormonal therapy  (H)
CL Item
Radiation  (R)
CL Item
Other  (O)
CL Item
Immunotherapy (I)
Specify
Item
Specify
text
C2348235 (UMLS CUI [1])
Date of First Treatment administration/ surgery
Item
Date of First Treatment administration/ surgery
date
C3469597 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C0205435 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C0543467 (UMLS CUI [2,1])
C0205435 (UMLS CUI [2,2])
C0011008 (UMLS CUI [2,3])
Date of last Treatment administration (Not applicable for surgery)
Item
Date of last Treatment administration (Not applicable for surgery)
date
C3469597 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
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