Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C2348585 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Item
Cause of Death
text
C0007465 (UMLS CUI [1])
CL Item
Progressive Disease (P)
CL Item
Toxicity: Haematologic (Complete Adverse Experience form) (H)
CL Item
Toxicity: Non-Haematologic (Complete Adverse Experience form) (N)
CL Item
Other, specify (Complete Adverse Experience form) (O)
Specify other cause of death
Item
Specify other cause of death
text
C0007465 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [2])
Date of Death
Item
Date of Death
date
C1148348 (UMLS CUI [1])
Was a post-mortem done?
Item
Was a post-mortem done?
boolean
C0004398 (UMLS CUI [1])
Please summarise autopsy findings
Item
Please summarise autopsy findings
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
C0011900 (UMLS CUI [1,3])
Physician's Signature
Item
Physician's Signature
text
C1519316 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Signature Date
Item
Signature Date
date
C0807937 (UMLS CUI [1])
Course Number
Item
Course Number
integer
C0237753 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
Item
If Course 1, please indicate the visit
integer
C0750729 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
Code List
If Course 1, please indicate the visit
CL Item
Prenext Course (2)
Date of Assessment
Item
Date of Assessment
date
C2985720 (UMLS CUI [1])
Item
Please mark the appropriate box to indicate month of report
integer
C0439231 (UMLS CUI [1,1])
C0684224 (UMLS CUI [1,2])
Code List
Please mark the appropriate box to indicate month of report
CL Item
Other, specify (9)
Specify Other month
Item
Specify Other month
text
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [2])
Has the patient died?
Item
Has the patient died?
boolean
C0011065 (UMLS CUI [1])
If patient died, enter date of last patient contact
Item
If patient died, enter date of last patient contact
date
C0805839 (UMLS CUI [1])
Was the patient lost to follow-up?
Item
Was the patient lost to follow-up?
boolean
C1302313 (UMLS CUI [1])
Item
Has disease progressed?
integer
C1335499 (UMLS CUI [1])
Code List
Has disease progressed?
CL Item
N/A (If patient progressed on study) (3)
Date of first documented disease progression since the Topotecan study conclusion
Item
Date of first documented disease progression since the Topotecan study conclusion
date
C0011008 (UMLS CUI [1,1])
C0242656 (UMLS CUI [1,2])
C1707478 (UMLS CUI [2,1])
C0146224 (UMLS CUI [2,2])
Item
Please mark box to indicate any post study cancer therapy received
integer
C1882428 (UMLS CUI [1,1])
C0920425 (UMLS CUI [1,2])
Code List
Please mark box to indicate any post study cancer therapy received
CL Item
Immunotherapy (6)
Chemotherapy - date treatment started
Item
Chemotherapy - date treatment started
date
C1531783 (UMLS CUI [1,1])
C0392920 (UMLS CUI [1,2])
Radiotherapy - date treatment started
Item
Radiotherapy - date treatment started
date
C1531783 (UMLS CUI [1,1])
C0392920 (UMLS CUI [1,2])
Surgery - date treatment started
Item
Surgery - date treatment started
date
C3173309 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
Hormonal - date treatment started
Item
Hormonal - date treatment started
date
C1531783 (UMLS CUI [1,1])
C0279025 (UMLS CUI [1,2])
Immunotherapy - date treatment started
Item
Immunotherapy - date treatment started
date
C1531783 (UMLS CUI [1,1])
C0021083 (UMLS CUI [1,2])
Item
Cause of Death
text
C0007465 (UMLS CUI [1])
CL Item
Progressive Disease (P)
CL Item
Other, specify (O)
Specify other Cause of Death
Item
Specify other Cause of Death
text
C0007465 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [2])
Date of Death
Item
Date of Death
date
C1148348 (UMLS CUI [1])
Was a post mortem done?
Item
Was a post mortem done?
boolean
C0004398 (UMLS CUI [1])
Summarise autopsy findings
Item
Summarise autopsy findings
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
Investigator's Signature
Item
Investigator's Signature
text
C2346576 (UMLS CUI [1])
Investigator's Signature Date
Item
Investigator's Signature Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])