Description:

Lung Cancer - Localized Disease Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A8FE-3FA4-E034-080020C9C0E0

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A8FE-3FA4-E034-080020C9C0E0

Keywords:
Versions (4) ▾
  1. 9/19/12
  2. 1/9/15
  3. 1/9/15
  4. 9/17/21
Uploaded on:

September 17, 2021

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Lung Cancer - Localized Disease Follow-Up Form - 2019386v2.31

No Instruction available.

  1. StudyEvent: Lung Cancer - Localized Disease Follow-Up Form
    1. No Instruction available.
Crf Header
Tbd
Vital Status
Primary Cause of Death
Tbd
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Information On Progression Or Relapse Of Localized Lung Cancer (both Nsclc And Sclc Trials)
Has the patient developed a first progression (or relapse) that has not been previously reported?
Lung
Liver
Pleura
CNS (excluding Brain)
Brain
Bone
Opposite Lung
Regional Lymph Nodes
Distant Lymph Nodes
Distant Skin/subcutaneous Tissue
Other
Disease Progression Site was within Radiation Portal (use only for protocols with radiation therapy)
Disease Progression Site was outside Radiation Portal
Tbd
Is the patient receiving any non-protocol cancer therapy not previously reported?
Non-Protocol Hormonal Therapy?
Non-Protocol Chemotherapy
Non-Protocol Immunotherapy?
Non-Protocol Biologic Response Modifier?
Non-Protocol High Dose Chemotherapy/Autologous Stem Cell Transplant
Non-Protocol Radiation Therapy?
Non-Protocol Surgery?
Other Non-Protocol Therapy
Tbd
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Tbd
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity that has not been previously reported
Allows Documentation Of Any Additional Cooments

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