Description:

CALGB 80702 Registration Worksheet Form Oxaliplatin, Leucovorin Calcium, and Fluorouracil With or Without Celecoxib in Treating Patients With Stage III Colon Cancer Previously Treated With Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7AD9533B-3CE6-57A8-E040-BB89AD434546

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7AD9533B-3CE6-57A8-E040-BB89AD434546

Keywords:
Versions (4) ▾
  1. 8/27/12
  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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Colorectal Cancer NCT01150045 Registration - CALGB 80702 Registration Worksheet Form - 2969752v1.0

A Phase III Trial of 6 Versus 12 Treatments of Adjuvant FOLFOX Plus Celecoxib or Placebo for Patients with Resected Stage III Colon Cancer

Header Module
Protocol Administration
Patient Demographics/pre-treatment Characteristics
Gender
Race (Mark all that apply)
Ethnicity (Mark one)
Patient Demographics/pre-treatment Characteristics2
Performance Status (ECOG/Zubrod scale)
cm
Kg
m2
Method of Payment (USA only Mark one)
Patient Demographics/pre-treatment Characteristics3
Certification Of Eligibility And Protocol Design
In the opinion of the investigator, is the patient eligible for 80702
In the opinion of the investigator, is the patient eligible for 150911
In the opinion of the investigator, is the patient eligible for 60905
Protocol Design
Initial Patient Consent For Specimen Use
Did the patient agree to participate in the Diet and Lifestyle study and complete the diet and lifestyle questionnaire
Patient's Initial Consent given for specimen use for research on the patient's cancer
Patient's initial consent given for blood specimen use for genetic research on patient's cancer?
Patient's Initial Consent given for specimen kept for future use in research to learn about, prevent, or treat cancer
Patient's Initial Consent given for specimen use for research unrelated to the patient's cancer?
Patient's initial consent given for further contact regarding specimen?
Notes
Registration Information

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