E1305 Registration Worksheet (step 1) Chemotherapy With or Without Bevacizumab in Treating Patients With Recurrent or Metastatic Head and Neck Cancer Source Form: NCI FormBuilder:


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  1. 9/19/12
  2. 1/9/15
  3. 9/17/21
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September 17, 2021

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Head and Neck Cancer NCT00588770 Eligibility - E1305 Registration Worksheet (step 1) - 2750715v1.0

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  1. StudyEvent: E1305 Registration Worksheet (step 1)
    1. No Instruction available.
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained
Has HIPAA authorization been obtained
Planned Chemotherapy Regimen
ECOG Performance Status
Prior Radiation Therapy to head and neck
Weight Loss in Previous Six Months
I agree to participate in the laboratory research studies that are being done as part of this clinical trial.
My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.
My specimens may be kept for use in research about other health problems (for example: causes of diabetes, Alzheimer's disease, or heart disease). (for example: causes of diabetes, Alzheimer's disease, and heart disease)
Someone from this institution may contact me in the future to ask me to take part in more research.

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