Description:

NSABP PROTOCOL B-38: FOLLOW-UP FORM - Form F38 NCT00093795 Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Positive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DAB4C879-F3AC-4161-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DAB4C879-F3AC-4161-E034-0003BA12F5E7

Keywords:
Versions (4) ▾
  1. 8/26/12
  2. 1/9/15
  3. 7/5/15
  4. 9/20/21
Uploaded on:

September 20, 2021

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL B-38: FOLLOW-UP FORM - Form F38 NCT00093795

No Instruction available.

  1. StudyEvent: NSABP PROTOCOL B-38: FOLLOW-UP FORM - Form F38
    1. No Instruction available.
Header module
Are data amended?
Vital Status
Patient's Vital Status
Source of Survival Information (if alive)
Primary Cause of Death
Was there evidence of recurrence at the time of death?
Cancer Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the last follow-up form)?
Hormonal Therapy
Since the last follow-up, has the patient started any hormonal therapy per protocol (tamoxifen or aromatase inhibitor)?
First Local-regional Recurrence
Has the patient been diagnosed with first local-regional recurrence (since submission of the last follow-up form)?
Site(s) of First Local-Regional Recurrence
First Distant Recurrence
Has the patient been diagnosed with first distant recurrence/progression (since submission of the last follow-up form)?
New Primary Cancer Or Mds
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Is this the first time Page 2 of Form F38 has been completed for this patient?
Is this the first time Page 2 of Form F38 has been completed for this patient?
If Yes, Answer The Questions In This Column.
Did the patient receive any Herceptin treatment? (since randomization)
Did the patient receive any systemic hormonal treatment? (If yes, answer for each listed treatment.)
Tamoxifen
Anastrozole
Exemestane
Letrozole
Raloxifene
LHRH agonist
Other
If No, Answer The Questions In This Column.
Did the patient receive any Herceptin treatment? (since randomization)
Did the patient receive any systemic hormonal treatment? (If yes, answer for each listed treatment.)
Tamoxifen
Anastrozole
Exemestane
Letrozole
Raloxifene
LHRH agonist
Other

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