Description:

USMCI 8214/Z6091: Follow Up Form Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=620B3C7C-4FFC-9435-E040-BB89AD430464

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=620B3C7C-4FFC-9435-E040-BB89AD430464

Keywords:
Versions (4) ▾
  1. 8/27/12
  2. 1/9/15
  3. 1/9/15
  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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Colorectal Cancer NCT01167725 Follow-Up - USMCI 8214/Z6091: Follow Up Form - 2832822v1.0

No Instruction available.

  1. StudyEvent: USMCI 8214/Z6091: Follow Up Form
    1. No Instruction available.
Header Module
Visit
Visit time point
Vital Status
Were you able to obtain any information about the patient since the last report
Vital Status
Primary Cause of Death
Cancer Follow-up Status
Has the patient had a documented clinical assessment for this cancer?
First Peritoneal Surface Recurrence
Has the patient been diagnosed with first peritoneal surface recurrence/progression
Method of Evaluation
Was CT done
Anatomic region
First Distant Recurrence
Has the patient been diagnosed with first distant recurrence/progression? (since submission of the last follow-up form)
Site of First Distant Recurrence
Notice Of First Subsequent Treatment
Has the patient received subsequent treatment for this cancer that has not been previously reported
Subsequent Treatment Type
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Late Adverse Event
Has the patient experienced (prior to treatment for progression or relapse or a second primary, and prior to non-protocol treatment) any severe (grade >=3) long term toxicity that has not been previously reported?
Late Adverse Event Reporting
CTC Adverse Event Grade
CTC AE Attribution Code

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