ID

43180

Beschrijving

Phase II Consortium - Phase II Lung Cancer - SCLC On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=005B53D3-2C60-14E5-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=005B53D3-2C60-14E5-E044-0003BA3F9857

Trefwoorden

Lung Neoplasms

D016430

On-Study Form

Geüploaded op

20 september 2021

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

On-Study Form Lung Cancer - SCLC

model
Details

On-Study Form Lung Cancer - SCLC

1 Formulieren

StudyEvent: Phase II Lung Cancer - SCLC On-Study Form
1. On-Study Form Lung Cancer - SCLC

Name

Type

Description | Question | Decode (Coded Value)

Datatype

Alias

CRF Header

Item Group

CRF Header

C1320722 (UMLS CUI-1)

Protocol ID Coordinating Group

Item

Coordinating Group Protocol No.

text

C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Coordinating Group Code

Item

Coordinating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)

Protocol Title

Item

Protocol Title

text

C25191 (NCI Thesaurus ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
C2986303 (UMLS CUI-1)

Patient Study ID

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)

Registering Group Code

Item

Registering Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25645 (NCI Thesaurus ObjectClass-2)

Medical Record Number

Item

Patient Medical Record Number

text

C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)

Trial subject ID Participating Group

Item

Other Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Institution or Affiliate

Item

Institution/Affiliate

text

C25191 (NCI Thesaurus ValueDomain)
C25454 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ObjectClass-2)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI-1)

Registering Institution Code

Item

Registering Institution Code

text

C25162 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25645 (NCI Thesaurus ObjectClass-2)

Investigator Name

Item

Physician of Record

text

C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)

Person Completing Form

Item

Person Completing Form

text

C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)

Date Form Completed

Item

Date Form Completed (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)

Data amended

Item

Are data amended (If data are amended, please circle in red when using paper form)

boolean

C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)

Pre-Treatment Characteristics

Item Group

Lung: Pre-treatment Characteristics

Patient Weight

Item

Patient Weight (kg)

float

C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI-1)

Weight Loss past six months

Item

Weight Loss in Previous Six Months

integer

C25664 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C3445 (NCI Thesaurus Property)
C25613 (NCI Thesaurus ValueDomain-2)
C1262477 (UMLS CUI-1)
C3828652 (UMLS CUI-2)

CL.2

Code List

Weight Loss in Previous Six Months

CL Item

<5% Of Body Weight (1)

CL Item

5 To <10% Of Body Weight (2)

CL Item

10 To <20% Of Body Weight (3)

CL Item

> Or (4)

CL Item

Unknown (0)

Weight Loss past six months

Item

Weight loss in previous 6 months

integer

C16960 (NCI Thesaurus ObjectClass)
C3445 (NCI Thesaurus Property)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1262477 (UMLS CUI-1)
C3828652 (UMLS CUI-2)

Smoking history

Item

Smoking History

text

C25284 (NCI Thesaurus ValueDomain)
C1519384 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C18772 (NCI Thesaurus Property)

CL.3

Code List

Smoking History

CL Item

Never Smoked (Never smoked)

CL Item

Pipe Or Cigar Smoker Only (Pipe or cigar smoker only)

CL Item

Cigarette Smoker <20 Pack-years (Cigarette smoker, <20 pack-years)

CL Item

Cigarette Smoker 20-40 Pack-years (Cigarette smoker, 20-40 pack-years)

CL Item

Cigarette Smoker >40 Pack-years (Cigarette smoker, >40 pack-years)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Current Smoker

Item

Does the patient currently smoke

boolean

C38148 (NCI Thesaurus ValueDomain)
C3241966 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C17934 (NCI Thesaurus ObjectClass)
C0449865 (NCI Metathesaurus Property)

Smoker amount smoked

Item

Number of Cigarettes per day (If yes,)

text

C17934 (NCI Thesaurus ObjectClass)
C1608325 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C0449865 (NCI Metathesaurus Property)
C25473 (NCI Thesaurus ValueDomain)
C25515 (NCI Thesaurus ValueDomain-2)

CL.5

Code List

Number of Cigarettes per day (If yes,)

CL Item

Fewer Than 10 Cigarettes (Fewer than 10 cigarettes)

CL Item

10 To 20 Cigarettes (10 to 20 cigarettes)

CL Item

More Than 20 Cigarettes (More than 20 cigarettes)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

Smoking Discontinued Duration

Item

Time since last cigarette (If no,)

text

C25484 (NCI Thesaurus Property)
C0453997 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus ValueDomain)

CL.6

Code List

Time since last cigarette (If no,)

CL Item

Less Than 1 Month (Less than 1 month)

CL Item

1 Month To <6 Months (1 month to <6 months)

CL Item

6 Months To <1 Year (6 months to <1 year)

CL Item

1 Year To <5 Years (1 year to <5 years)

CL Item

5 Years To <10 Years (5 years to <10 years)

CL Item

More Than 10 Years (More than 10 years)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

Disease Description SCLC

Item Group

Lung: Disease Description Stage I-III

Extent of disease

Item

Extent of disease

text

C4917 (NCI Thesaurus ObjectClass)
C0449279 (UMLS CUI-1)
C25688 (NCI Thesaurus ValueDomain)
C20625 (NCI Thesaurus Property)

CL.7

Code List

Extent of disease

CL Item

Limited (Limited)

CL110648 (NCI Metathesaurus)

CL Item

Extensive (Extensive)

C47863 (NCI Thesaurus)
C0205231 (UMLS 2011AA)

CL Item

Recurrent (Recurrent)

C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)

Neoplasm Recurrence, locoregional

Item

Has the patient been diagnosed with first local-regional recurrence

boolean

C19987 (NCI Thesaurus ObjectClass)
C0027643 (UMLS CUI-1)
C25388 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C15220 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)

Duration until Neoplasm Recurrence, locoregional

Item

Time since diagnosis (If yes,)

text

C19987 (NCI Thesaurus ObjectClass)
C0027643 (UMLS CUI-1)
C25388 (NCI Thesaurus Property)
C2919551 (UMLS CUI-2)
C25509 (NCI Thesaurus Property-2)
C15220 (NCI Thesaurus Property-3)
C15220 (NCI Thesaurus ValueDomain)
C25330 (NCI Thesaurus ValueDomain-2)

CL.9

Code List

Time since diagnosis (If yes,)

CL Item

Less Than 3 Months (< 3 months)

CL Item

Greater Than Or Equal To 3 Months (>= 3 months)

Mixed histology

Item

Mixed histology?

boolean

C38148 (NCI Thesaurus ValueDomain)
C0019638 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C0205430 (UMLS CUI-2)
C16681 (NCI Thesaurus Property)
C26457 (NCI Thesaurus Property-2)

Histologic Type

Item

Histologic Type (If yes check all apply)

text

C3262 (NCI Thesaurus ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
C25372 (NCI Thesaurus ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0449574 (UMLS CUI-1)

CL.11

Code List

Histologic Type (If yes check all apply)

CL Item

Squamous Cell Carcinoma (Squamous cell carcinoma)

C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)

CL Item

Adenocarcinoma (Adenocarcinoma)

C2852 (NCI Thesaurus)
C0001418 (UMLS 2011AA)

CL Item

Large Cell Undifferentiated (Large cell undifferentiated)

CL Item

Non-small Cell Lung Cancer (nsclc), Nos (Non-small cell lung cancer NOS)

CL Item

Large Cell With Neuroendocrine Features (Large cell with neuroendocrine features)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C17649 (NCI Thesaurus-3)
C0205394 (UMLS 2011AA-4)

Histologic Type, other

Item

Specify Other Histologic Type

text

C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)

Measurable Disease

Item

Is measurable disease present? (only applicable in studies where there is disease at baseline)

boolean

C38148 (NCI Thesaurus ValueDomain)
C1513041 (UMLS CUI-1)
C25626 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C37894 (NCI Thesaurus ObjectClass-2)

Non-Measurable Disease

Item

Is non-measurable disease present? (only applicable in studies where there is disease at baseline)

boolean

C38148 (NCI Thesaurus ValueDomain)
C1334988 (UMLS CUI-1)
C25626 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C25589 (NCI Thesaurus ObjectClass-2)

Metastatic Sites

Item

Metastatic Sites (check all that apply)

text

C12468 (NCI Thesaurus ObjectClass)
C0280457 (UMLS CUI-1)
C9305 (NCI Thesaurus ObjectClass-2)
C14174 (NCI Thesaurus Property)
C25548 (NCI Thesaurus Property-2)
C13717 (NCI Thesaurus ValueDomain)

CL.14

Code List

Metastatic Sites (check all that apply)

CL Item

Hilar Nodes (Hilar nodes)

CL Item

Mediastinal Nodes (Mediastinal nodes)

CL Item

Supraclavicular Or Scalene Nodes (Supraclavicular/scalene nodes)

CL Item

Pleura (Pleura)

C12469 (NCI Thesaurus)
C0032225 (UMLS 2011AA)

CL Item

Liver (Liver)

C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)

CL Item

Adrenal Gland (Adrenal(s))

C12666 (NCI Thesaurus)
C0001625 (UMLS 2011AA)

CL Item

Bone (Bone)

C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)

CL Item

Bone Marrow (Bone marrow)

C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)

CL Item

Brain (Brain)

C12439 (NCI Thesaurus)
C0006104 (UMLS 2011AA)

CL Item

Skin (Skin)

C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

Metastatic Sites, other

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C0280457 (UMLS CUI-1)
C14174 (NCI Thesaurus Property)
C3844311 (UMLS CUI-2)
C9305 (NCI Thesaurus ObjectClass)
C25548 (NCI Thesaurus Property-2)

Pleural Effusion

Item

Is Pleural Effusion present?

boolean

C38148 (NCI Thesaurus ValueDomain)
C0032227 (UMLS CUI-1)
C12468 (NCI Thesaurus ObjectClass)
C3003 (NCI Thesaurus Property)
C25223 (NCI Thesaurus Property-2)

Malignant Pleural Effusion

Item

Is it Malignant? (If yes)

text

C12468 (NCI Thesaurus ObjectClass)
C0080032 (UMLS CUI-1)
C3003 (NCI Thesaurus Property)
C25223 (NCI Thesaurus Property-2)
C14143 (NCI Thesaurus ValueDomain)
C0021212 (NCI Metathesaurus ValueDomain)

CL.16

Code List

Is it Malignant? (If yes)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown (not tapped))

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Primary Site

Item

Lesion Site (Primary)

text

C13717 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C3824 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)

Primary Site MedDRA Code

Item

MedDRA Code (for Primary Disease Site)

text

C41331 (NCI Thesaurus ObjectClass)
C0449695 (UMLS CUI-1)
C71886 (NCI Thesaurus ObjectClass-2)
C1552878 (UMLS CUI-2)
C25162 (NCI Thesaurus Property)
C43820 (NCI Thesaurus Property-2)
C25162 (NCI Thesaurus ValueDomain)
C41331 (NCI Thesaurus ValueDomain-2)
C45255 (NCI Thesaurus ValueDomain-3)
C43820 (NCI Thesaurus ValueDomain-4)
C25714 (NCI Thesaurus ValueDomain-5)

Paraneoplastic syndrome

Item

Paraneoplastic syndrome

boolean

C38147 (NCI Thesaurus ValueDomain)
C0030472 (UMLS CUI-1)
C25626 (NCI Thesaurus Property)
C0030705 (NCI Metathesaurus ObjectClass)
C3311 (NCI Thesaurus Property-2)

Paraneoplastic syndrome, specify

Item

Specify (If yes)

text

C25685 (NCI Thesaurus ValueDomain)
C25626 (NCI Thesaurus Property)
C0030705 (NCI Metathesaurus ObjectClass)
C3311 (NCI Thesaurus Property-2)
C0030472 (UMLS CUI-1)
C1521902 (UMLS CUI-2)

Prior Treatment SCLC

Item Group

Lung: Prior Treatment (CDUS Module)

Prior therapy type

Item

Prior therapy type (per CDUS reporting guidelines check all that apply)

text

C25284 (NCI Thesaurus ValueDomain)
C1514463 (UMLS CUI-1)
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25365 (NCI Thesaurus Property)

CL.18

Code List

Prior therapy type (per CDUS reporting guidelines check all that apply)

CL Item

Agents Administered To Control The Replication And/or Spread Of Viruses (Anti-retroviral therapy)

CL Item

Treatment With An Agent That Prevents Or Impairs The Translation Of The Genetic Message For Production Of A Specific Protein (Antisense)

CL Item

High Dose Chemotherapy Combined With Transplantation Of Bone Marrow Cells (Bone marrow transplant)

CL Item

Non-systemic Chemotherapy Treatment Or Chemotherapy Not Described By Chemotherapy Single Agent Systemic Or Multi-agent Systemic (Chemotherapy (NOS))

CL Item

Systemic Chemotherapy With A Regimen Containing Multiple Agents (Chemotherapy multiple agents systemic)

CL Item

Prior Therapy With Agents That Are Not Known To Cause Damage To Cycling Cells (Chemotherapy non-cytotoxic)

CL Item

Systemic Chemotherapy With A Single Agent Regimen (Chemotherapy single agent systemic)

CL Item

Treatment Of Human Disease By Gene Transfer (Gene transfer)

CL Item

Cancer Therapy Which Incorporates Hormonal Manipulation (Hormonal therapy)

CL Item

Drug And/or Immunotherapy (Drug and/or Immunotherapy)

CL Item

No Previous Exposure To Drug (nos) (No prior therapy)

CL Item

Anticancer Treatment With A Live, Replication-competent Virus (Oncolytic virotherapy)

CL Item

Prior Therapy (nos) (Prior therapy NOS)

CL Item

Targeted Ionizing Radiation Therapy Utilizing Radioactive Implants Or Seeds (Radiation therapy)

CL Item

Surgical Procedure, Or Operation, With Therapeutic Intent (Surgery)

CL Item

Therapy Nos (Therapy (NOS))

CL Item

Substance Or Group Of Substances Administered To Induce The Immune System To Recognize And Destroy Tumors Or Microorganisms (Vaccine)

Number of prior therapy regimens

Item

Number of prior therapy regimens (For example, planned treatment of chemotherapy + RT = 1 regimen)

integer

C25629 (NCI Thesaurus ObjectClass)
C0750480 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass-2)
C25463 (NCI Thesaurus ValueDomain)
C0040808 (UMLS CUI-2)
C15697 (NCI Thesaurus Property)
C0332152 (UMLS CUI-3)

Primary Site MedDRA Code

Item

MedDRA Code (for Primary Disease Site)

text

Prior Systemic Therapy

Item Group

Prior Systemic Therapy - SCLC

Prior systemic therapy

Item

Prior systemic therapy

boolean

C38147 (NCI Thesaurus ValueDomain)
C1515119 (UMLS CUI-1)
C15698 (NCI Thesaurus ObjectClass)
C0332152 (UMLS CUI-2)
C25629 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)

Number of prior therapy regimens

Item

Number of prior therapy regimens (For example, planned treatment of chemotherapy + RT = 1 regimen)

integer

Agent

Item

Agent Name

text

C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)

Concomitant Medication Start Date

Item

Agent Start Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C2826734 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)

Concomitant Medication End Date

Item

Agent End Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C2826744 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)

Cumulative Dose Agent

Item

Agent Total Cumulative Dose

double

C1708 (NCI Thesaurus ObjectClass)
C2986497 (UMLS CUI-1)
C25470 (NCI Thesaurus ObjectClass-2)
C1521826 (UMLS CUI-2)
C25304 (NCI Thesaurus Property)
C25256 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)

Units

Item

Units

text

C25704 (NCI Thesaurus ValueDomain)
C1519795 (UMLS CUI-1)
C44278 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C25256 (NCI Thesaurus Property)

Overall Response Duration

Item

Overall Response Duration (weeks)

float

C25755 (NCI Thesaurus ObjectClass)
C0237585 (UMLS CUI-1)
C25605 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C25605 (NCI Thesaurus ValueDomain)
C25330 (NCI Thesaurus ValueDomain-2)

Prior Surgery

Item Group

Prior Surgery SCLC

Prior Surgery

Item

Prior Surgery

boolean

C38148 (NCI Thesaurus ValueDomain)
C0744961 (UMLS CUI-1)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)

Surgical Approach

Item

Surgical Approach

text

C25284 (NCI Thesaurus ValueDomain)
C0449446 (UMLS CUI-1)
C12468 (NCI Thesaurus ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)

CL.21

Code List

Surgical Approach

CL Item

Thoracotomy (thoracotomy)

CL Item

Thoracoscopy / Video-assisted (vats) (Thoracoscopy / Video-assisted (VATS))

CL Item

Thoracoscopy / Video-assisted (vats), With Conversion To Thoracotomy (Thoracoscopy / Video-assisted (VATS), with conversion to Thoracotomy)

Primary Surgery Type

Item

Primary Surgery Type

text

C25251 (NCI Thesaurus ObjectClass)
C0944781 (UMLS CUI-1)
C12468 (NCI Thesaurus ObjectClass-2)
C15329 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)

CL.22

Code List

Primary Surgery Type

CL Item

Exploration, No Resection (Exploration, No Resection)

CL Item

Segmentectomy (Segmentectomy)

CL Item

Wedge Resection (Wedge Resection)

CL Item

Lobectomy (Lobectomy)

C15272 (NCI Thesaurus)
C0023928 (UMLS 2011AA)

CL Item

Bilobectomy (Bilobectomy)

CL Item

Pneumonectomy (Pneumonectomy)

C15305 (NCI Thesaurus)
C0032284 (UMLS 2011AA)

Surgery Date

Item

Surgery Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C1628561 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C15329 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)

Prior Radiation Therapy

Item Group

Prior Radiation Therapy SCLC

Prior Radiation Therapy

Item

Prior Radiation Therapy

boolean

C38148 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C0332152 (UMLS CUI-2)
C25629 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)

Total Dose to Lung

Item

Total Dose to Lung (cGy)

float

C15313 (NCI Thesaurus ObjectClass)
C2169193 (UMLS CUI-1)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS CUI-2)
C25382 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)

Radiation Therapy End Date

Item

Radiation Therapy End Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C0806020 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
C25496 (NCI Thesaurus Property-2)

Prophylactic Cranial Irradiation

Item

Did the patient receive prophylactic cranial irradiation?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1514496 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25639 (NCI Thesaurus Property)
C15913 (NCI Thesaurus Property-2)

RT Daily Dose per Field

Item

RT Daily Dose per Field (If yes)

float

C15313 (NCI Thesaurus ObjectClass)
C25473 (NCI Thesaurus ObjectClass-2)
C13717 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C25488 (NCI Thesaurus ValueDomain)

Radiation Therapy Total Dose

Item

RT Total Dose

float

C25304 (NCI Thesaurus ValueDomain)
C2169193 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C25488 (NCI Thesaurus ValueDomain-2)
C25382 (NCI Thesaurus Property)

Units

Item

Units

text

C1708 (NCI Thesaurus ObjectClass)
C1519795 (UMLS CUI-1)
C25256 (NCI Thesaurus Property)
C25709 (NCI Thesaurus ValueDomain)

CL.29

Code List

Units

CL Item

Grays (Gy)

CL Item

Microcurie (mcCi)

Hyperfractionated Radiation Therapy

Item

Was radiation therapy hyperfractionated?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1831915 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C15745 (NCI Thesaurus ObjectClass-2)

Units

Item

Units

text

C1708 (NCI Thesaurus ObjectClass)
C1519795 (UMLS CUI-1)
C25256 (NCI Thesaurus Property)
C25709 (NCI Thesaurus ValueDomain)

CL.29

Code List

Units

CL Item

Grays (Gy)

CL Item

Microcurie (mcCi)

Radiation Therapy Body Site

Item

Radiation Therapy Site

text

C25191 (NCI Thesaurus ValueDomain)
C1997599 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C15313 (NCI Thesaurus ObjectClass)

Radiation Therapy Dose per Fraction

Item

RT Dose per Fraction

float

C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS CUI-1)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS CUI-2)
C25514 (NCI Thesaurus Property)
C1264633 (UMLS CUI-3)

Units

Item

Units

text

C1708 (NCI Thesaurus ObjectClass)
C1519795 (UMLS CUI-1)
C25256 (NCI Thesaurus Property)
C25709 (NCI Thesaurus ValueDomain)

CL.29

Code List

Units

CL Item

Grays (Gy)

CL Item

Microcurie (mcCi)

Total Number of Fractions

Item

Total Number of Fractions

integer

C25304 (NCI Thesaurus Property)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C1264633 (UMLS CUI-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS CUI-3)
C25514 (NCI Thesaurus Property-2)

Units

Item

Units

text

C1708 (NCI Thesaurus ObjectClass)
C1519795 (UMLS CUI-1)
C25256 (NCI Thesaurus Property)
C25709 (NCI Thesaurus ValueDomain)

CL.29

Code List

Units

CL Item

Grays (Gy)

CL Item

Microcurie (mcCi)

Unscheduled Interruptions in Radiation Therapy

Item

Were there any unscheduled interruptions in radiation therapy?

text

C25180 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C1512900 (UMLS CUI-2)
C25542 (NCI Thesaurus Property)

CL.30

Code List

Were there any unscheduled interruptions in radiation therapy?

CL Item

Yes, Due To Toxicity (Yes, due to toxicity)

CL Item

Yes, Due To Other Reason (Yes, due to other reasons)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

Radiation Therapy Interruptions Reason

Item

RT Interruptions Reason (Specify)

text

C25704 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C1512900 (UMLS CUI-2)
C25542 (NCI Thesaurus Property)
C0566251 (UMLS CUI-3)

Comments

Item Group

Comments

C0947611 (UMLS CUI-1)

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

Terug naar het begin van de pagina

ID

Beschrijving

Link

Trefwoorden

Versies (7)

Geüploaded op

DOI

Licentie

Model Commentaren :

Itemgroep Commentaren voor :

Item Commentaren voor :

On-Study Form Lung Cancer - SCLC

On-Study Form Lung Cancer - SCLC

Beschrijving

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Beschrijving

Datatype

Maateenheden

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Maateenheden

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Beschrijving