ID

43187

Description

SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BACD42B3-A5E1-6833-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BACD42B3-A5E1-6833-E034-0003BA12F5E7

Keywords

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/20/21 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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    Breast Cancer NCT00070564 Follow-Up - SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM - 2101304v3.0

    No Instruction available.

    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM
      1. No Instruction available.
    Header
    Description

    Header

    SWOG Patient ID
    Description

    Trial subject ID SWOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    SWOG Study No.
    Description

    Protocol ID SWOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Registration Step
    Description

    Registration Number

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Institution/Affiliate
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Physician
    Description

    Investigator Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Participating Group Name
    Description

    ParticipatingGroupName

    Data type

    text

    Participating Group Protocol Number
    Description

    ParticipatingGroupProtocolNumber

    Data type

    float

    Participating Group Patient ID
    Description

    Trial subject ID Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Header
    Description

    Header

    Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
    Description

    HasthepatientbeendiagnosedwithcontralateralinsitubreastcancersincethesubmissionofthelastFollow-upForm?

    Data type

    boolean

    Date of diagnosis
    Description

    NewCancerDiagnosisDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Has the patient been diagnosed with first local-regional recurrence since submission of last follow-up form?
    Description

    Neoplasm Recurrence, locoregional

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C19987
    UMLS CUI-1
    C0027643
    NCI Thesaurus Property
    C25388
    NCI Thesaurus Property-2
    C25509
    NCI Thesaurus Property-3
    C15220
    NCI Thesaurus ValueDomain
    C38148
    Date of First Local-Regional Progression
    Description

    ProgressionDate,FirstLocal-Regional

    Data type

    date

    Site(s) of First Local-Regional Progression (select all that apply)
    Description

    ProgressionSite(s),FirstLocal-Regional

    Data type

    text

    How was this progression information obtained?
    Description

    ProgressionAssessmentSource

    Data type

    text

    How was this progression information obtained?
    Description

    ProgressionAssessmentSource

    Data type

    text

    Has the patient been diagnosed with first distant recurrence/progression since submission of last follow-up form?
    Description

    FirstProgressionDistantPresentInd-3

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C19987
    UMLS 2011AA ObjectClass
    C0242656
    NCI Thesaurus Property
    C25321
    UMLS 2011AA Property
    C0443203
    NCI Thesaurus Property-2
    C25509
    UMLS 2011AA Property-2
    C1279901
    NCI Thesaurus Property-3
    C15220
    UMLS 2011AA Property-3
    C0011900
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Date of First Distant Progression
    Description

    ProgressionDate,FirstDistant

    Data type

    date

    Site(s) of First Distant Progression
    Description

    ProgressionSite,FirstDistant

    Data type

    text

    Other, NOS (site of first distant progression
    Description

    Other,NOS(siteoffirstdistantprogression

    Data type

    text

    Comments
    Description

    Comments

    Comments
    Description

    Research Comments

    Data type

    text

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

    Similar models

    No Instruction available.

    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Investigator Name
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    ParticipatingGroupName
    Item
    Participating Group Name
    text
    ParticipatingGroupProtocolNumber
    Item
    Participating Group Protocol Number
    float
    Trial subject ID Participating Group
    Item
    Participating Group 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)
    HasthepatientbeendiagnosedwithcontralateralinsitubreastcancersincethesubmissionofthelastFollow-upForm?
    Item
    Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
    boolean
    NewCancerDiagnosisDate
    Item
    Date of diagnosis
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    Neoplasm Recurrence, locoregional
    Item
    Has the patient been diagnosed with first local-regional recurrence since submission of last follow-up form?
    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)
    ProgressionDate,FirstLocal-Regional
    Item
    Date of First Local-Regional Progression
    date
    Item
    Site(s) of First Local-Regional Progression (select all that apply)
    text
    Code List
    Site(s) of First Local-Regional Progression (select all that apply)
    CL Item
    Ipsilateral Breast (Ipsilateral Breast)
    CL Item
    Axillary Breast (Axillary Breast)
    CL Item
    Supraclavicular nodes (Supraclavicular nodes)
    CL Item
    Chest wall (Chest wall)
    CL Item
    Internal mammary nodes (Internal mammary nodes)
    CL Item
    Infraclavicular nodes (Infraclavicular nodes)
    CL Item
    Axilla (Axilla)
    Item
    How was this progression information obtained?
    text
    Code List
    How was this progression information obtained?
    CL Item
    Clinical Assessment (Clinical assessment)
    CL Item
    Patient Self Report Only (Patient self-report only)
    Item
    How was this progression information obtained?
    text
    Code List
    How was this progression information obtained?
    CL Item
    Clinical Assessment (Clinical assessment)
    CL Item
    Patient Self Report Only (Patient self-report only)
    FirstProgressionDistantPresentInd-3
    Item
    Has the patient been diagnosed with first distant recurrence/progression since submission of last follow-up form?
    boolean
    C19987 (NCI Thesaurus ObjectClass)
    C0242656 (UMLS 2011AA ObjectClass)
    C25321 (NCI Thesaurus Property)
    C0443203 (UMLS 2011AA Property)
    C25509 (NCI Thesaurus Property-2)
    C1279901 (UMLS 2011AA Property-2)
    C15220 (NCI Thesaurus Property-3)
    C0011900 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    ProgressionDate,FirstDistant
    Item
    Date of First Distant Progression
    date
    Item
    Site(s) of First Distant Progression
    text
    Code List
    Site(s) of First Distant Progression
    CL Item
    Bone (bone)
    C12366 (NCI Thesaurus)
    C0262950 (UMLS 2011AA)
    CL Item
    Central Nervous System (braine)
    C12438 (NCI Thesaurus)
    C3714787 (UMLS 2011AA)
    CL Item
    Central Nervous System (other CNS)
    C12438 (NCI Thesaurus)
    C3714787 (UMLS 2011AA)
    CL Item
    Liver (liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Lymph Nodes (distant) (nodes)
    CL Item
    Specify Other Location Not Described (other soft tissue)
    CL Item
    Lung (lung/pleura)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    CL Item
    Skin (skin)
    C12470 (NCI Thesaurus)
    C1123023 (UMLS 2011AA)
    CL Item
    Specify Other Location Not Described (other visceral)
    CL Item
    Other, Generalized, Nos, Carcinomatosis (other, NOS)
    Other,NOS(siteoffirstdistantprogression
    Item
    Other, NOS (site of first distant progression
    text
    Item Group
    Comments
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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