ID

43187

Descrição

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

Palavras-chave

Versões (3)
  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 20/09/2021 20/09/2021 -
Transferido a

20 de setembro de 2021

DOI

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Licença

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

Inglês

No Instruction available.

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

Header

SWOG Patient ID
Descrição

Trial subject ID SWOG

Tipo de dados

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.
Descrição

Protocol ID SWOG

Tipo de dados

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
Descrição

Registration Number

Tipo de dados

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
Descrição

Institution Name

Tipo de dados

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
Descrição

Investigator Name

Tipo de dados

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
Descrição

ParticipatingGroupName

Tipo de dados

text

Participating Group Protocol Number
Descrição

ParticipatingGroupProtocolNumber

Tipo de dados

float

Participating Group Patient ID
Descrição

Trial subject ID Participating Group

Tipo de dados

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
Descrição

Header

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

HasthepatientbeendiagnosedwithcontralateralinsitubreastcancersincethesubmissionofthelastFollow-upForm?

Tipo de dados

boolean

Date of diagnosis
Descrição

NewCancerDiagnosisDate

Tipo de dados

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?
Descrição

Neoplasm Recurrence, locoregional

Tipo de dados

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
Descrição

ProgressionDate,FirstLocal-Regional

Tipo de dados

date

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

ProgressionSite(s),FirstLocal-Regional

Tipo de dados

text

How was this progression information obtained?
Descrição

ProgressionAssessmentSource

Tipo de dados

text

How was this progression information obtained?
Descrição

ProgressionAssessmentSource

Tipo de dados

text

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

FirstProgressionDistantPresentInd-3

Tipo de dados

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
Descrição

ProgressionDate,FirstDistant

Tipo de dados

date

Site(s) of First Distant Progression
Descrição

ProgressionSite,FirstDistant

Tipo de dados

text

Other, NOS (site of first distant progression
Descrição

Other,NOS(siteoffirstdistantprogression

Tipo de dados

text

Comments
Descrição

Comments

Comments
Descrição

Research Comments

Tipo de dados

text

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

No Instruction available.

1 Formulários
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 SUPPLEMENTARY FOLLOW UP FORM
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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
CL.3
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
CL.7
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
CL.7
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
CL.6
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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