Description:

NCIC MA.32 Relapse/Progression Report Form A Phase III Randomized Trial of Metformin vs Placebo in Early Stage Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=80FF5860-630C-7873-E040-BB89AD43136F

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=80FF5860-630C-7873-E040-BB89AD43136F

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 11/9/12
  3. 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 NCT01101438 On-Study - NCIC MA.32 Relapse/Progression Report Form - 3019298v1.0

The aim of the "Relapse/Progression Report" is to collect progression (objective and/or CA125 progression) information as defined in the protocol. The "Relapse/Progression Report" should be completed and submitted within 8 weeks of disease progression.

Recurrence/progression - Questions
Recurrent disease
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
Recurrence
Has the patient been diagnosed with first local-regional recurrence (or progression)
Has the patient been diagnosed with first local-regional recurrence (or progression)
Sites (progression or relapse)
Sites (progression or relapse)
Method of Evaluation
Method of Evaluation
Method of Evaluation
Method of Evaluation
Type of imaging
Type of imaging
Type of imaging
Type of imaging
Has the patient been diagnosed with first distant recurrence/progression?
Site of First Distant Recurrence
Recurrence
Method of Evaluation
Method of Evaluation
Type of imaging
Type of imaging
Recurrence
Method of Evaluation
Method of Evaluation
Type of imaging
Type of imaging

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