ID
43227
Description
E2108 Step 2 On-Study Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E2EE15D-B7A5-69C7-E040-BB89AD431929
Link
Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 9/20/21 9/20/21 -
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September 20, 2021
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01242800 On-Study - E2108 Step 2 On-Study Form - 3130597v1.0
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
- StudyEvent: E2108 Step 2 On-Study Form
Description
Unnamed2
Description
Patient Initials
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Protocol Number ECOG
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C1512162
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25491
Description
Study Number Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
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
Description
Patient ID ECOG
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1512162
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25491
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
Description
Unnamed4
Description
Data amended
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Description
Data amended date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property
- C25416
- NCI Thesaurus ValueDomain-2
- C25367
Description
Unnamed3
Description
ECOG Performance Status
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1520224
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ValueDomain-2
- C25491
- NCI Thesaurus ObjectClass
- C20641
Description
Patient Weight
Data type
float
Measurement units
- Kg
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005910
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25208
Description
PatientMenopauseStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C3231
- UMLS 2011AA Property
- C0025320
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
Disease Description
Description
BreastCytogeneticsHER2/neuPolyclonalAntibodyTestScore
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus ObjectClass-2
- C16487
- UMLS 2011AA ObjectClass-2
- C0010802
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus Property-2
- C17756
- UMLS 2011AA Property-2
- C0242957
- NCI Thesaurus Property-3
- C61381
- UMLS 2011AA Property-3
- C0312586
- NCI Thesaurus ValueDomain
- C25338
- UMLS 2011AA ValueDomain
- C0449820
Description
FISHAssessmentChromosome17ResultHER2NeuNumber
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus ObjectClass-2
- C17563
- UMLS 2011AA ObjectClass-2
- C0162789
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C13212
- UMLS 2011AA Property-2
- C0008659
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ValueDomain-2
- C17756
- UMLS 2011AA ValueDomain-2
- C0242957
Description
DataUnknownText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C17998
- UMLS 2011AA Property
- C0439673
Description
ERLevelTumorStatus
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C3262
- UMLS 2011AA ValueDomain
- C0027651
- NCI Thesaurus ObjectClass
- C17069
- UMLS 2011AA ObjectClass
- C0034804
- NCI Thesaurus ValueDomain-2
- C25688
- UMLS 2011AA ValueDomain-2
- C0449438
- NCI Thesaurus Property
- C25554
- UMLS 2011AA Property
- C0441889
Description
PgRStatusType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C17075
- UMLS 2011AA ObjectClass
- C0034833
- NCI Metathesaurus Property
- C0678257
Description
OppositeBreastInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus Property
- C25547
- NCI Thesaurus ObjectClass-2
- C25602
- UMLS 2011AA ObjectClass-2
- C1521805
Description
DistantLymphNodeInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
- NCI Thesaurus ObjectClass-2
- C25321
- UMLS 2011AA ObjectClass-2
- C0443203
- NCI Thesaurus Property
- C25547
Description
DistantTissueSubcutaneousInvolvedSkinInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25321
- UMLS 2011AA ObjectClass
- C0443203
- NCI Thesaurus ObjectClass-2
- C12801
- UMLS 2011AA ObjectClass-2
- C0040300
- NCI Thesaurus Property
- C25547
- NCI Thesaurus Property-2
- C13353
- UMLS 2011AA Property
- C0443315
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ValueDomain-2
- C12470
- UMLS 2011AA ValueDomain-2
- C1123023
Description
BoneInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12366
- UMLS 2011AA ObjectClass
- C0262950
- NCI Thesaurus Property
- C25547
Description
BoneMarrowInvolvementInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12431
- UMLS 2011AA ObjectClass
- C0005953
- NCI Thesaurus Property
- C25548
- UMLS 2011AA Property
- C1314939
Description
LungInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12468
- UMLS 2011AA ObjectClass
- C0024109
- NCI Thesaurus Property
- C25547
Description
MalignantNeoplasmLiverMetastaticInvolvementInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus Property-2
- C12392
- UMLS 2011AA Property-2
- C0023884
- NCI Thesaurus Property-3
- C25548
- UMLS 2011AA Property-3
- C1314939
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
PleuraInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12469
- UMLS 2011AA ObjectClass
- C0032225
- NCI Thesaurus Property
- C25547
Description
BrainInvolvedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12439
- UMLS 2011AA ObjectClass
- C0006104
- NCI Thesaurus Property
- C25547
Description
OtherCNSInvolvedSiteInd-3
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus ObjectClass-2
- C12438
- UMLS 2011AA ObjectClass-2
- C3714787
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus Property-2
- C25547
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
MalignantNeoplasmMetastaticInvolvementInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C14174
- UMLS 2011AA Property
- C0036525
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property-2
- C25548
- UMLS 2011AA Property-2
- C1314939
Description
TumorExtensionSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus Property
- C25270
- UMLS 2011AA Property
- C0231448
Description
Treatment Plan
Description
TreatmentPlanAdditionalChemotherapyAdministrationTherapyInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C60735
- UMLS 2011AA ObjectClass
- C0599880
- NCI Thesaurus Property
- C15632
- UMLS 2011AA Property
- C0392920
- NCI Thesaurus Property-2
- C25406
- UMLS 2011AA Property-2
- C1524062
- NCI Thesaurus Property-3
- C25409
- UMLS 2011AA Property-3
- C1533734
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
TreatmentPlanAdditionalEndocrineTherapyAdministrationTherapyInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C60735
- UMLS 2011AA ObjectClass
- C0599880
- NCI Thesaurus Property
- C15445
- UMLS 2011AA Property
- C0279025
- NCI Thesaurus Property-2
- C25406
- UMLS 2011AA Property-2
- C1524062
- NCI Thesaurus Property-3
- C25409
- UMLS 2011AA Property-3
- C1533734
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
Overall Response Per Recist Criteria - Target, Nontarget And New Lesions
Description
CirculatingTumorCellSpecimenCollectionInd-2
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C25453
- UMLS 2011AA Property
- C1516698
- NCI Thesaurus ObjectClass
- C63797
- UMLS 2011AA ObjectClass
- C0027625
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
Description
LaboratoryProcedureCirculatingTumorCellResultDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C63797
- UMLS 2011AA Property-2
- C0027625
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
Description
CirculatingTumorCellSpecimenCollectionCount
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus Property
- C25453
- UMLS 2011AA Property
- C1516698
- NCI Thesaurus ObjectClass
- C63797
- UMLS 2011AA ObjectClass
- C0027625
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
Description
Comments
Description
Investigator Signature
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Description
Investigator Signature Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- UMLS CUI-2
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
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INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
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C1314939 (UMLS 2011AA Property-2)
C0439673 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25270 (NCI Thesaurus Property)
C0231448 (UMLS 2011AA Property)
C0599880 (UMLS 2011AA ObjectClass)
C15632 (NCI Thesaurus Property)
C0392920 (UMLS 2011AA Property)
C25406 (NCI Thesaurus Property-2)
C1524062 (UMLS 2011AA Property-2)
C25409 (NCI Thesaurus Property-3)
C1533734 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0599880 (UMLS 2011AA ObjectClass)
C15445 (NCI Thesaurus Property)
C0279025 (UMLS 2011AA Property)
C25406 (NCI Thesaurus Property-2)
C1524062 (UMLS 2011AA Property-2)
C25409 (NCI Thesaurus Property-3)
C1533734 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C63797 (NCI Thesaurus ObjectClass)
C0027625 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C0750480 (UMLS 2011AA ValueDomain)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C63797 (NCI Thesaurus ObjectClass)
C0027625 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)