ID

43361

Beschrijving

E2805 Renal Cell Carcinoma On-Study Form NCT00326898 Sunitinib or Sorafenib in Treating Patients With Kidney Cancer That Was Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=053ADDEA-1681-66BC-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=053ADDEA-1681-66BC-E044-0003BA3F9857

Trefwoorden

Versies (4)
  1. 18-12-14 18-12-14 - Martin Dugas
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 16-06-15 16-06-15 -
  4. 20-09-21 20-09-21 -
Geüploaded op

20 september 2021

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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E2805 Renal Cell Carcinoma On-Study Form NCT00326898

Engels

INSTRUCTIONS: Complete this form at the end of each cycle (1 cycle = 3 weeks), and at required follow-ups if specified by the Long-Term Follow-Up Form (to report late adverse events).

1 Formulieren  
Header
Beschrijving

Header

ECOG Protocol Number
Beschrijving

Protocol Number ECOG

Datatype

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
DCI Name
Beschrijving

Generic drug form

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C3242750
NCI Thesaurus Property
C19464
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus ObjectClass-2
C25452
Registration Step
Beschrijving

Registration Number

Datatype

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
Reporting Period
Beschrijving

Clinical Trial Period

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2347804
NCI Thesaurus ObjectClass
C25214
NCI Thesaurus Property
C25616
NCI Thesaurus ObjectClass-2
C25651
Participating Group Protocol Number
Beschrijving

Study Number Participating Group

Datatype

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
Institution/Affiliate
Beschrijving

Institution Name

Datatype

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
Data amendment
Beschrijving

Data amendment

Please mark an 'X' if data have been amended
Beschrijving

Data amended

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Date data amended
Beschrijving

Data amended date

Datatype

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
Patient demographics
Beschrijving

Patient demographics

ECOG Patient ID
Beschrijving

Patient ID ECOG

Datatype

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
ECOG Performance Status (Prior to Surgery)
Beschrijving

ECOG Performance Status

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS CUI-1
C1520224
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain-2
C25491
NCI Thesaurus ObjectClass
C20641
Mark an 'X' if N/A
Beschrijving

DataUnknownText

Datatype

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
History Of Disease
Beschrijving

History Of Disease

Does the patient have a history of thromboembolic events
Beschrijving

PersonThromboembolismPersonalMedicalHistoryInd-3

Datatype

boolean

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Metathesaurus Property
C0040038
Does the patient have a history of cardiovascular disease
Beschrijving

CardiovascularDiseasePresentInd-2

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C25292
UMLS 2011AA ObjectClass
C0007226
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
Date of Initial Pathologic Diagnosis
Beschrijving

CancerInitialDiagnosisDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C15220
UMLS 2011AA Property-2
C0011900
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Date of Most Recent Prior Recurrence
Beschrijving

RecurrentDiseasePriorOnsetMostRecentDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C14173
UMLS 2011AA ObjectClass
C2945760
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C25279
UMLS 2011AA Property-2
C0332162
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25577
UMLS 2011AA ValueDomain-2
C1513491
Descriptionof Primary Disease
Beschrijving

Descriptionof Primary Disease

Clinical T Stage
Beschrijving

RenalCellCarcinomaClinicalTStage

Datatype

text

Alias
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus ObjectClass
C9385
UMLS 2011AA ObjectClass
C0007134
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus Property-2
C25728
UMLS 2011AA Property-2
C0475455
Clinical N Stage
Beschrijving

RenalCellCarcinomaClinicalNStage

Datatype

text

Alias
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus ObjectClass
C9385
UMLS 2011AA ObjectClass
C0007134
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus Property-2
C25580
UMLS 2011AA Property-2
C0456532
Clinical M Stage
Beschrijving

RenalCellCarcinomaClinicalMStage

Datatype

text

Alias
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus ObjectClass
C9385
UMLS 2011AA ObjectClass
C0007134
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus Property-2
C25727
UMLS 2011AA Property-2
C0456533
Description Of Current Disease
Beschrijving

Description Of Current Disease

How was disease discovered
Beschrijving

RenalCellCarcinomaDiagnosisType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C9385
UMLS 2011AA ObjectClass
C0007134
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Current Disease Symptoms
Beschrijving

Current Disease Symptoms

Hematuria (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryHematuriaPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus Property-4
C3090
UMLS 2011AA Property-4
C0018965
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Dyspnea (Disease symptoms present prior to surgery)
Beschrijving

DyspneaSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C2998
UMLS 2011AA ObjectClass
C0013404
NCI Thesaurus ObjectClass-2
C4876
UMLS 2011AA ObjectClass-2
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Pain (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryPainPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C3303
UMLS 2011AA Property-3
C0030193
NCI Thesaurus Property-4
C25629
UMLS 2011AA Property-4
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Chills (Disease symptoms present prior to surgery)
Beschrijving

ChillsSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus ObjectClass-2
C35143
UMLS 2011AA ObjectClass-2
C0085593
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Fatigue (Disease symptoms present prior to surgery)
Beschrijving

FatigueSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C3036
UMLS 2011AA ObjectClass
C0015672
NCI Thesaurus ObjectClass-2
C4876
UMLS 2011AA ObjectClass-2
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Fever >38 degrees C or 100 degrees F (Disease symptoms present prior to surgery)
Beschrijving

FeverSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus ObjectClass-2
C3038
UMLS 2011AA ObjectClass-2
C0015967
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Night sweats (Disease symptoms present prior to surgery)
Beschrijving

NightSweatsSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus Property-4
C3279
UMLS 2011AA Property-4
C0028081
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Weight loss >= 10% (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryWeightLossPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C3445
UMLS 2011AA Property-3
C1262477
NCI Thesaurus Property-4
C25629
UMLS 2011AA Property-4
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Elevated LDH (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryElevatedLactateDehydrogenasePresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus Property-4
C25493
UMLS 2011AA Property-4
C0205250
NCI Thesaurus Property-5
C25184
UMLS 2011AA Property-5
C0022917
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Low hemoglobin (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryReducedHemoglobinPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C25640
UMLS 2011AA Property-2
C0392756
NCI Thesaurus Property-3
C17173
UMLS 2011AA Property-3
C0038894
NCI Thesaurus Property-4
C16676
UMLS 2011AA Property-4
C0019046
NCI Thesaurus Property-5
C25629
UMLS 2011AA Property-5
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Elevated serum calcium (Disease symptoms present prior to surgery)
Beschrijving

CalciumElevatedSymptomPriorSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C331
UMLS 2011AA ObjectClass
C0006675
NCI Thesaurus ObjectClass-2
C25493
UMLS 2011AA ObjectClass-2
C0205250
NCI Thesaurus ObjectClass-3
C4876
UMLS 2011AA ObjectClass-3
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Other symptoms (Disease symptoms present prior to surgery)
Beschrijving

SymptomPriorSurgeryOtherPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus Property-3
C17173
UMLS 2011AA Property-3
C0038894
NCI Thesaurus Property-4
C25629
UMLS 2011AA Property-4
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Hematuria (Disease symptoms present after surgery)
Beschrijving

SymptomPostSurgeryHematuriaPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus Property-4
C3090
UMLS 2011AA Property-4
C0018965
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Dyspnea (Disease symptoms present after surgery)
Beschrijving

DyspneaSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C2998
UMLS 2011AA ObjectClass
C0013404
NCI Thesaurus ObjectClass-2
C4876
UMLS 2011AA ObjectClass-2
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Pain (Disease symptoms present after surgery)
Beschrijving

PainSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C3303
UMLS 2011AA Property-3
C0030193
NCI Thesaurus Property-4
C38008
UMLS 2011AA Property-4
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Chills (Disease symptoms present after surgery)
Beschrijving

ChillsSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus ObjectClass-2
C35143
UMLS 2011AA ObjectClass-2
C0085593
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Fatigue (Disease symptoms present after surgery)
Beschrijving

FatigueSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C3036
UMLS 2011AA ObjectClass
C0015672
NCI Thesaurus ObjectClass-2
C4876
UMLS 2011AA ObjectClass-2
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Fever >38 degrees C or 100 degrees F (Disease symptoms present after surgery)
Beschrijving

FeverSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus ObjectClass-2
C3038
UMLS 2011AA ObjectClass-2
C0015967
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Night sweats (Disease symptoms present after surgery)
Beschrijving

NightSweatsSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus Property-4
C3279
UMLS 2011AA Property-4
C0028081
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Weight loss >= 10% (Disease symptoms present after surgery)
Beschrijving

SymptomPostSurgeryWeightLossPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C3445
UMLS 2011AA Property-3
C1262477
NCI Thesaurus Property-4
C38008
UMLS 2011AA Property-4
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Elevated LDH (Disease symptoms present after surgery)
Beschrijving

SymptomPostSurgeryElevatedLactateDehydrogenasePresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus Property-4
C25493
UMLS 2011AA Property-4
C0205250
NCI Thesaurus Property-5
C25184
UMLS 2011AA Property-5
C0022917
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Low hemoglobin (Disease symptoms present after surgery)
Beschrijving

HemoglobinDecreaseSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16676
UMLS 2011AA ObjectClass
C0019046
NCI Thesaurus ObjectClass-2
C4876
UMLS 2011AA ObjectClass-2
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Elevated serum calcium (Disease symptoms present after surgery)
Beschrijving

CalciumElevatedSymptomPostSurgeryPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C331
UMLS 2011AA ObjectClass
C0006675
NCI Thesaurus ObjectClass-2
C25493
UMLS 2011AA ObjectClass-2
C0205250
NCI Thesaurus ObjectClass-3
C4876
UMLS 2011AA ObjectClass-3
C1457887
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C17173
UMLS 2011AA Property-2
C0038894
NCI Thesaurus Property-3
C38008
UMLS 2011AA Property-3
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Other symptoms (Disease symptoms present after surgery)
Beschrijving

SymptomPostSurgeryOtherPresentInd-3

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus Property-3
C17173
UMLS 2011AA Property-3
C0038894
NCI Thesaurus Property-4
C38008
UMLS 2011AA Property-4
C0687676
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Specify other symptoms (Disease symptoms present after surgery)
Beschrijving

SymptomPriorSurgeryOtherPresentSpecify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4876
UMLS 2011AA ObjectClass
C1457887
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus Property-3
C17173
UMLS 2011AA Property-3
C0038894
NCI Thesaurus Property-4
C25629
UMLS 2011AA Property-4
C0332152
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Muga Scanning
Beschrijving

Muga Scanning

Date of assessment
Beschrijving

HeartMUGATestDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C38073
UMLS 2011AA Property
C0521317
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
Left Ventricular Ejection Fraction at Rest
Beschrijving

HeartLVEFTestPercentageValue

Datatype

float

Maateenheden
  • %
Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
%
LVEF Institutional Lower Limit of Normal
Beschrijving

HeartLVEFTestPercentageLowerLimitofNormalValue

Datatype

float

Maateenheden
  • %
Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
NCI Thesaurus ValueDomain-3
C25555
UMLS 2011AA ValueDomain-3
C1518030
%
Date of assessment (Note: If patient was unable to obtain MUGA scan due to the shortage of the isotope Technetium-99, an ECHO may be substituted - at baseline and all subsequent visits for new patients. In this case, fill in the section below.)
Beschrijving

EchocardiogramDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C37945
UMLS 2011AA ObjectClass
C2243117
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Footer Module
Beschrijving

Footer Module

Investigator Signature
Beschrijving

Investigator Signature

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
Investigator Signature Date
Beschrijving

Investigator Signature Date

Datatype

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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Similar models

INSTRUCTIONS: Complete this form at the end of each cycle (1 cycle = 3 weeks), and at required follow-ups if specified by the Long-Term Follow-Up Form (to report late adverse events).

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Generic drug form
Item
DCI Name
text
C25191 (NCI Thesaurus ValueDomain)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-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)
Item
Reporting Period
text
C25284 (NCI Thesaurus ValueDomain)
C2347804 (UMLS CUI-1)
C25214 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C25651 (NCI Thesaurus ObjectClass-2)
CL.1
Code List
Reporting Period
CL Item
Baseline (Baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
Study Number Participating Group
Item
Participating Group Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-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)
Item Group
Data amendment
Data amended
Item
Please mark an 'X' if data have been amended
text
C25704 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Data amended date
Item
Date data amended
date
C25164 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Item Group
Patient demographics
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Item
ECOG Performance Status (Prior to Surgery)
text
C25664 (NCI Thesaurus ValueDomain)
C1520224 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C25491 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
CL.2
Code List
ECOG Performance Status (Prior to Surgery)
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
CL Item
Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
CL Item
Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
DataUnknownText
Item
Mark an 'X' if N/A
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C17998 (NCI Thesaurus Property)
C0439673 (UMLS 2011AA Property)
Item Group
History Of Disease
PersonThromboembolismPersonalMedicalHistoryInd-3
Item
Does the patient have a history of thromboembolic events
boolean
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C0040038 (NCI Metathesaurus Property)
CardiovascularDiseasePresentInd-2
Item
Does the patient have a history of cardiovascular disease
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25292 (NCI Thesaurus ObjectClass)
C0007226 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
CancerInitialDiagnosisDate
Item
Date of Initial Pathologic Diagnosis
date
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
RecurrentDiseasePriorOnsetMostRecentDate
Item
Date of Most Recent Prior Recurrence
date
C14173 (NCI Thesaurus ObjectClass)
C2945760 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25279 (NCI Thesaurus Property-2)
C0332162 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
Item Group
Descriptionof Primary Disease
Item
Clinical T Stage
text
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C9385 (NCI Thesaurus ObjectClass)
C0007134 (UMLS 2011AA ObjectClass)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
CL.5
Code List
Clinical T Stage
CL Item
No Evidence Of Primary Tumor (T0)
CL Item
Tumor 7 Cm Or Less In Greatest Dimension Limited To The Kidney (T1)
CL Item
Tumor Less Than 4 Cm Limited To Kidney (T1a)
CL Item
Tumor Greater Than 4 Cm But Less Than 7 Cm Limited To The Kidney (T1b)
CL Item
Tumor Greater Than 7 Cm In Greatest Dimension Limited To The Kidney (T2)
CL Item
Tumor Extends Into Major Veins Or Invades The Adrenal Gland Or Perinephric Tissues But Not Beyond Gerotas Fascia (T3)
CL Item
Tumor Invades The Adrenal Gland Or Perinephric Tissues But Not Beyond Gerotas Fascia (T3a)
CL Item
Tumor Grossly Extends Into The Renal Vein(s) Or Vena Cava Below The Diaphragm (T3b)
CL Item
Tumor Grossly Extends Into The Renal Vein(s) Or Vena Cava Above The Diaphragm (T3c)
CL Item
Tumor Invades Beyond Gerotas Fascia (T4)
CL Item
Primary Tumor Cannot Be Assessed (TX)
Item
Clinical N Stage
text
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C9385 (NCI Thesaurus ObjectClass)
C0007134 (UMLS 2011AA ObjectClass)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
CL.6
Code List
Clinical N Stage
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis In A Single Regional Lymph Node (N1)
CL Item
Metastasis In More Than One Regional Lymph Node (N2)
CL Item
Regional Lymph Node Cannot Be Assessed (NX)
Item
Clinical M Stage
text
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C9385 (NCI Thesaurus ObjectClass)
C0007134 (UMLS 2011AA ObjectClass)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25727 (NCI Thesaurus Property-2)
C0456533 (UMLS 2011AA Property-2)
CL.7
Code List
Clinical M Stage
CL Item
No Distant Metastasis (M0)
CL Item
Distant Metastasis (M1)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
CL Item
Distant Metastasis Cannot Be Assessed (MX)
Item Group
Description Of Current Disease
Item
How was disease discovered
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C9385 (NCI Thesaurus ObjectClass)
C0007134 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CL.8
Code List
How was disease discovered
CL Item
Incidental Renal Cell (Incidental renal cell)
CL Item
Symptomatic Renal Cell (Symptomatic renal cell)
Item Group
Current Disease Symptoms
Item
Hematuria (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C3090 (NCI Thesaurus Property-4)
C0018965 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.9
Code List
Hematuria (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Dyspnea (Disease symptoms present prior to surgery)
text
C2998 (NCI Thesaurus ObjectClass)
C0013404 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus ObjectClass-2)
C1457887 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.10
Code List
Dyspnea (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Pain (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C3303 (NCI Thesaurus Property-3)
C0030193 (UMLS 2011AA Property-3)
C25629 (NCI Thesaurus Property-4)
C0332152 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.11
Code List
Pain (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Chills (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C35143 (NCI Thesaurus ObjectClass-2)
C0085593 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.12
Code List
Chills (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Fatigue (Disease symptoms present prior to surgery)
text
C3036 (NCI Thesaurus ObjectClass)
C0015672 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus ObjectClass-2)
C1457887 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.13
Code List
Fatigue (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Fever >38 degrees C or 100 degrees F (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C3038 (NCI Thesaurus ObjectClass-2)
C0015967 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.14
Code List
Fever >38 degrees C or 100 degrees F (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Night sweats (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C3279 (NCI Thesaurus Property-4)
C0028081 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.15
Code List
Night sweats (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Weight loss >= 10% (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C3445 (NCI Thesaurus Property-3)
C1262477 (UMLS 2011AA Property-3)
C25629 (NCI Thesaurus Property-4)
C0332152 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.16
Code List
Weight loss >= 10% (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Elevated LDH (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C25493 (NCI Thesaurus Property-4)
C0205250 (UMLS 2011AA Property-4)
C25184 (NCI Thesaurus Property-5)
C0022917 (UMLS 2011AA Property-5)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.17
Code List
Elevated LDH (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Low hemoglobin (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25640 (NCI Thesaurus Property-2)
C0392756 (UMLS 2011AA Property-2)
C17173 (NCI Thesaurus Property-3)
C0038894 (UMLS 2011AA Property-3)
C16676 (NCI Thesaurus Property-4)
C0019046 (UMLS 2011AA Property-4)
C25629 (NCI Thesaurus Property-5)
C0332152 (UMLS 2011AA Property-5)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.18
Code List
Low hemoglobin (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Elevated serum calcium (Disease symptoms present prior to surgery)
text
C331 (NCI Thesaurus ObjectClass)
C0006675 (UMLS 2011AA ObjectClass)
C25493 (NCI Thesaurus ObjectClass-2)
C0205250 (UMLS 2011AA ObjectClass-2)
C4876 (NCI Thesaurus ObjectClass-3)
C1457887 (UMLS 2011AA ObjectClass-3)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.19
Code List
Elevated serum calcium (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Other symptoms (Disease symptoms present prior to surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C17173 (NCI Thesaurus Property-3)
C0038894 (UMLS 2011AA Property-3)
C25629 (NCI Thesaurus Property-4)
C0332152 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.20
Code List
Other symptoms (Disease symptoms present prior to surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Hematuria (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C3090 (NCI Thesaurus Property-4)
C0018965 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.21
Code List
Hematuria (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Dyspnea (Disease symptoms present after surgery)
text
C2998 (NCI Thesaurus ObjectClass)
C0013404 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus ObjectClass-2)
C1457887 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.22
Code List
Dyspnea (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Pain (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C3303 (NCI Thesaurus Property-3)
C0030193 (UMLS 2011AA Property-3)
C38008 (NCI Thesaurus Property-4)
C0687676 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.23
Code List
Pain (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Chills (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C35143 (NCI Thesaurus ObjectClass-2)
C0085593 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.24
Code List
Chills (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Fatigue (Disease symptoms present after surgery)
text
C3036 (NCI Thesaurus ObjectClass)
C0015672 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus ObjectClass-2)
C1457887 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.25
Code List
Fatigue (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Fever >38 degrees C or 100 degrees F (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C3038 (NCI Thesaurus ObjectClass-2)
C0015967 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.26
Code List
Fever >38 degrees C or 100 degrees F (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Night sweats (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C3279 (NCI Thesaurus Property-4)
C0028081 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.27
Code List
Night sweats (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Weight loss >= 10% (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C3445 (NCI Thesaurus Property-3)
C1262477 (UMLS 2011AA Property-3)
C38008 (NCI Thesaurus Property-4)
C0687676 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.28
Code List
Weight loss >= 10% (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Elevated LDH (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C25493 (NCI Thesaurus Property-4)
C0205250 (UMLS 2011AA Property-4)
C25184 (NCI Thesaurus Property-5)
C0022917 (UMLS 2011AA Property-5)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.29
Code List
Elevated LDH (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Low hemoglobin (Disease symptoms present after surgery)
text
C16676 (NCI Thesaurus ObjectClass)
C0019046 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus ObjectClass-2)
C1457887 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.30
Code List
Low hemoglobin (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Elevated serum calcium (Disease symptoms present after surgery)
text
C331 (NCI Thesaurus ObjectClass)
C0006675 (UMLS 2011AA ObjectClass)
C25493 (NCI Thesaurus ObjectClass-2)
C0205250 (UMLS 2011AA ObjectClass-2)
C4876 (NCI Thesaurus ObjectClass-3)
C1457887 (UMLS 2011AA ObjectClass-3)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C17173 (NCI Thesaurus Property-2)
C0038894 (UMLS 2011AA Property-2)
C38008 (NCI Thesaurus Property-3)
C0687676 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.31
Code List
Elevated serum calcium (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Other symptoms (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C17173 (NCI Thesaurus Property-3)
C0038894 (UMLS 2011AA Property-3)
C38008 (NCI Thesaurus Property-4)
C0687676 (UMLS 2011AA Property-4)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.32
Code List
Other symptoms (Disease symptoms present after surgery)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
SymptomPriorSurgeryOtherPresentSpecify
Item
Specify other symptoms (Disease symptoms present after surgery)
text
C4876 (NCI Thesaurus ObjectClass)
C1457887 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C17173 (NCI Thesaurus Property-3)
C0038894 (UMLS 2011AA Property-3)
C25629 (NCI Thesaurus Property-4)
C0332152 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Muga Scanning
HeartMUGATestDate
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C38073 (NCI Thesaurus Property)
C0521317 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
HeartLVEFTestPercentageValue
Item
Left Ventricular Ejection Fraction at Rest
float
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
HeartLVEFTestPercentageLowerLimitofNormalValue
Item
LVEF Institutional Lower Limit of Normal
float
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C25555 (NCI Thesaurus ValueDomain-3)
C1518030 (UMLS 2011AA ValueDomain-3)
EchocardiogramDate
Item
Date of assessment (Note: If patient was unable to obtain MUGA scan due to the shortage of the isotope Technetium-99, an ECHO may be substituted - at baseline and all subsequent visits for new patients. In this case, fill in the section below.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C37945 (NCI Thesaurus ObjectClass)
C2243117 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item Group
Footer Module
Investigator Signature
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Investigator Signature Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
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