Header
Patient ID NSABP
text
Patient Initials
Section A - Radiation Therapy (rt) -- All Patients
RadiationTherapyAdministeredInd-2
boolean
Radiation Therapy Start Date
date
Radiation Therapy End Date
RadiationTherapyIncreaseFractionationWholeBreastAdministeredInd-2
RadiationTherapyPriorBoostAdministeredTotalDose
float
RadiationTherapyPriorBoostFractionationAdministeredCount
RadiationTherapyBoostAdministeredind-2
BrachytherapyImplantInd-3
RadiationTherapyBoostAdministeredTotalDose
RTTotalFractionBoostCount
Unscheduled Interruptions in Radiation Therapy
RTToxicityInterruptionInd-2
NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason
Section B Trastuzumab Administration -- Group 2 Patients Only
TrastuzumabAgentFirstDoseAdministeredInd-2
TrastuzumabAgentFirstDoseAdministeredDate
TrastuzumabAgentFirstDoseAdministeredDose
TrastuzumabAgentSecondDoseAdministeredInd-2
TrastuzumabAgentSecondDoseAdministeredDate
TrastuzumabAgentSecondDoseAdministeredDose
TrastuzumabAgentDiscontinueAdministrationReason
TrastuzumabAgentDiscontinueAdministrationSpecify
Adverse Events/side Effects/complications
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
AdverseEventSeverityGrade
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Research Comments
Person Completing Form
Date Form Completed