Phase II Consortium Phase II Lung Cancer - Advanced Disease Follow-Up Form Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/27/21 9/27/21 -
Uploaded on:

September 27, 2021

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Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Phase II Lung Cancer - Advanced Disease Follow-Up Form - 2399268v1.0

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  1. StudyEvent: Phase II Lung Cancer - Advanced Disease Follow-Up Form
    1. No Instruction available.
Crf Header
Form Administration
Are data amended (If data are amended, please circle in red when using paper form)
Lung: Pre-treatment Characteristics
Patient's Vital Status
Primary Cause of Death
Lung: Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Lung: Notice Of Progression/site
Has the patient developed a first progression (or relapse) that has not been previously reported?
Sites of progression (check all that apply)
Lung: Subsequent Non-protocol Therapy
Is the patient receiving any non-protocol cancer therapy not previously reported?
Non-Protocol Therapy Type (check all that apply)
Lung: Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Lung: Long-term Toxicity
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity that has not been previously reported

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