ID
5611
Descrição
RTOG 1010 Demographic Data Form (A5) Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8666BB88-BFD1-08B9-E040-BB89AD434AC6
Link
Palavras-chave
Versões (4)
- 26/08/2012 26/08/2012 -
- 11/08/2014 11/08/2014 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
Transferido a
11 de agosto de 2014
DOI
Para um pedido faça login.
Licença
Creative Commons BY-NC 3.0 Legacy
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Adenocarcinoma of the Gastroesophageal Junction NCT01196390 Demographic - RTOG 1010 Demographic Data Form (A5) - 3085100v1.0
INSTRUCTIONS: Submit this form at patient's entry on study. Complete the information by filling in boxes or blanks as requested. See separate page for instructions
- StudyEvent: RTOG 1010 Demographic Data Form (A5)
Descrição
Unnamed2
Descrição
FormCompletionDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C40988
- UMLS 2011AA ObjectClass
- C1516308
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
Descrição
DataAmendedInd-3
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Descrição
ResponsiblePersonDescriptionType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Descrição
PatientRaceCategory
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Descrição
PatientEthnicGroupCategory
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C16564
- UMLS 2011AA Property
- C0015031
Descrição
PersonHighestEducationType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C16529
- UMLS 2011AA Property
- C0013622
- NCI Thesaurus Property
- C25525
- UMLS 2011AA Property
- C1522410
Descrição
PersonHighestEducationSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C16529
- UMLS 2011AA Property
- C0013622
- NCI Thesaurus Property
- C25525
- UMLS 2011AA Property
- C1522410
Descrição
PersonPediatricReligionName
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C39299
- UMLS 2011AA Property
- C0231335
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
- NCI Thesaurus Property
- C17085
- UMLS 2011AA Property
- C0035039
Descrição
PersonPediatricReligionSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C39299
- UMLS 2011AA Property
- C0231335
- NCI Thesaurus Property
- C17085
- UMLS 2011AA Property
- C0035039
Descrição
MaritalStatusDescriptionType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25188
- UMLS 2011AA ObjectClass
- C0024819
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Descrição
PersonBirthCountryType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25464
- UMLS 2011AA Property
- C0454664
- NCI Thesaurus Property
- C25155
- UMLS 2011AA Property
- C0005615
Descrição
PatientBirthStateSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C30010
- UMLS 2011AA Property
- C1301808
- NCI Thesaurus Property
- C25155
- UMLS 2011AA Property
- C0005615
Descrição
PersonBirthCountryIndividualSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25464
- UMLS 2011AA Property
- C0454664
- NCI Thesaurus Property
- C25155
- UMLS 2011AA Property
- C0005615
Descrição
PatientLongestDurationResidenceType
Tipo de dados
text
Alias
- NCI Metathesaurus ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property
- C25330
- UMLS 2011AA Property
- C0449238
- NCI Thesaurus Property
- C25273
- UMLS 2011AA Property
- C0237096
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrição
PatientStateLongestDurationResidenceCode
Tipo de dados
text
Alias
- NCI Metathesaurus ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property
- C30010
- UMLS 2011AA Property
- C1301808
- NCI Thesaurus Property
- C25330
- UMLS 2011AA Property
- C0449238
- NCI Thesaurus Property
- C25273
- UMLS 2011AA Property
- C0237096
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ValueDomain
- C30010
- UMLS 2011AA ValueDomain
- C1301808
Descrição
PatientCountryLongestDurationResidenceName
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property
- C25464
- UMLS 2011AA Property
- C0454664
- NCI Thesaurus Property
- C25330
- UMLS 2011AA Property
- C0449238
- NCI Thesaurus Property
- C25273
- UMLS 2011AA Property
- C0237096
- NCI Thesaurus ValueDomain
- C25464
- UMLS 2011AA ValueDomain
- C0454664
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
Descrição
Cigarette History
Descrição
Smoked at least 100 cigarettes during lifetime (5 packs)
Tipo de dados
integer
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
- UMLS CUI-1
- C1519384
Descrição
Patient Initial Cigarette Smoking Age Year Count
Tipo de dados
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
- NCI Thesaurus Property
- C18270
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain
- C25463
- UMLS CUI-1
- C1519384
Descrição
Cigarettes Smoking Year Number
Tipo de dados
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C1802
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus Property
- C17934
- UMLS CUI-1
- C1519384
Descrição
Smoking Use Average Number
Tipo de dados
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C17934
- NCI Thesaurus Property
- C25340
- UMLS CUI-1
- C1519384
Descrição
Patient Smoking Cessation Age Year
Tipo de dados
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain
- C25463
- NCI Metathesaurus Property
- C0085134
- UMLS CUI-1
- C1519384
Descrição
Other Disease Diagnosis Type
Tipo de dados
integer
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Descrição
Other Disease Diagnosis Specify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Descrição
Family History
Descrição
BrotherPatientFamilyMembersAssessmentNumber
Tipo de dados
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C25289
- UMLS 2011AA ObjectClass
- C0337527
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Descrição
SisterPatientFamilyMembersAssessmentNumber
Tipo de dados
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C25680
- UMLS 2011AA ObjectClass
- C0337514
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Descrição
SonPatientFamilyMembersAssessmentNumber
Tipo de dados
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C25205
- UMLS 2011AA ObjectClass
- C0037683
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Descrição
DaughterPatientFamilyMembersAssessmentNumber
Tipo de dados
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C25165
- UMLS 2011AA ObjectClass
- C0011011
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Descrição
PatientAdoptedInd-3
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25290
- UMLS 2011AA Property
- C0425382
Descrição
RelativeFamilyCancerHistoryType
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25173
- UMLS 2011AA ObjectClass
- C0015576
- NCI Thesaurus ObjectClass
- C21480
- UMLS 2011AA ObjectClass
- C0080103
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property
- C18772
- UMLS 2011AA Property
- C0262926
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrição
PersonFirstCancerDiagnosisAgeYearCount
Tipo de dados
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property
- C25509
- UMLS 2011AA Property
- C1279901
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
- NCI Thesaurus Property
- C25150
- UMLS 2011AA Property
- C0001779
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Descrição
CancerSiteType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
Descrição
CancerSiteSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
Descrição
CancerPreventionTrialKnowledgeDocumentedInd-2
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
- NCI Thesaurus Property
- C25356
- UMLS 2011AA Property
- C1301725
- NCI Metathesaurus Property
- C0376554
Descrição
CancerPreventionTrialParticipationScale
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
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INSTRUCTIONS: Submit this form at patient's entry on study. Complete the information by filling in boxes or blanks as requested. See separate page for instructions
- StudyEvent: RTOG 1010 Demographic Data Form (A5)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
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C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
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C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
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C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
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C0027361 (UMLS 2011AA ObjectClass)
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C1273518 (UMLS 2011AA ObjectClass)
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C0678257 (UMLS 2011AA Property)
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C1513907 (UMLS 2011AA)
C0078988 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C1515945 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0007457 (UMLS 2011AA)
C0085756 (UMLS 2011AA)
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C1519384 (UMLS CUI-1)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0085134 (NCI Metathesaurus Property)
C1519384 (UMLS CUI-1)
C17649 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C2359476 (UMLS CUI-1)
C17649 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C2359476 (UMLS CUI-1)
C0030705 (UMLS 2011AA ObjectClass)
C25289 (NCI Thesaurus ObjectClass)
C0337527 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25680 (NCI Thesaurus ObjectClass)
C0337514 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25205 (NCI Thesaurus ObjectClass)
C0037683 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25165 (NCI Thesaurus ObjectClass)
C0011011 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25290 (NCI Thesaurus Property)
C0425382 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0015576 (UMLS 2011AA ObjectClass)
C21480 (NCI Thesaurus ObjectClass)
C0080103 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0015671 (UMLS 2011AA)
C0026591 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C0024109 (UMLS 2011AA)
C0006141 (UMLS 2011AA)
C0009368 (UMLS 2011AA)
C0033572 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus Property)
C1301725 (UMLS 2011AA Property)
C0376554 (NCI Metathesaurus Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0349674 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C0205448 (UMLS 2011AA)