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  1. StudyEvent: NCI Cooperative Group Treatment Summary Form (CALGB-90104)
    1. No Instruction available.
Mskcc 00-138; Calgb-90104; Ecog
Beschrijving

Mskcc 00-138; Calgb-90104; Ecog

Coordinating Group Protocol Number
Beschrijving

CoordinatingGroupProtocolNumber

Datatype

text

Coordinating Group Code
Beschrijving

CoordinatingGroupCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Beschrijving

ProtocolTitle

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C42774
UMLS 2011AA Property
C1705823
Patient Study ID, Coordinating Group
Beschrijving

PatientStudyID,CoordinatingGroup

Datatype

text

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Participating Group Code
Beschrijving

ParticipatingGroupCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Beschrijving

InstitutionName

Datatype

text

Affiliate
Beschrijving

AffiliateName

Datatype

text

Patient Last Name (initials acceptable)
Beschrijving

PatientName,Last

Datatype

text

Patient First Name (initials acceptable)
Beschrijving

PatientName,First

Datatype

text

Patient Middle Name (initials acceptable)
Beschrijving

PatientName,Middle

Datatype

text

Form Administration
Beschrijving

Form Administration

Person Completing Form, Last Name
Beschrijving

PersonCompletingForm,LastName

Datatype

text

Person Completing Form, First Name
Beschrijving

PersonCompletingForm,FirstName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Are data amended?
Beschrijving

AmendedDataInd

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Treatment Schedule - Chemotherapy
Beschrijving

Treatment Schedule - Chemotherapy

Date of First Dose for This Reporting Period
Beschrijving

TreatmentFirstDoseBeginDate

Datatype

date

Date of Last Dose for This Reporting Period
Beschrijving

TreatmentLastDoseEndDate

Datatype

date

Total Number of cycles Given
Beschrijving

TotalCourseNumber

Datatype

double

Off-treatment And Modifications
Beschrijving

Off-treatment And Modifications

Reason Treatment Ended (check one)
Beschrijving

OffTreatmentReason

Datatype

text

Other, specify
Beschrijving

OffTreatmentReason,Other

Datatype

text

Were there any dose modificiations or additions/omissions to protocol treatment? (check one)
Beschrijving

DoseModification(Change)

Datatype

text

Specify (if yes, unplanned)
Beschrijving

DoseModificationReason

Datatype

text

Ccrr Module For Nci Cooperative Group Treatment Summary Form (calgb-90104)
Beschrijving

Ccrr Module For Nci Cooperative Group Treatment Summary Form (calgb-90104)

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No Instruction available.

1 Formulieren
  1. StudyEvent: NCI Cooperative Group Treatment Summary Form (CALGB-90104)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Mskcc 00-138; Calgb-90104; Ecog
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
ProtocolTitle
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C42774 (NCI Thesaurus Property)
C1705823 (UMLS 2011AA Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate
text
PatientName,Last
Item
Patient Last Name (initials acceptable)
text
PatientName,First
Item
Patient First Name (initials acceptable)
text
PatientName,Middle
Item
Patient Middle Name (initials acceptable)
text
Item Group
Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Treatment Schedule - Chemotherapy
TreatmentFirstDoseBeginDate
Item
Date of First Dose for This Reporting Period
date
TreatmentLastDoseEndDate
Item
Date of Last Dose for This Reporting Period
date
TotalCourseNumber
Item
Total Number of cycles Given
double
Item Group
Off-treatment And Modifications
Item
Reason Treatment Ended (check one)
text
CL.2
Code List
Reason Treatment Ended (check one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
CL Item
Disease Progression, Relapse Prior To Beginning Protocol Therapy (Disease progression, relapse prior to beginning protocol therapy)
CL Item
Toxicity/side Effects/complications (Toxicity/side effects/complications)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal after beginning protocol therapy)
CL Item
Patient Withdrawal Or Refusal Prior To Beginning Protocol Therapy (Patient withdrawal or refusal prior to beginning protocol therapy)
CL Item
Disease Progression, Relapse During Active Treatment (Disease recurrence)
CL Item
Death After Beginning Protocol Therapy (Death after beginning protocol therapy)
CL Item
Death Prior To Beginning Protocol Therapy (Death prior to beginning protocol therapy)
CL Item
Alternative Therapy (Alternative therapy)
CL Item
Other (Other complicating disease)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
OffTreatmentReason,Other
Item
Other, specify
text
Item
Were there any dose modificiations or additions/omissions to protocol treatment? (check one)
text
CL.3
Code List
Were there any dose modificiations or additions/omissions to protocol treatment? (check one)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
DoseModificationReason
Item
Specify (if yes, unplanned)
text
Item Group
Ccrr Module For Nci Cooperative Group Treatment Summary Form (calgb-90104)
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