ID

6174

Beschreibung

NSABP Protocol B-40 - Treatment Form for Hormonal Therapy A Randomized Phase III Trial of Neoadjuvant Therapy in Patients With Palpable and Operable Breast Cancer Evaluating the Effect on Pathologic Complete Response (pCR) of Adding Capecitabine or Gemcitabine to Docetaxel When Administered Before AC With or Without Bevacizumab and Correlative Science Studies Attempting to Identify Predictors of High Likelihood for pCR With Each of the Regimens Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1B7E215E-B69B-0BD3-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1B7E215E-B69B-0BD3-E044-0003BA3F9857

Stichworte

Versionen (1)
  1. 15.12.14 15.12.14 - Martin Dugas
Hochgeladen am

15. Dezember 2014

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00408408 Treatment - NSABP Protocol B-40 - Treatment Form for Hormonal Therapy - 2511670v1.0

Englisch

This paper worksheet may be completed to faciliate the entry of the information in NSABP Coordinator Online. Partially completed forms may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL.

1 Formulare  
General information
Beschreibung

General information

Alias
UMLS CUI-1
C1508263
Patient Initials (Last First Middle)
Beschreibung

Patient Initials (Last First Middle)

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
UMLS CUI-1
C2986440
NSABP Patient ID
Beschreibung

Patient National Surgical Adjuvant Breast Project Identifier Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25364
NCI Thesaurus Property
C15818
UMLS CUI-1
C1549740
Institution/Affiliate
Beschreibung

CombinedInstitutionName

Datentyp

text

Person Completing Form, Last Name
Beschreibung

Person Completing Form, Last Name

Datentyp

text

Alias
UMLS CUI-1
C1550483
UMLS CUI-2
C1301584
Person Completing Form, First Name
Beschreibung

Person Completing Form, First Name

Datentyp

text

Alias
UMLS CUI-1
C1550483
UMLS CUI-2
C1443235
Person Completing Form, Phone
Beschreibung

Person Completing Form, Phone

Datentyp

text

Alias
UMLS CUI-1
C1550483
UMLS CUI-2
C0039457
Are data amended
Beschreibung

Are data amended

Datentyp

boolean

Alias
UMLS CUI-1
C0680532
Date form completed
Beschreibung

Date form completed

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain
C25367
UMLS CUI-1
C1115437
Reason form completed
Beschreibung

Reason hormone therapy form completed

Datentyp

integer

Alias
NCI Thesaurus ValueDomain
C25638
NCI Thesaurus ObjectClass
C19464
NCI Thesaurus Property
C25250
NCI Thesaurus ObjectClass
C15445
Hormone therapy
Beschreibung

Hormone therapy

Alias
UMLS CUI-1
C0279025
Agent Name
Beschreibung

Agent Name (Tamoxifen, Aromatase Inhibitor, Other specify)

Datentyp

integer

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain
C42614
UMLS CUI-1
C1254351
Other hormone therapy, specify
Beschreibung

Other hormone therapy

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C15445
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25382
Was agent administered
Beschreibung

Was agent administered

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25382
UMLS CUI-1
C1254351
UMLS CUI-2
C1521801
Agent Start Date
Beschreibung

Agent Start Date

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain
C25431
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
UMLS CUI-1
C0451613
Agent End Date (Leave date boxes blank if agent will continue beyond 5 years.)
Beschreibung

Agent End Date (Leave date boxes blank if agent will continue beyond 5 years.)

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
UMLS CUI-1
C0850893
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Ähnliche Modelle

This paper worksheet may be completed to faciliate the entry of the information in NSABP Coordinator Online. Partially completed forms may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL.

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General information
C1508263 (UMLS CUI-1)
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property)
C1549740 (UMLS CUI-1)
CombinedInstitutionName
Item
Institution/Affiliate
text
Person Completing Form Last Name
Item
Person Completing Form, Last Name
text
C1550483 (UMLS CUI-1)
C1301584 (UMLS CUI-2)
Person Completing Form First Name
Item
Person Completing Form, First Name
text
C1550483 (UMLS CUI-1)
C1443235 (UMLS CUI-2)
Person Completing Form Phone
Item
Person Completing Form, Phone
text
C1550483 (UMLS CUI-1)
C0039457 (UMLS CUI-2)
Amended data
Item
Are data amended
boolean
C0680532 (UMLS CUI-1)
Date form completed
Item
Date form completed
date
C25164 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
Item
Reason form completed
integer
C25638 (NCI Thesaurus ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C15445 (NCI Thesaurus ObjectClass)
CL.2
Code List
Reason form completed
CL Item
Patient Will Not Begin Hormonal Therapy (1)
CL Item
Patient Received Less Than 5 Years Of Hormonal Therapy, And Hormonal Treatment Has Ended (2)
CL Item
Patient Received 5 Years Of Hormonal Therapy, And Hormonal Treatment Has Ended (3)
CL Item
Patient Received 5 Years Of Hormonal Therapy, And Hormonal Treatment Will Continue (4)
Item Group
Hormone therapy
C0279025 (UMLS CUI-1)
Item
Agent Name
integer
C25364 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C1254351 (UMLS CUI-1)
Agent
Code List
Agent Name
CL Item
Tamoxifen (1)
CL Item
Aromatase Inhibitor (2)
CL Item
Other (specify) (3)
Other hormone therapy
Item
Other hormone therapy, specify
text
C25685 (NCI Thesaurus ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
Agent administered
Item
Was agent administered
boolean
C38147 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1254351 (UMLS CUI-1)
C1521801 (UMLS CUI-2)
Agent Start Date
Item
Agent Start Date
date
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C0451613 (UMLS CUI-1)
Agent End Date
Item
Agent End Date (Leave date boxes blank if agent will continue beyond 5 years.)
date
C25164 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C0850893 (UMLS CUI-1)
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