ID

6233

Beskrivning

SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227) S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C46950-C286-3B4D-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C46950-C286-3B4D-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

18 december 2014

DOI

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Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Treatment - SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227) - 2057355v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227)
    1. No Instruction available.
Unnamed1
Beskrivning

Unnamed1

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Patient Initials (L, F M)
Beskrivning

PatientInitialsName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution / Affiliate
Beskrivning

InstitutionName

Datatyp

text

Physician (Groups other than SWOG)
Beskrivning

RegisteredInvestigator

Datatyp

text

Group Name
Beskrivning

ParticipatingGroupName

Datatyp

text

Study No.
Beskrivning

NCIProtocolNumber

Datatyp

text

Pt. ID
Beskrivning

Pt.ID

Datatyp

text

Status
Beskrivning

Status

Date of Last Contact or Death
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Vital Status
Beskrivning

Patient'sVitalStatus

Datatyp

text

Treatment For Cycles 2-6
Beskrivning

Treatment For Cycles 2-6

Were there any dose modifications or additions/omissions to protocol treatment
Beskrivning

DoseModification(Change)

Datatyp

text

Cycle 2
Beskrivning

Cycle 2

Cycle Start Date
Beskrivning

CourseBeginDate

Datatyp

date

Cycle Stop Date
Beskrivning

CycleStopDate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

double

BSA (First day of this cycle)
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Cycle 3
Beskrivning

Cycle 3

Cycle Start Date
Beskrivning

CourseBeginDate

Datatyp

date

Cycle Stop Date
Beskrivning

CycleStopDate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

double

BSA (First day of this cycle)
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Comments
Beskrivning

Comments

Comments
Beskrivning

Comments

Datatyp

text

Cycle 4
Beskrivning

Cycle 4

Cycle Start Date
Beskrivning

CourseBeginDate

Datatyp

date

Cycle Stop Date
Beskrivning

CycleStopDate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

double

BSA (First day of this cycle)
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Cycle 5
Beskrivning

Cycle 5

Cycle Start Date
Beskrivning

CourseBeginDate

Datatyp

date

Cycle Stop Date
Beskrivning

CycleStopDate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

double

BSA (First day of this cycle)
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Cycle 6
Beskrivning

Cycle 6

Cycle Start Date
Beskrivning

CourseBeginDate

Datatyp

date

Cycle Stop Date
Beskrivning

CycleStopDate

Datatyp

text

Weight (First day of this cycle)
Beskrivning

PatientWeight

Datatyp

double

BSA (First day of this cycle)
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Total dose for this cycle: gemcitabine (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

double

Others, specify
Beskrivning

AgentName

Datatyp

text

Others, specify
Beskrivning

AgentName

Datatyp

text

Others, specify
Beskrivning

AgentName

Datatyp

text

Others, specify
Beskrivning

AgentName

Datatyp

text

Comments
Beskrivning

Comments

Comments
Beskrivning

Comments

Datatyp

text

Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)
Beskrivning

Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Unnamed1
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitialsName
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
NCIProtocolNumber
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Status
DeathDate/LastContactDate
Item
Date of Last Contact or Death
date
Item
Vital Status
text
CL.1
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Treatment For Cycles 2-6
Item
Were there any dose modifications or additions/omissions to protocol treatment
text
CL.2
Code List
Were there any dose modifications or additions/omissions to protocol treatment
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned, specify in comments)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned, specify in comments)
Item Group
Cycle 2
CourseBeginDate
Item
Cycle Start Date
date
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
double
BodySurfaceArea
Item
BSA (First day of this cycle)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
Item Group
Cycle 3
CourseBeginDate
Item
Cycle Start Date
date
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
double
BodySurfaceArea
Item
BSA (First day of this cycle)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
Item Group
Comments
Comments
Item
Comments
text
Item Group
Cycle 4
CourseBeginDate
Item
Cycle Start Date
date
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
double
BodySurfaceArea
Item
BSA (First day of this cycle)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
Item Group
Cycle 5
CourseBeginDate
Item
Cycle Start Date
date
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
double
BodySurfaceArea
Item
BSA (First day of this cycle)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
Item Group
Cycle 6
CourseBeginDate
Item
Cycle Start Date
date
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
double
BodySurfaceArea
Item
BSA (First day of this cycle)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
double
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)
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