ID

6237

Descripción

SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (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=A9C3C405-9249-3D84-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C3C405-9249-3D84-E034-0003BA12F5E7

Palabras clave

Versiones (2)
  1. 18/12/14 18/12/14 - Martin Dugas
  2. 9/1/15 9/1/15 - Martin Dugas
Subido en

18 de diciembre de 2014

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Treatment - SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227) - 2057464v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227)
    1. No Instruction available.
Unnamed1
Descripción

Unnamed1

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Patient Initials (L, F M)
Descripción

PatientInitialsName

Tipo de datos

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
Descripción

InstitutionName

Tipo de datos

text

Physician (Groups other than SWOG)
Descripción

RegisteredInvestigator

Tipo de datos

text

Group Name
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No.
Descripción

Particip.GroupProtocolNumber

Tipo de datos

double

Pt. ID
Descripción

PatientStudyID,ParticipatingGroup

Tipo de datos

text

Status
Descripción

Status

Date of Last Contact or Death
Descripción

DeathDate/LastContactDate

Tipo de datos

date

Vital Status
Descripción

Patient'sVitalStatus

Tipo de datos

text

First Cycle Of Treatment
Descripción

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Descripción

CourseBeginDate

Tipo de datos

date

Cycle end date (Date immediately prior to the date next cycle begins, or date decision made to discontinue patient from protocol treatment if last cycle.)
Descripción

Cycleenddate

Tipo de datos

text

Weight first day this cycle (kg)
Descripción

PatientWeight

Tipo de datos

double

BSA first day this cycle
Descripción

BodySurfaceArea

Tipo de datos

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Were there any dose modifications or additions/omissions to protocol treatment
Descripción

DoseModification(Change)

Tipo de datos

text

Total dose of gemcitabine for this cycle (Arm 2 only)
Descripción

AgentTotalDose(percourse)

Tipo de datos

double

Total dose of gemcitabine for this cycle (Arm 2 only)
Descripción

AgentTotalDose(percourse)

Tipo de datos

double

Total dose of gemcitabine for this cycle (Arm 2 only)
Descripción

AgentTotalDose(percourse)

Tipo de datos

double

Concomitant Medications / Medical Interventions
Descripción

Concomitant Medications / Medical Interventions

Start Date
Descripción

AgentBeginDate

Tipo de datos

date

Stop Date
Descripción

AgentEndDate

Tipo de datos

date

Others, specify
Descripción

AgentName

Tipo de datos

text

Others, specify
Descripción

AgentName

Tipo de datos

text

Comments
Descripción

Comments

Comments
Descripción

Comments

Tipo de datos

text

Ccrr Module For Southwest Oncology Group S0227 Treatment Form For First Cycle (s0227)
Descripción

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

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
Particip.GroupProtocolNumber
Item
Study No.
double
PatientStudyID,ParticipatingGroup
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
First Cycle Of Treatment
CourseBeginDate
Item
Cycle start date (same as treatment start date)
date
Cycleenddate
Item
Cycle end date (Date immediately prior to the date next cycle begins, or date decision made to discontinue patient from protocol treatment if last cycle.)
text
PatientWeight
Item
Weight first day this cycle (kg)
double
BodySurfaceArea
Item
BSA first day this cycle
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
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)
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
double
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
double
Item Group
Concomitant Medications / Medical Interventions
AgentBeginDate
Item
Start Date
date
AgentEndDate
Item
Stop Date
date
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 Form For First Cycle (s0227)
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