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ID

6365

Descripción

Lung Cancer - NSCLC Advanced On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE93D710-5D45-22F0-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE93D710-5D45-22F0-E034-0003BA12F5E7

Palabras clave

Versiones (4)
  1. 18/12/14 18/12/14 - Martin Dugas
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 9/1/15 9/1/15 - Martin Dugas
  4. 17/9/21 17/9/21 -
Subido en

18 de diciembre de 2014

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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    On-Study - Lung Cancer - NSCLC Advanced On-Study Form - 2263427v3.0

    Inglés

    No Instruction available.

    1 formularios  
    1. StudyEvent: Lung Cancer - NSCLC Advanced On-Study Form
      1. No Instruction available.
    Crf Header
    Descripción

    Crf Header

    Coordinating Group Protocol No.
    Descripción

    ProtocolCoordinatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C25462
    UMLS 2011AA Property
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Coordinating Group Code
    Descripción

    CoordinatingGroupIdentifierCode

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus ObjectClass
    C25462
    UMLS 2011AA ObjectClass
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Protocol Title
    Descripción

    ProtocolTitleName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C42774
    UMLS 2011AA Property
    C1705823
    Patient Study ID
    Descripción

    PatientCoordinatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25462
    UMLS 2011AA Property
    C0700114
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Institution/Affiliate
    Descripción

    CombinedInstitutionName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS 2011AA ObjectClass
    C0205195
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ValueDomain
    C21541
    UMLS 2011AA ValueDomain
    C0018704
    Other Patient ID
    Descripción

    PatientParticipatingIdentifierNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participating Group Code
    Descripción

    ParticipatingGroupIdentifierCode

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Patient Name (initials acceptable)
    Descripción

    PatientName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Lung: Pre-treatment Characteristics
    Descripción

    Lung: Pre-treatment Characteristics

    Patient Height (cm)
    Descripción

    PatientHeightMeasurement

    Tipo de datos

    double

    Unidades de medida
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25347
    UMLS 2011AA Property
    C0489786
    cm
    Patient Weight (kg)
    Descripción

    PatientWeightMeasurement

    Tipo de datos

    double

    Unidades de medida
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25208
    UMLS 2011AA Property
    C0043100
    Kg
    Body Surface Area (m^2)
    Descripción

    PatientBodySurfaceAreaMeasurement

    Tipo de datos

    double

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25157
    UMLS 2011AA Property
    C0005902
    Performance Status (check one)
    Descripción

    PerformanceStatusAssessmentEasternCooperativeOncologyGroupScale

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain
    C25491
    UMLS 2011AA ValueDomain
    C1512162
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    Weight loss in previous six months (check one)
    Descripción

    PatientWeightLossPercentageScale

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C3445
    UMLS 2011AA Property
    C0043096
    NCI Thesaurus ValueDomain
    C25613
    UMLS 2011AA ValueDomain
    C0439165
    Lung: Disease Description - Nsclc Advanced
    Descripción

    Lung: Disease Description - Nsclc Advanced

    Stage
    Descripción

    LungTumorGroupingStage

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass
    C12468
    UMLS 2011AA ObjectClass
    C0024109
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    NCI Thesaurus Property
    C25523
    UMLS 2011AA Property
    C1522242
    Histologic Type
    Descripción

    LungTumorHistologicClassificationLungTumorHistologicCategory

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass
    C12468
    UMLS 2011AA ObjectClass
    C0024109
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property
    C25161
    UMLS 2011AA Property
    C0008902
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    NCI Thesaurus ValueDomain
    C25526
    UMLS 2011AA ValueDomain
    C0205462
    Specify Other Histologic Type
    Descripción

    TumorHistologicCategorySpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property
    C25161
    UMLS 2011AA Property
    C0008902
    Is measurable disease present? (only applicable in studies where there is residual disease at baseline)
    Descripción

    MeasurableDiseasePresentInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ObjectClass
    C2991
    UMLS 2011AA ObjectClass
    C0012634
    NCI Thesaurus ObjectClass
    C37894
    UMLS 2011AA ObjectClass
    C1513040
    Is non-measurable disease present? (only applicable in studies where there is residual disease at baseline)
    Descripción

    Non-measurableDiseasePresentInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ObjectClass
    C2991
    UMLS 2011AA ObjectClass
    C0012634
    NCI Thesaurus ObjectClass
    C25589
    UMLS 2011AA ObjectClass
    C1518373
    Metastatic Sites (check all that apply)
    Descripción

    LungMalignantNeoplasmMetastaticInvolvementSite

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C12468
    UMLS 2011AA ObjectClass
    C0024109
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C14174
    UMLS 2011AA Property
    C0036525
    NCI Thesaurus Property
    C25548
    UMLS 2011AA Property
    C1314939
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    Is pleural effusion present?
    Descripción

    LungPleuralEffusionInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C12468
    UMLS 2011AA ObjectClass
    C0024109
    NCI Thesaurus Property
    C3003
    UMLS 2011AA Property
    C0013687
    NCI Thesaurus Property
    C25223
    UMLS 2011AA Property
    C1522720
    Is it Malignant? (If yes,)
    Descripción

    LungPleuralEffusionMalignantInd

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C12468
    UMLS 2011AA ObjectClass
    C0024109
    NCI Thesaurus Property
    C3003
    UMLS 2011AA Property
    C0013687
    NCI Thesaurus Property
    C25223
    UMLS 2011AA Property
    C1522720
    NCI Thesaurus ValueDomain
    C14143
    UMLS 2011AA ValueDomain
    C0205282
    NCI Metathesaurus ValueDomain
    C0021212
    Units used for labs
    Descripción

    AssessmentMeasurableLabType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C37984
    UMLS 2011AA Property
    C0022877
    NCI Thesaurus Property
    C37894
    UMLS 2011AA Property
    C1513040
    Albumin (g/dl)
    Descripción

    BloodSpecimenLaboratoryProcedureAlbuminValue

    Tipo de datos

    double

    Alias
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ValueDomain
    C214
    UMLS 2011AA ValueDomain
    C0001924
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Hemoglobin (g/dl)
    Descripción

    LaboratoryProcedureHemoglobinResultSpecifiedValue

    Tipo de datos

    double

    Unidades de medida
    • g/dL
    Alias
    NCI Thesaurus Property
    C16676
    UMLS 2011AA Property
    C0019046
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    g/dL
    Lactate Dehydrogenase (LDH) (U/L only collect if RT study)
    Descripción

    LaboratoryProcedureLactateDehydrogenaseResultSpecifiedValue

    Tipo de datos

    double

    Unidades de medida
    • U/L
    Alias
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property
    C25184
    UMLS 2011AA Property
    C0022917
    U/L
    Lactate Dehydrogenase ULN (U/L Provide laboratory's upper limit of normal)
    Descripción

    LaboratoryProcedureLactateDehydrogenaseResultSpecifiedUpperLimitofNormalValue

    Tipo de datos

    double

    Unidades de medida
    • U/L
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property
    C25184
    UMLS 2011AA Property
    C0022917
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain
    C38024
    UMLS 2011AA ValueDomain
    C0205369
    NCI Thesaurus ValueDomain
    C25706
    UMLS 2011AA ValueDomain
    C1519815
    U/L
    Lung: Prior Treatment - Nsclc Advanced
    Descripción

    Lung: Prior Treatment - Nsclc Advanced

    Prior Surgery (Code "No" if incisional/needle biopsy is the only prior surgery)
    Descripción

    PriorSurgeryPerformedInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    Prior Radiation Therapy
    Descripción

    PriorRTAdministeredInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Prior Systemic Chemotherapy
    Descripción

    PriorChemotherapyAdministeredInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Comments
    Descripción

    Comments

    Comments
    Descripción

    ResearchCommentsText

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    UMLS 2011AA Property
    C0282411
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    Similar models

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    1 formularios
    1. StudyEvent: Lung Cancer - NSCLC Advanced On-Study Form
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Crf Header
    ProtocolCoordinatingIdentifierNumber
    Item
    Coordinating Group Protocol No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus Property)
    C0700114 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    CoordinatingGroupIdentifierCode
    Item
    Coordinating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus ObjectClass)
    C0700114 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ProtocolTitleName
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C42774 (NCI Thesaurus Property)
    C1705823 (UMLS 2011AA Property)
    PatientCoordinatingIdentifierNumber
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25462 (NCI Thesaurus Property)
    C0700114 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    CombinedInstitutionName
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C0205195 (UMLS 2011AA ObjectClass)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ValueDomain)
    C0018704 (UMLS 2011AA ValueDomain)
    PatientParticipatingIdentifierNumber
    Item
    Other Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ParticipatingGroupIdentifierCode
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientName
    Item
    Patient Name (initials acceptable)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Item Group
    Lung: Pre-treatment Characteristics
    PatientHeightMeasurement
    Item
    Patient Height (cm)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25347 (NCI Thesaurus Property)
    C0489786 (UMLS 2011AA Property)
    PatientWeightMeasurement
    Item
    Patient Weight (kg)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25208 (NCI Thesaurus Property)
    C0043100 (UMLS 2011AA Property)
    PatientBodySurfaceAreaMeasurement
    Item
    Body Surface Area (m^2)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25157 (NCI Thesaurus Property)
    C0005902 (UMLS 2011AA Property)
    Item
    Performance Status (check one)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus ValueDomain)
    C1512162 (UMLS 2011AA ValueDomain)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    CL.1
    Code List
    Performance Status (check one)
    CL Item
    Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
    CL Item
    Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
    CL Item
    Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
    CL Item
    Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
    CL Item
    Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
    Item
    Weight loss in previous six months (check one)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C3445 (NCI Thesaurus Property)
    C0043096 (UMLS 2011AA Property)
    C25613 (NCI Thesaurus ValueDomain)
    C0439165 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Weight loss in previous six months (check one)
    CL Item
    <5% Of Body Weight (< 5% of body weight)
    CL Item
    5 To <10% Of Body Weight (5 to < 10% of body weight)
    CL Item
    10 To <20% Of Body Weight (10 to <20% of body weight)
    CL Item
    > Or = 20% Of Body Weight (> or = 20% of body weight)
    Item Group
    Lung: Disease Description - Nsclc Advanced
    Item
    Stage
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12468 (NCI Thesaurus ObjectClass)
    C0024109 (UMLS 2011AA ObjectClass)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    C25523 (NCI Thesaurus Property)
    C1522242 (UMLS 2011AA Property)
    CL.3
    Code List
    Stage
    CL Item
    Stage Iiib (IIIB (not recurrent))
    C27978 (NCI Thesaurus)
    C0456599 (UMLS 2011AA)
    CL Item
    Stage Iv (IV (not recurrent))
    C27971 (NCI Thesaurus)
    C0441772 (UMLS 2011AA)
    CL Item
    Recurrent (Recurrent)
    C14173 (NCI Thesaurus)
    C2945760 (UMLS 2011AA)
    Item
    Histologic Type
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12468 (NCI Thesaurus ObjectClass)
    C0024109 (UMLS 2011AA ObjectClass)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25161 (NCI Thesaurus Property)
    C0008902 (UMLS 2011AA Property)
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    C25526 (NCI Thesaurus ValueDomain)
    C0205462 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Histologic Type
    CL Item
    Squamous Cell Carcinoma (Squamous cell carcinoma)
    C2929 (NCI Thesaurus)
    C0007137 (UMLS 2011AA)
    CL Item
    Adenocarcinoma (Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    CL Item
    Large Cell Undifferentiated (Large cell undifferentiated)
    CL Item
    Bronchoalveolar (bac) (Bronchoalveolar carcinoma (BAC))
    CL Item
    Non-small Cell Lung Cancer (nsclc), Nos (Non-small cell lung cancer NOS)
    CL Item
    Other (Other specify)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    TumorHistologicCategorySpecify
    Item
    Specify Other Histologic Type
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25161 (NCI Thesaurus Property)
    C0008902 (UMLS 2011AA Property)
    Item
    Is measurable disease present? (only applicable in studies where there is residual disease at baseline)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C2991 (NCI Thesaurus ObjectClass)
    C0012634 (UMLS 2011AA ObjectClass)
    C37894 (NCI Thesaurus ObjectClass)
    C1513040 (UMLS 2011AA ObjectClass)
    CL.5
    Code List
    Is measurable disease present? (only applicable in studies where there is residual disease at baseline)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item
    Is non-measurable disease present? (only applicable in studies where there is residual disease at baseline)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C2991 (NCI Thesaurus ObjectClass)
    C0012634 (UMLS 2011AA ObjectClass)
    C25589 (NCI Thesaurus ObjectClass)
    C1518373 (UMLS 2011AA ObjectClass)
    CL.6
    Code List
    Is non-measurable disease present? (only applicable in studies where there is residual disease at baseline)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item
    Metastatic Sites (check all that apply)
    text
    C12468 (NCI Thesaurus ObjectClass)
    C0024109 (UMLS 2011AA ObjectClass)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C14174 (NCI Thesaurus Property)
    C0036525 (UMLS 2011AA Property)
    C25548 (NCI Thesaurus Property)
    C1314939 (UMLS 2011AA Property)
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    CL.7
    Code List
    Metastatic Sites (check all that apply)
    CL Item
    Hilar Nodes (Hilar nodes)
    CL Item
    Mediastinal Nodes (Mediastinal nodes)
    CL Item
    Supraclavicular Or Scalene Nodes (Supraclavicular/scalene nodes)
    CL Item
    Ipsilateral Lung (Ipsilateral lung)
    CL Item
    Contralateral Lung (Contralateral lung)
    CL Item
    Pleura (Pleura)
    C12469 (NCI Thesaurus)
    C0032225 (UMLS 2011AA)
    CL Item
    Liver (Liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Adrenal Gland (Adrenal(s))
    C12666 (NCI Thesaurus)
    C0001625 (UMLS 2011AA)
    CL Item
    Bone (Bone)
    C12366 (NCI Thesaurus)
    C0262950 (UMLS 2011AA)
    CL Item
    Bone Marrow (Bone marrow)
    C12431 (NCI Thesaurus)
    C0005953 (UMLS 2011AA)
    CL Item
    Brain (Brain)
    C12439 (NCI Thesaurus)
    C0006104 (UMLS 2011AA)
    CL Item
    Skin (Skin)
    C12470 (NCI Thesaurus)
    C1123023 (UMLS 2011AA)
    Item
    Is pleural effusion present?
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C12468 (NCI Thesaurus ObjectClass)
    C0024109 (UMLS 2011AA ObjectClass)
    C3003 (NCI Thesaurus Property)
    C0013687 (UMLS 2011AA Property)
    C25223 (NCI Thesaurus Property)
    C1522720 (UMLS 2011AA Property)
    CL.8
    Code List
    Is pleural effusion present?
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item
    Is it Malignant? (If yes,)
    text
    C12468 (NCI Thesaurus ObjectClass)
    C0024109 (UMLS 2011AA ObjectClass)
    C3003 (NCI Thesaurus Property)
    C0013687 (UMLS 2011AA Property)
    C25223 (NCI Thesaurus Property)
    C1522720 (UMLS 2011AA Property)
    C14143 (NCI Thesaurus ValueDomain)
    C0205282 (UMLS 2011AA ValueDomain)
    C0021212 (NCI Metathesaurus ValueDomain)
    CL.9
    Code List
    Is it Malignant? (If yes,)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Unknown (Unknown (not tapped))
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Units used for labs
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C37984 (NCI Thesaurus Property)
    C0022877 (UMLS 2011AA Property)
    C37894 (NCI Thesaurus Property)
    C1513040 (UMLS 2011AA Property)
    CL.10
    Code List
    Units used for labs
    CL Item
    Scientific/international (S/I)
    CL Item
    Imperial (Imperial)
    BloodSpecimenLaboratoryProcedureAlbuminValue
    Item
    Albumin (g/dl)
    double
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C214 (NCI Thesaurus ValueDomain)
    C0001924 (UMLS 2011AA ValueDomain)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    LaboratoryProcedureHemoglobinResultSpecifiedValue
    Item
    Hemoglobin (g/dl)
    double
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    LaboratoryProcedureLactateDehydrogenaseResultSpecifiedValue
    Item
    Lactate Dehydrogenase (LDH) (U/L only collect if RT study)
    double
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25184 (NCI Thesaurus Property)
    C0022917 (UMLS 2011AA Property)
    LaboratoryProcedureLactateDehydrogenaseResultSpecifiedUpperLimitofNormalValue
    Item
    Lactate Dehydrogenase ULN (U/L Provide laboratory's upper limit of normal)
    double
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25184 (NCI Thesaurus Property)
    C0022917 (UMLS 2011AA Property)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C38024 (NCI Thesaurus ValueDomain)
    C0205369 (UMLS 2011AA ValueDomain)
    C25706 (NCI Thesaurus ValueDomain)
    C1519815 (UMLS 2011AA ValueDomain)
    Item Group
    Lung: Prior Treatment - Nsclc Advanced
    Item
    Prior Surgery (Code "No" if incisional/needle biopsy is the only prior surgery)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    CL.11
    Code List
    Prior Surgery (Code "No" if incisional/needle biopsy is the only prior surgery)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item
    Prior Radiation Therapy
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.12
    Code List
    Prior Radiation Therapy
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item
    Prior Systemic Chemotherapy
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.13
    Code List
    Prior Systemic Chemotherapy
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item Group
    Comments
    ResearchCommentsText
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0282411 (UMLS 2011AA Property)
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