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ID

6476

Beschrijving

E1A06 Maintenance Treatment Form Melphalan, Prednisone, and Thalidomide or Lenalidomide in Treating Patients With Newly Diagnosed Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4066DEFA-0353-324B-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4066DEFA-0353-324B-E044-0003BA3F9857

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 01-01-15 01-01-15 - Martin Dugas
Geüploaded op

1 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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    Treatment Form Multiple Myeloma Maintenance E1A06

    No Instruction available.

    1. StudyEvent: E1A06 Maintenance Treatment Form
      1. No Instruction available.
    Header section
    Beschrijving

    Header section

    Alias
    UMLS CUI-1
    C1320722
    Patient Initials (Last, First)
    Beschrijving

    Patient Initials

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    ECOG Protocol Number
    Beschrijving

    Protocol Number ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    Participating Group Protocol Number
    Beschrijving

    Study Number Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Institution/Affiliate
    Beschrijving

    Institution Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    ECOG Patient ID
    Beschrijving

    Patient ID ECOG

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    Participating Group Patient ID
    Beschrijving

    Trial subject ID Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    DCI Name
    Beschrijving

    Form name

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C3242370
    NCI Thesaurus Property
    C19464
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus ObjectClass-2
    C25452
    Registration Step
    Beschrijving

    Registration Number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Please mark an 'X' if data have been amended. (Please circle amended items in red)
    Beschrijving

    Data amended

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Date data amended
    Beschrijving

    Data amended date

    Datatype

    date

    Maateenheden
    • mm/dd/yyyy
    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI-1
    C0680532
    UMLS CUI-2
    C0011008
    mm/dd/yyyy
    On Treatment
    Beschrijving

    On Treatment

    On Treatment Report Period (Maintenance Therapy: Begins with Cycle 13)
    Beschrijving

    Cycle number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25214
    NCI Thesaurus Property-2
    C25616
    NCI Thesaurus ObjectClass
    C15368
    Specify Cycle
    Beschrijving

    Chemotherapy cycle

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25214
    UMLS CUI-1
    C1302181
    NCI Thesaurus Property-2
    C25616
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus ValueDomain-2
    C25472
    NCI Thesaurus ValueDomain-3
    C25275
    Reporting Period Start Date (mm/dd/yyyy)
    Beschrijving

    Reporting Period Start Date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25616
    UMLS CUI-1
    C2361257
    NCI Thesaurus Property-2
    C25651
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Reporting Period End Date (mm/dd/yyyy)
    Beschrijving

    Reporting Period End Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2361259
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25651
    Vital Status
    Beschrijving

    Vital Status

    Alias
    UMLS CUI-1
    C1148433
    Patient's Vital Status
    Beschrijving

    Patient Status

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C3846084
    NCI Thesaurus ValueDomain
    C18003
    NCI Thesaurus ValueDomain-2
    C25688
    NCI Thesaurus Property
    C25717
    Date of last contact or death
    Beschrijving

    Date last contact

    Datatype

    date

    Maateenheden
    • mm/dd/yyyy
    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25461
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI-1
    C0805839
    mm/dd/yyyy
    Primary Cause of Death
    Beschrijving

    Primary Cause of Death

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C0007465
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C28554
    NCI Thesaurus ValueDomain-2
    C25251
    Describe cause of death
    Beschrijving

    Cause of Death, specify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C0007465
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1521902
    NCI Thesaurus Property
    C28554
    Patient Characteristics
    Beschrijving

    Patient Characteristics

    Weight (Day 1 of this reporting period cycle)
    Beschrijving

    Patient Weight

    Datatype

    float

    Maateenheden
    • kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25208
    UMLS CUI-1
    C0005910
    kg
    Body Surface Area (BSA Day 1 of this reporting period cycle)
    Beschrijving

    Body Surface Area

    Datatype

    float

    Maateenheden
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C0005902
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus Property
    C25157
    m2
    Therapy Administered - Section I
    Beschrijving

    Therapy Administered - Section I

    Agent Name (Complete base on completed Patient Pill Diary)
    Beschrijving

    Agent

    Datatype

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Was the agent administered during this reporting period? (Lenalidomide)
    Beschrijving

    Agent administered during reporting period

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C0450442
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-2
    C1521801
    NCI Thesaurus Property
    C25382
    Agent Start Date
    Beschrijving

    Concomitant Medication Start Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2826734
    NCI Thesaurus ValueDomain-2
    C25431
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25275
    Total Dose of Agents/Drugs for this Cycle (mg - this report period)
    Beschrijving

    Agent Total Dose

    Datatype

    float

    Alias
    NCI Thesaurus ValueDomain
    C25304
    UMLS CUI-1
    C2986497
    NCI Thesaurus Property
    C25379
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    Were there any dose modifications or additions/omissions to Thalidomide protocol treatment
    Beschrijving

    Dose modification Thalidomide

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C870
    UMLS CUI-2
    C0039736
    NCI Thesaurus ObjectClass-2
    C25488
    NCI Thesaurus Property
    C25572
    Was treatment modification to Thalidomide planned (per protocol)?
    Beschrijving

    Dose modification Thalidomide per protocol

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C870
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass-2
    C25488
    UMLS CUI-2
    C0039736
    NCI Thesaurus Property
    C25320
    UMLS CUI-3
    C1698058
    NCI Thesaurus Property-2
    C25572
    NCI Thesaurus ValueDomain
    C38147
    Dose Modification Start Date
    Beschrijving

    Dose modification start date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C0808070
    NCI Thesaurus Property
    C25572
    Dose Modification End Date
    Beschrijving

    Dose modification end date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C0806020
    NCI Thesaurus Property
    C25572
    Total Modified Dose
    Beschrijving

    Total Modified Dose

    Datatype

    float

    Maateenheden
    • mg
    Alias
    NCI Thesaurus ValueDomain
    C25304
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25572
    UMLS CUI-1
    C2986497
    UMLS CUI-2
    C0392747
    mg
    Dose modification
    Beschrijving

    Dose Modification Status

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-1
    C1707811
    NCI Thesaurus ValueDomain
    C25688
    NCI Thesaurus Property
    C25572
    Dose Modification Reason
    Beschrijving

    Dose Modification Reason

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C0392360
    NCI Thesaurus Property
    C25572
    Other, specify
    Beschrijving

    Dose Modification Reason, other

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C3840932
    NCI Thesaurus Property
    C25572
    Therapy Administered - Section I
    Beschrijving

    Therapy Administered - Section I

    Agent Name (Complete base on completed Patient Pill Diary)
    Beschrijving

    Agent

    Datatype

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Was the agent administered during this reporting period? (Lenalidomide)
    Beschrijving

    Agent administered during reporting period

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C0450442
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-2
    C1521801
    NCI Thesaurus Property
    C25382
    Agent Start Date
    Beschrijving

    Concomitant Medication Start Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2826734
    NCI Thesaurus ValueDomain-2
    C25431
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25275
    Total Dose of Agents/Drugs for this Cycle (mg - this report period)
    Beschrijving

    Agent Total Dose

    Datatype

    float

    Alias
    NCI Thesaurus ValueDomain
    C25304
    UMLS CUI-1
    C2986497
    NCI Thesaurus Property
    C25379
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    Were there any dose modifications or additions/omissions to Lenalidomide protocol treatment
    Beschrijving

    Dose modification Lenalidomide

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C2668
    UMLS CUI-2
    C1144149
    NCI Thesaurus ObjectClass-2
    C25488
    NCI Thesaurus Property
    C25572
    Was treatment modification to Lenalidomide planned (per protocol)? (If yes,)
    Beschrijving

    Dose modification Lenalidomide per protocol

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C2668
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass-2
    C25488
    UMLS CUI-2
    C1144149
    NCI Thesaurus Property
    C25320
    UMLS CUI-3
    C1698058
    NCI Thesaurus Property-2
    C25572
    NCI Thesaurus ValueDomain
    C38147
    Start Date of Dose Modification
    Beschrijving

    Dose modification begin date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1707811
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS CUI-2
    C0808070
    NCI Thesaurus ObjectClass
    C25488
    NCI Thesaurus Property
    C25572
    End Date of Dose Modification
    Beschrijving

    Dose modification end date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C0806020
    NCI Thesaurus Property
    C25572
    Total Modified Dose
    Beschrijving

    Total Modified Dose

    Datatype

    float

    Maateenheden
    • mg
    Alias
    NCI Thesaurus ValueDomain
    C25304
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25572
    UMLS CUI-1
    C2986497
    UMLS CUI-2
    C0392747
    mg
    Dose modification
    Beschrijving

    Dose Modification Status

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-1
    C1707811
    NCI Thesaurus ValueDomain
    C25688
    NCI Thesaurus Property
    C25572
    Dose Modification Reason
    Beschrijving

    Dose Modification Reason

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C0392360
    NCI Thesaurus Property
    C25572
    Other, specify
    Beschrijving

    Dose Modification Reason, other

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-2
    C3840932
    NCI Thesaurus Property
    C25572
    Therapy Administered - Prophylaxis Treatment
    Beschrijving

    Therapy Administered - Prophylaxis Treatment

    Alias
    UMLS CUI-1
    C0199176
    Did patient recieve DVT prophylaxis (this report period)
    Beschrijving

    Deep Vein Thrombosis prophylaxis

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0853245
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus ValueDomain
    C38147
    Start date of first (prophylactic) treatment
    Beschrijving

    DVT prophylaxis start date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0853245
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    UMLS CUI-2
    C0808070
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Date of most recent (prophylactic) treatment
    Beschrijving

    DVT prophylaxis most recent date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0853245
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    UMLS CUI-2
    C1513491
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-3
    C0011008
    NCI Thesaurus ValueDomain-2
    C25577
    Aspirin (81 mg) (Were any of the following given? answer no 1 or yes 2 for each of the following)
    Beschrijving

    Aspirin 81 mg

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0783425
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus Property-2
    C49341
    NCI Thesaurus Property-3
    C287
    NCI Thesaurus ValueDomain
    C38147
    Aspirin (325 mg)
    Beschrijving

    Aspirin 325 mg

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0714615
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus Property-2
    C287
    NCI Thesaurus Property-3
    C49342
    NCI Thesaurus ValueDomain
    C38147
    Aspirin (other dose)
    Beschrijving

    Aspirin, other dose

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0004057
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C17649
    NCI Thesaurus Property-2
    C25639
    NCI Thesaurus Property-3
    C287
    NCI Thesaurus Property-4
    C25256
    NCI Thesaurus ValueDomain
    C38147
    If other dose of Aspirin given, specify dose
    Beschrijving

    Aspirin dose

    Datatype

    float

    Maateenheden
    • mg
    Alias
    NCI Thesaurus ObjectClass
    C49343
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C17649
    NCI Thesaurus Property-2
    C25639
    NCI Thesaurus Property-3
    C287
    NCI Thesaurus Property-4
    C25256
    NCI Thesaurus ValueDomain
    C25488
    UMLS CUI-1
    C0004057
    UMLS CUI-2
    C0178602
    mg
    Low molecular weight heparin
    Beschrijving

    Heparin, Low-Molecular-Weight

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus Property-2
    C2578
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C0019139
    Warfarin
    Beschrijving

    Warfarin (Coumadin)

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C49343
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus Property-2
    C945
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI-1
    C0043031
    If Coumadin given, specify dose
    Beschrijving

    Warfarin dose

    Datatype

    float

    Maateenheden
    • mg
    Alias
    NCI Thesaurus ObjectClass
    C49343
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    NCI Thesaurus Property-2
    C945
    NCI Thesaurus ValueDomain
    C25488
    UMLS CUI-1
    C0366686
    mg
    Other, specify
    Beschrijving

    DVT prevention, specify

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C49343
    UMLS CUI-1
    C0853245
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus ObjectClass-3
    C15405
    NCI Thesaurus Property
    C25639
    UMLS CUI-2
    C1521902
    NCI Thesaurus ValueDomain
    C25685
    Has the patient received erythropoietin-type agents (e.g., Epogen, Procrit or Aranesp) (this report period)
    Beschrijving

    Erythropoietin-type agents

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0014822
    NCI Thesaurus ObjectClass
    C20429
    NCI Thesaurus ObjectClass-2
    C37902
    NCI Thesaurus Property
    C25382
    Section E: Non-protocol Therapy
    Beschrijving

    Section E: Non-protocol Therapy

    Was any non-protocol therapy given during protocol treatment (not previously reported)?
    Beschrijving

    Non-protocol therapy

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25590
    UMLS CUI-1
    C1518384
    NCI Thesaurus ObjectClass-2
    C16212
    UMLS CUI-2
    C0087111
    NCI Thesaurus Property
    C25320
    NCI Thesaurus Property-2
    C49236
    NCI Thesaurus Property-3
    C25456
    NCI Thesaurus Property-4
    C25382
    NCI Thesaurus ValueDomain
    C38148
    Comments
    Beschrijving

    Comments

    Alias
    UMLS CUI-1
    C0947611
    Comments
    Beschrijving

    Research Comments

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Investigator Signature
    Beschrijving

    Investigator Signature

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    NCI Thesaurus ObjectClass
    C17089
    Investigator Signature Date
    Beschrijving

    Investigator Signature Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    UMLS CUI-2
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C17089

    Similar models

    No Instruction available.

    1. StudyEvent: E1A06 Maintenance Treatment Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    Header section
    C1320722 (UMLS CUI-1)
    Patient Initials
    Item
    Patient Initials (Last, First)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Protocol Number ECOG
    Item
    ECOG Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Study Number Participating Group
    Item
    Participating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Patient ID ECOG
    Item
    ECOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Form name
    Item
    DCI Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C3242370 (UMLS CUI-1)
    C19464 (NCI Thesaurus Property)
    C25474 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus ObjectClass-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Data amended
    Item
    Please mark an 'X' if data have been amended. (Please circle amended items in red)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Data amended date
    Item
    Date data amended
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    C0680532 (UMLS CUI-1)
    C0011008 (UMLS CUI-2)
    Item Group
    On Treatment
    Item
    On Treatment Report Period (Maintenance Therapy: Begins with Cycle 13)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25616 (NCI Thesaurus Property-2)
    C15368 (NCI Thesaurus ObjectClass)
    Code List
    On Treatment Report Period (Maintenance Therapy: Begins with Cycle 13)
    CL Item
    > Cycle 34 (> Cycle 34)
    CL Item
    Cycle 14 (Cycle 14)
    CL Item
    Cycle 16 (Cycle 16)
    CL Item
    Cycle 18 (Cycle 18)
    CL Item
    Cycle 20 (Cycle 20)
    CL Item
    Cycle 22 (Cycle 22)
    CL Item
    Cycle 24 (Cycle 24)
    CL Item
    Cycle 26 (Cycle 26)
    CL Item
    Cycle 28 (Cycle 28)
    CL Item
    Cycle 30 (Cycle 30)
    CL Item
    Cycle 32 (Cycle 32)
    CL Item
    Cycle 34 (Cycle 34)
    Chemotherapy cycle
    Item
    Specify Cycle
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25214 (NCI Thesaurus Property)
    C1302181 (UMLS CUI-1)
    C25616 (NCI Thesaurus Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C25472 (NCI Thesaurus ValueDomain-2)
    C25275 (NCI Thesaurus ValueDomain-3)
    Reporting Period Start Date
    Item
    Reporting Period Start Date (mm/dd/yyyy)
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C2361257 (UMLS CUI-1)
    C25651 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Reporting Period End Date
    Item
    Reporting Period End Date (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2361259 (UMLS CUI-1)
    C25616 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25651 (NCI Thesaurus Property-2)
    Item Group
    Vital Status
    C1148433 (UMLS CUI-1)
    Item
    Patient's Vital Status
    text
    C16960 (NCI Thesaurus ObjectClass)
    C3846084 (UMLS CUI-1)
    C18003 (NCI Thesaurus ValueDomain)
    C25688 (NCI Thesaurus ValueDomain-2)
    C25717 (NCI Thesaurus Property)
    Code List
    Patient's Vital Status
    CL Item
    Alive (Alive)
    CL Item
    Dead (Dead)
    Date last contact
    Item
    Date of last contact or death
    date
    C16960 (NCI Thesaurus ObjectClass)
    C25461 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C0805839 (UMLS CUI-1)
    Item
    Primary Cause of Death
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0007465 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C28554 (NCI Thesaurus Property)
    C25251 (NCI Thesaurus ValueDomain-2)
    Code List
    Primary Cause of Death
    CL Item
    Due To Other Cause (Due to other cause)
    CL Item
    Due To Protocol Treatment (Due to protocol treatment)
    CL Item
    Due To This Disease (Due to this disease)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Cause of Death, specify
    Item
    Describe cause of death
    text
    C25685 (NCI Thesaurus ValueDomain)
    C0007465 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1521902 (UMLS CUI-2)
    C28554 (NCI Thesaurus Property)
    Item Group
    Patient Characteristics
    Patient Weight
    Item
    Weight (Day 1 of this reporting period cycle)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25208 (NCI Thesaurus Property)
    C0005910 (UMLS CUI-1)
    Body Surface Area
    Item
    Body Surface Area (BSA Day 1 of this reporting period cycle)
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0005902 (UMLS CUI-1)
    C25712 (NCI Thesaurus ValueDomain)
    C25157 (NCI Thesaurus Property)
    Item Group
    Therapy Administered - Section I
    Agent
    Item
    Agent Name (Complete base on completed Patient Pill Diary)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Agent administered during reporting period
    Item
    Was the agent administered during this reporting period? (Lenalidomide)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C0450442 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1521801 (UMLS CUI-2)
    C25382 (NCI Thesaurus Property)
    Concomitant Medication Start Date
    Item
    Agent Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2826734 (UMLS CUI-1)
    C25431 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    Agent Total Dose
    Item
    Total Dose of Agents/Drugs for this Cycle (mg - this report period)
    float
    C25304 (NCI Thesaurus ValueDomain)
    C2986497 (UMLS CUI-1)
    C25379 (NCI Thesaurus Property)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    Dose modification Thalidomide
    Item
    Were there any dose modifications or additions/omissions to Thalidomide protocol treatment
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C870 (NCI Thesaurus ObjectClass)
    C0039736 (UMLS CUI-2)
    C25488 (NCI Thesaurus ObjectClass-2)
    C25572 (NCI Thesaurus Property)
    Dose modification Thalidomide per protocol
    Item
    Was treatment modification to Thalidomide planned (per protocol)?
    boolean
    C870 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass-2)
    C0039736 (UMLS CUI-2)
    C25320 (NCI Thesaurus Property)
    C1698058 (UMLS CUI-3)
    C25572 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    Dose modification start date
    Item
    Dose Modification Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C0808070 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Dose modification end date
    Item
    Dose Modification End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C0806020 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Total Modified Dose
    Item
    Total Modified Dose
    float
    C25304 (NCI Thesaurus ValueDomain)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C2986497 (UMLS CUI-1)
    C0392747 (UMLS CUI-2)
    Item
    Dose modification
    text
    C25488 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25688 (NCI Thesaurus ValueDomain)
    C25572 (NCI Thesaurus Property)
    Code List
    Dose modification
    CL Item
    Dose Delayed (Dose delayed)
    CL Item
    Dose Held (Dose held)
    CL Item
    Dose Missed (Dose missed)
    CL Item
    Dose Escalated (Dose escalated)
    CL Item
    Dose Reduced (Dose reduced)
    C49505 (NCI Thesaurus)
    C1707814 (UMLS 2011AA)
    C49505 (NCI Thesaurus-3)
    C1707814 (UMLS 2011AA-4)
    CL Item
    Drug Discontinued (Drug discontinued)
    CL Item
    No Dose Modification (No dose modification)
    Item
    Dose Modification Reason
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C0392360 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Code List
    Dose Modification Reason
    CL Item
    Adverse Event (Adverse event)
    C41331 (NCI Thesaurus)
    C0877248 (UMLS 2011AA)
    CL Item
    Alternative Therapy For Other Reason (Alternative therapy for other reason)
    CL Item
    Dosing Error (Dosing error)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Patient Refusal/noncompliance (Patient refusal/noncompliance)
    CL Item
    Scheduling (Scheduling)
    CL Item
    Second Primary Cancer (Second primary)
    Dose Modification Reason, other
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C3840932 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Item Group
    Therapy Administered - Section I
    Agent
    Item
    Agent Name (Complete base on completed Patient Pill Diary)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Agent administered during reporting period
    Item
    Was the agent administered during this reporting period? (Lenalidomide)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C0450442 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1521801 (UMLS CUI-2)
    C25382 (NCI Thesaurus Property)
    Concomitant Medication Start Date
    Item
    Agent Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2826734 (UMLS CUI-1)
    C25431 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    Agent Total Dose
    Item
    Total Dose of Agents/Drugs for this Cycle (mg - this report period)
    float
    C25304 (NCI Thesaurus ValueDomain)
    C2986497 (UMLS CUI-1)
    C25379 (NCI Thesaurus Property)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    Dose modification Lenalidomide
    Item
    Were there any dose modifications or additions/omissions to Lenalidomide protocol treatment
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C2668 (NCI Thesaurus ObjectClass)
    C1144149 (UMLS CUI-2)
    C25488 (NCI Thesaurus ObjectClass-2)
    C25572 (NCI Thesaurus Property)
    Dose modification Lenalidomide per protocol
    Item
    Was treatment modification to Lenalidomide planned (per protocol)? (If yes,)
    boolean
    C2668 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass-2)
    C1144149 (UMLS CUI-2)
    C25320 (NCI Thesaurus Property)
    C1698058 (UMLS CUI-3)
    C25572 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    Dose modification begin date
    Item
    Start Date of Dose Modification
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0808070 (UMLS CUI-2)
    C25488 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    Dose modification end date
    Item
    End Date of Dose Modification
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C0806020 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Total Modified Dose
    Item
    Total Modified Dose
    float
    C25304 (NCI Thesaurus ValueDomain)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C2986497 (UMLS CUI-1)
    C0392747 (UMLS CUI-2)
    Item
    Dose modification
    text
    C25488 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25688 (NCI Thesaurus ValueDomain)
    C25572 (NCI Thesaurus Property)
    Code List
    Dose modification
    CL Item
    Dose Delayed (Dose delayed)
    CL Item
    Dose Held (Dose held)
    CL Item
    Dose Missed (Dose missed)
    CL Item
    Dose Escalated (Dose escalated)
    CL Item
    Dose Reduced (Dose reduced)
    C49505 (NCI Thesaurus)
    C1707814 (UMLS 2011AA)
    C49505 (NCI Thesaurus-3)
    C1707814 (UMLS 2011AA-4)
    CL Item
    Drug Discontinued (Drug discontinued)
    CL Item
    No Dose Modification (No dose modification)
    Item
    Dose Modification Reason
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C0392360 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Code List
    Dose Modification Reason
    CL Item
    Adverse Event (Adverse event)
    C41331 (NCI Thesaurus)
    C0877248 (UMLS 2011AA)
    CL Item
    Alternative Therapy For Other Reason (Alternative therapy for other reason)
    CL Item
    Dosing Error (Dosing error)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Patient Refusal/noncompliance (Patient refusal/noncompliance)
    CL Item
    Scheduling (Scheduling)
    CL Item
    Second Primary Cancer (Second primary)
    Dose Modification Reason, other
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25488 (NCI Thesaurus ObjectClass)
    C3840932 (UMLS CUI-2)
    C25572 (NCI Thesaurus Property)
    Item Group
    Therapy Administered - Prophylaxis Treatment
    C0199176 (UMLS CUI-1)
    Deep Vein Thrombosis prophylaxis
    Item
    Did patient recieve DVT prophylaxis (this report period)
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C0853245 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    DVT prophylaxis start date
    Item
    Start date of first (prophylactic) treatment
    date
    C49343 (NCI Thesaurus ObjectClass)
    C0853245 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C0808070 (UMLS CUI-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    DVT prophylaxis most recent date
    Item
    Date of most recent (prophylactic) treatment
    date
    C49343 (NCI Thesaurus ObjectClass)
    C0853245 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C1513491 (UMLS CUI-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS CUI-3)
    C25577 (NCI Thesaurus ValueDomain-2)
    Aspirin 81 mg
    Item
    Aspirin (81 mg) (Were any of the following given? answer no 1 or yes 2 for each of the following)
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C0783425 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C49341 (NCI Thesaurus Property-2)
    C287 (NCI Thesaurus Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    Aspirin 325 mg
    Item
    Aspirin (325 mg)
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C0714615 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C287 (NCI Thesaurus Property-2)
    C49342 (NCI Thesaurus Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    Aspirin, other dose
    Item
    Aspirin (other dose)
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C0004057 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C17649 (NCI Thesaurus Property)
    C25639 (NCI Thesaurus Property-2)
    C287 (NCI Thesaurus Property-3)
    C25256 (NCI Thesaurus Property-4)
    C38147 (NCI Thesaurus ValueDomain)
    Aspirin dose
    Item
    If other dose of Aspirin given, specify dose
    float
    C49343 (NCI Thesaurus ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C17649 (NCI Thesaurus Property)
    C25639 (NCI Thesaurus Property-2)
    C287 (NCI Thesaurus Property-3)
    C25256 (NCI Thesaurus Property-4)
    C25488 (NCI Thesaurus ValueDomain)
    C0004057 (UMLS CUI-1)
    C0178602 (UMLS CUI-2)
    Heparin, Low-Molecular-Weight
    Item
    Low molecular weight heparin
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C2578 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C0019139 (UMLS CUI-1)
    Warfarin
    Item
    Warfarin
    boolean
    C49343 (NCI Thesaurus ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C945 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C0043031 (UMLS CUI-1)
    Warfarin dose
    Item
    If Coumadin given, specify dose
    float
    C49343 (NCI Thesaurus ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C945 (NCI Thesaurus Property-2)
    C25488 (NCI Thesaurus ValueDomain)
    C0366686 (UMLS CUI-1)
    DVT prevention, specify
    Item
    Other, specify
    text
    C49343 (NCI Thesaurus ObjectClass)
    C0853245 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass-2)
    C15405 (NCI Thesaurus ObjectClass-3)
    C25639 (NCI Thesaurus Property)
    C1521902 (UMLS CUI-2)
    C25685 (NCI Thesaurus ValueDomain)
    Erythropoietin-type agents
    Item
    Has the patient received erythropoietin-type agents (e.g., Epogen, Procrit or Aranesp) (this report period)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0014822 (UMLS CUI-1)
    C20429 (NCI Thesaurus ObjectClass)
    C37902 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    Item Group
    Section E: Non-protocol Therapy
    Non-protocol therapy
    Item
    Was any non-protocol therapy given during protocol treatment (not previously reported)?
    boolean
    C25590 (NCI Thesaurus ObjectClass)
    C1518384 (UMLS CUI-1)
    C16212 (NCI Thesaurus ObjectClass-2)
    C0087111 (UMLS CUI-2)
    C25320 (NCI Thesaurus Property)
    C49236 (NCI Thesaurus Property-2)
    C25456 (NCI Thesaurus Property-3)
    C25382 (NCI Thesaurus Property-4)
    C38148 (NCI Thesaurus ValueDomain)
    Item Group
    Comments
    C0947611 (UMLS CUI-1)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Investigator Signature
    Item
    Investigator Signature
    text
    C25704 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    Investigator Signature Date
    Item
    Investigator Signature Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C25367 (NCI Thesaurus ValueDomain-2)
    C17089 (NCI Thesaurus ObjectClass)

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