Beschreibung:

CALGB 90601: Follow-Up Form Gemcitabine Hydrochloride and Cisplatin With or Without Bevacizumab in Treating Patients With Advanced Urinary Tract Cancer NCT00942331 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6591C082-D8C1-EC1C-E040-BB89AD43479B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6591C082-D8C1-EC1C-E040-BB89AD43479B

Stichworte:

Klinische Studie [Dokumenttyp]

Tumoren

Verlaufsstudien

Harnblasentumoren

Versionen (2) ▾

26.08.12
08.01.15

Hochgeladen am:

8. Januar 2015

DOI:

Keine DOI zugewiesen. Für eine Beantragung loggen Sie sich ein.

Lizenz:

Creative Commons BY-NC 3.0 Legacy

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Follow-Up Form Bladder Cancer (NCT00942331)

Details

No Instruction available.

StudyEvent: CALGB 90601: Follow-Up Form
1. No Instruction available.

CALGB Form (C-1767)

CALGB Study No.

CALGB Patient ID

Reporting Period Start Date

Date of Last Contact or Death

Are data amended

Yes

Patient Initials

Patient Hospital No.

Institution/Affiliate

Participating Group

Participating Group Study No.

Participating Group Patient ID

Comments

Completed by

Date Form Completed

Treatment Status

Treatment Status (Mark one with an X)

On Study, On Protocol Treatment (On study, on protocol treatment)

Follow-up, Off Protocol Therapy (Follow-up, off protocol therapy)

Other (Other)

Other, specify

Disease Follow-up Status

Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)

Yes

Date of most recent physical exam

Measurable Disease Response

Response Status at This Assessment

Complete Response (CR)

Insufficient Evaluation (Insufficient evaluation to determine response status)

Partial Response (PR)

Stable Disease (SD)

Complete Response (CR) First Observed Date

Partial Response (PR) First Observed Date

Progressive Disease First Observed Date

Sites of Progression

Bladder (Bladder)

Bone (Bone)

Central Nervous System/brain (CNS/Brain)

Liver (Liver)

Lung, Nos (Lung)

5 weitere Items in der Detailansicht.

Other specify

Notice Of New Primary

Has a new primary cancer or MDS been diagnosed that has not been previously reported?

Yes

New Primary Cancer Date

Site of New Primary

New Primary, Histologic type

Long-term Toxicity

Has the patient experienced post diagnosis of progression or new primary, any severe (Grade > 3), long-term toxicity that has not been previously reported

Yes

Non-protocol Therapy

Has the patient received any non-protocol cancer therapy during this reporting period?

Yes

Specify (If yes,)

Hormonal Therapy (Hormonal Therapy)

Radiation Therapy (Radiation therapy)

Chemotherapy (Chemotherapy)

Surgery (Surgery)

Other Non-protocol Therapy (Other non-protocol therapy)

Specify (hormonal therapy)

Specify (radiation therapy)