Description:

AMC-045 Off Protocol Treatment Summary Form (F05) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7284A0F2-BE44-FDEC-E040-BB89AD43537B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7284A0F2-BE44-FDEC-E040-BB89AD43537B

Keywords:

Clinical Trial

Off-Treatment

Anus Neoplasms

Versions (2) ▾

8/26/12
1/8/15

Uploaded on:

January 8, 2015

DOI:

No DOI assigned. To request one pleaselog in.

License:

Creative Commons BY-NC 3.0 Legacy

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Anal Cancer NCT00324415 Off Treatment - AMC-045 Off Protocol Treatment Summary Form (F05) - 2936946v1.0

Details

Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

StudyEvent: AMC-045 Off Protocol Treatment Summary Form (F05)
1. Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

Ccrr Module For Off Protocol Treatment Summary - Rf05b

Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)

Reason Treatment Ended (select the primary reason)

Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)

Death On Study (Death on study)

Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal/refusal after beginning protocol therapy)

9 more items in the detailed view.

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