FormCompletionDate
Item
Visit Date (Enter the date the form is being completed.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
TreatmentPhaseEndDate
Item
Date Off Treatment (Enter the date when all courses have been completed including the normal observation period or discontinued and no further treatment courses are planned.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0087111 (NCI Metathesaurus ObjectClass)
C0205390 (NCI Metathesaurus ObjectClass-2)
C0205197 (NCI Metathesaurus Property)
Item
Reason Off Treatment (Select an off treatment reason from one of the following reason groups:)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Code List
Reason Off Treatment (Select an off treatment reason from one of the following reason groups:)
CL Item
Study Complete (C)
CL Item
Declined To Participate (X)
CL Item
Disease Progression Before Treatment (B)
CL Item
No Treatment, Per Protocol Criteria (Z)
CL Item
Not Treated - Other Reasons (U)
CL Item
Disease Progression (P)
C17747 (NCI Thesaurus)
C0242656 (UMLS 2011AA)
CL Item
Death On Study (D)
CL Item
Toxicity (T)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Complicating Disease (S)
CL Item
Cytogenetic Resistance (G)
CL Item
Alternative Treatment (A)
CL Item
Refused Further Treatment (R)
CL Item
Protocol Violation (V)
C48251 (NCI Thesaurus)
C1709750 (UMLS 2011AA)
CL Item
Pi Discretion (N)
CL Item
Other (O)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Treatment Period Completed (Q)
Off-TreatmentOtherDescriptionShortText
Item
Explain 'Other' Reason Off Treatment (Enter an explanation for selecting "Other" for a Reason Off Treatment.)
text
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus ValueDomain-2)
C0678257 (UMLS 2011AA ValueDomain-2)
C25249 (NCI Thesaurus ValueDomain-3)
C1806781 (UMLS 2011AA ValueDomain-3)
Follow-UpStatusBeginPeriodIndicator
Item
Patient Began Protocol Specified Follow-up (Indicate whether or not the patient began the protocol-specified follow-up period.)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25431 (NCI Thesaurus Property-2)
C0439659 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ObjectClass)
C0449438 (UMLS 2011AA ObjectClass)
Treatment End Date
Item
Date of Last Medication Administration
date
C25164 (NCI Thesaurus ValueDomain)
C1531784 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C25496 (NCI Thesaurus Property-2)
Item
Best Response to Treatment (Select the best overall response to treatment while on protocol.)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C15368 (NCI Thesaurus ObjectClass)
C25432 (NCI Thesaurus ObjectClass-2)
C1522427 (UMLS 2011AA ObjectClass)
Code List
Best Response to Treatment (Select the best overall response to treatment while on protocol.)
CL Item
Complete Response (CR)
CL Item
Less Than Partial Response (MR)
CL Item
Not Assessed (NA)
CL Item
Not Evauable (NE)
CL Item
Not Applicable Per Protocol (NP)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Partial Response (PR)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (SD)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Complete Response Unconfirmed (CRU)
CL Item
Non-cr/non-pd (Non-CR/Non-PD)
CL Item
Disease Unchanged (DU)
BestResponseDate
Item
Date of Best Response (Enter the date that a Best Response of Treatment response of CR, PR, or MR was first observed, or that an SD response began.)
date
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25432 (NCI Thesaurus ObjectClass-2)
C1522427 (UMLS 2011AA ObjectClass-2)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25279 (NCI Thesaurus Property-2)
C0332162 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
ProgressionDate
Item
Date of Disease Progression (Enter the date that progression or relapse was first observed i.e.: date of scan.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)