Description:

CALGB 40503 FOLLOW-UP FORM Tamoxifen or Letrozole With or Without Bevacizumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2403F6CA-49D5-5F41-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2403F6CA-49D5-5F41-E044-0003BA3F9857

Keywords:
Versions (2) ▾
  1. 8/26/12
  2. 1/8/15
Uploaded on:

January 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00601900 Follow-Up - CALGB 40503 FOLLOW-UP FORM - 2551098v1.0

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

Header
Are data amended
Unnamed2
Vital Status
Patient's vital status (Mark one with an X.)
Primary cause of death (Mark one with an X.)
Has the patient had a documented clinical assessment for this cancer (since submission of last follow-up form)
Was patient restaged during this time period (If Yes, complete the following questions and submit C-817 Follow-Up Solid Tumor Measurement Form)
Overall Tumor Response
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first progression (If yes, specify the therapy given)
Notice Of Progression
Has the patient developed a first progression (or relapse) that has not been previously reported? (or relapse)
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Skeletal Related Events
Did patient experience any skeletal related event?
Type of skeletal related event (Mark all that apply with an X.)
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