Description:

E1208 Long-Term Follow-up Form Chemoembolization With or Without Sorafenib Tosylate in Treating Patients With Liver Cancer That Cannot Be Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=705708B9-0164-E0FE-E040-BB89AD435F94

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=705708B9-0164-E0FE-E040-BB89AD435F94
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  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
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January 8, 2015

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Creative Commons BY-NC 3.0 Legacy
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Liver Cancer NCT01004978 Follow-Up - E1208 Long-Term Follow-up Form - 2926924v1.0

INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule). Submit original to the ECOG Coordinating Center. Keep a copy for your files. NOTE: This form is required at the specified report periods regardless of whether new information is available

Header
Off Treatment Report Period (since registration choose one)
Unnamed2
Vital Status
Patient's Vital Status
Primary Cause of Death (if applicable)
Section Ii - Reporting Period
Section Iv - Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Section Iii - Disease Follow-up Status
Has the patient had a documented imaging assessment for this cancer
Has the patient developed a first progression that has not been previously reported? (or relapse)
Did a physician make a formal diagnosis of progressive disease?
Section V - Adverse Events
Has the patient experienced any severe (Grade = 3) long term toxicity that has not been previously reported? (prior to diagnosis of progression/relapse Grade >=3NOTE: Do not report adverse events occurring after start of non-protocol therapy.)
Section Vi - Non-protocol Therapy Prior To Progression
Has the patient received any non-protocol cancer therapy prior to first progression
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