0 Beoordelingen

ID

6843

Beschrijving

CALGB 90202: Follow-Up Form Zoledronate in Preventing Skeletal (Bone)-Related Events in Patients Who Are Receiving Androgen Deprivation Therapy For Prostate Cancer and Bone Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05291069-4AD0-383B-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05291069-4AD0-383B-E044-0003BA3F9857

Trefwoorden

  1. 18-12-14 18-12-14 - Martin Dugas
  2. 08-01-15 08-01-15 - Martin Dugas
Geüploaded op

8 januari 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Itemgroep Commentaren voor :

Item Commentaren voor :


    Geen commentaren

    U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

    Prostate Cancer NCT00079001 Follow-Up - CALGB 90202: Follow-Up Form - 2427399v1.0

    No Instruction available.

    1. StudyEvent: CALGB 90202: Follow-Up Form
      1. No Instruction available.
    Ccrr Module For Calgb 90202: Skeletal Survey Form
    Beschrijving

    Ccrr Module For Calgb 90202: Skeletal Survey Form

    CALGB Form
    Beschrijving

    Form ID CALGB

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3262252
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25442
    CALGB Study No.
    Beschrijving

    Protocol ID CALGB

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    CALGB Patient ID
    Beschrijving

    Trial subject ID CALGB

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    Reporting Period Start Date
    Beschrijving

    Reporting Period Start Date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25616
    UMLS CUI-1
    C2361257
    NCI Thesaurus Property-2
    C25651
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Reporting Period End Date
    Beschrijving

    Reporting Period End Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2361259
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25651
    Are data amended
    Beschrijving

    Data amended

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Patient Initials
    Beschrijving

    Patient Initials

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Medical Record No.
    Beschrijving

    Medical Record Number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Institution/Affiliate
    Beschrijving

    Institution Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group
    Beschrijving

    Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Protocol Number
    Beschrijving

    Study Number Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Beschrijving

    Trial subject ID Participating Group

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Vital Status
    Beschrijving

    Vital Status

    Patient Vital Status
    Beschrijving

    Patient Status

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C3846084
    NCI Thesaurus ValueDomain
    C18003
    NCI Thesaurus ValueDomain-2
    C25688
    NCI Thesaurus Property
    C25717
    Primary Cause of Death
    Beschrijving

    Primary Cause of Death

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C0007465
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C28554
    NCI Thesaurus ValueDomain-2
    C25251
    Describe cause of death
    Beschrijving

    Cause of Death, specify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C0007465
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1521902
    NCI Thesaurus Property
    C28554
    Date of Last Contact or Death
    Beschrijving

    Date last contact

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C0805839
    NCI Thesaurus Property
    C25461
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Treatment Status
    Beschrijving

    Treatment Status

    Treatment Status (Mark one with an X)
    Beschrijving

    Treatment Status

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ValueDomain
    C25688
    UMLS CUI-1
    C0749659
    NCI Thesaurus Property
    C25365
    Other, specify
    Beschrijving

    TreatmentDescriptionSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Did patient receive androgen deprivation therapy? (during this report period)
    Beschrijving

    AndrogenSuppressionTherapyAdministrationInd-2

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ObjectClass-2
    C15676
    UMLS 2011AA ObjectClass
    C1515985
    Type of Androgen Deprivation (If yes, - Mark one with an X)
    Beschrijving

    AndrogenSuppressionTherapyAdministrationType

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ObjectClass-2
    C15676
    UMLS 2011AA ObjectClass
    C1515985
    Start date of Androgen Deprivation (if not previously reported)
    Beschrijving

    AndrogenSuppressionTherapyAdministrationBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C15676
    UMLS 2011AA ObjectClass
    C1515985
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    End date of Androgen Deprivation (if not previously reported)
    Beschrijving

    AndrogenSuppressionTherapyAdministrationEndDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ObjectClass-2
    C15676
    UMLS 2011AA ObjectClass
    C1515985
    Current Supplements
    Beschrijving

    Current Supplements

    Calcium
    Beschrijving

    CalciumNutritionalSupplementUseInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C331
    UMLS 2011AA ObjectClass
    C0006675
    NCI Thesaurus ObjectClass-2
    C1505
    UMLS 2011AA ObjectClass-2
    C0242295
    NCI Thesaurus Property
    C25340
    UMLS 2011AA Property
    C0457083
    Vitamin D
    Beschrijving

    VitaminDNutritionalSupplementUseInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C1505
    UMLS 2011AA ObjectClass
    C0242295
    NCI Thesaurus ObjectClass-2
    C941
    UMLS 2011AA ObjectClass-2
    C2936842
    NCI Thesaurus Property
    C25340
    UMLS 2011AA Property
    C0457083
    Total Daily Dose of Agent (or Drug) (If yes,)
    Beschrijving

    Concomitant Medication Daily Dose

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C25473
    UMLS CUI-1
    C2826638
    NCI Thesaurus ObjectClass-2
    C1708
    NCI Thesaurus Property
    C25304
    NCI Thesaurus Property-2
    C25256
    NCI Thesaurus ValueDomain
    C25488
    NCI Thesaurus ValueDomain-2
    C1708
    Average number of pills per week
    Beschrijving

    NutritionalSupplementWeekPillUseAverageCount

    Datatype

    float

    Alias
    NCI Metathesaurus ObjectClass
    C0242295
    NCI Thesaurus Property
    C29844
    UMLS 2011AA Property
    C0439230
    NCI Thesaurus Property-2
    C25340
    UMLS 2011AA Property-2
    C0457083
    NCI Metathesaurus Property
    C0994475
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus ValueDomain-2
    C37917
    UMLS 2011AA ValueDomain-2
    C1510992
    Notice Of Skeletal Related Event
    Beschrijving

    Notice Of Skeletal Related Event

    Did patient experience any skeletal related event? (during this reporting period)
    Beschrijving

    PatientSkeletalSystemEventInd-2

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25499
    UMLS 2011AA Property
    C0441471
    NCI Thesaurus Property-2
    C12788
    UMLS 2011AA Property-2
    C0037253
    Type of skeletal related event (Mark all that apply with an X)
    Beschrijving

    PatientSkeletalSystemEventType

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25499
    UMLS 2011AA Property
    C0441471
    NCI Thesaurus Property-2
    C12788
    UMLS 2011AA Property-2
    C0037253
    Date of event
    Beschrijving

    PatientSkeletalSystemEventDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25499
    UMLS 2011AA Property
    C0441471
    NCI Thesaurus Property-2
    C12788
    UMLS 2011AA Property-2
    C0037253
    Clinical fracture (Mark all that apply with an X)
    Beschrijving

    PatientClinicalSkeletalSystemFractureType

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C3046
    UMLS 2011AA Property-2
    C0016658
    NCI Thesaurus Property-3
    C12788
    UMLS 2011AA Property-3
    C0037253
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Clinical vertebral fractures (Select one:)
    Beschrijving

    PatientClinicalVertebralFractureStatus

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C3046
    UMLS 2011AA Property-2
    C0016658
    NCI Thesaurus Property-3
    C25715
    UMLS 2011AA Property-3
    C0549207
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Nonvertebral fractures (Select one:)
    Beschrijving

    PatientNotVertebralFractureStatus

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25594
    UMLS 2011AA Property
    C1518422
    NCI Thesaurus Property-2
    C3046
    UMLS 2011AA Property-2
    C0016658
    NCI Thesaurus Property-3
    C25715
    UMLS 2011AA Property-3
    C0549207
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Hip fractures (Select one:)
    Beschrijving

    PatientClinicalPelvisFractureStatus

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C12767
    UMLS 2011AA Property-2
    C0030797
    NCI Thesaurus Property-3
    C3046
    UMLS 2011AA Property-3
    C0016658
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Wrist fractures (Select one:)
    Beschrijving

    PatientClinicalCarpalBoneFractureStatus

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C3046
    UMLS 2011AA Property-2
    C0016658
    NCI Thesaurus Property-3
    C12688
    UMLS 2011AA Property-3
    C0007285
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Disease Follow-up Status
    Beschrijving

    Disease Follow-up Status

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

    Documented clinical assessment for this cancer

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1522577
    NCI Thesaurus Property
    C16033
    UMLS CUI-2
    C0006826
    NCI Thesaurus ObjectClass
    C9305
    NCI Thesaurus Property-2
    C25365
    Date of Last Clinical Assessment
    Beschrijving

    Follow-Up Date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS CUI-1
    C3694716
    NCI Thesaurus Property
    C16033
    NCI Thesaurus Property-2
    C25365
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Notice Of Progression
    Beschrijving

    Notice Of Progression

    Has the patient developed new bone metastases, a first biochemical progression, or developed an indication for radiation therapy to the bone that has not been previously reported? (NOTE: Three consecutive PSA rises must be documented on Form C-714 before switch to Open Label is initiated.)
    Beschrijving

    BoneMetastasisBiochemicalDiseaseProgressionPresentInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12366
    UMLS 2011AA ObjectClass
    C0262950
    NCI Thesaurus ObjectClass-2
    C25434
    UMLS 2011AA ObjectClass-2
    C0205474
    NCI Thesaurus ObjectClass-3
    C19151
    UMLS 2011AA ObjectClass-3
    C0027627
    NCI Thesaurus ObjectClass-4
    C17747
    UMLS 2011AA ObjectClass-4
    C0242656
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Date of First Biochemical Progression (PSA)
    Beschrijving

    BiochemicalProgressionFirstDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus ObjectClass-2
    C25434
    UMLS 2011AA ObjectClass
    C0205474
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property-2
    C2745955
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25509
    UMLS 2011AA ValueDomain-2
    C1279901
    PSA Value at Progression
    Beschrijving

    LaboratoryProcedureProstate-SpecificAntigenCancerProgressionOutcomeValue

    Datatype

    float

    Maateenheden
    • ng/ml
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C17525
    UMLS 2011AA Property
    C0138741
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus Property-3
    C19987
    UMLS 2011AA Property-3
    C0242656
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    ng/ml
    Date of Bone Progression
    Beschrijving

    CancerProgressionBoneObservedDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C12366
    UMLS 2011AA Property
    C0262950
    NCI Thesaurus ObjectClass
    C19987
    UMLS 2011AA ObjectClass
    C0242656
    NCI Thesaurus Property-2
    C25599
    UMLS 2011AA Property-2
    C1441672
    Notice Of New Primary
    Beschrijving

    Notice Of New Primary

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

    New primary cancer

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C0751623
    NCI Thesaurus ObjectClass
    C25586
    NCI Thesaurus ObjectClass-2
    C9305
    NCI Thesaurus Property
    C15220
    Date of diagnosis
    Beschrijving

    NewCancerDiagnosisDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C25586
    UMLS 2011AA ObjectClass
    C0205314
    NCI Thesaurus ObjectClass-2
    C9305
    UMLS 2011AA ObjectClass-2
    C0006826
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Site of New Primary
    Beschrijving

    NewCancerSiteText

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25586
    UMLS 2011AA ObjectClass
    C0205314
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus ObjectClass-2
    C9305
    UMLS 2011AA ObjectClass-2
    C0006826
    New Primary, Histologic type
    Beschrijving

    PrimaryTumorNewHistologicCategory

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25251
    UMLS 2011AA ObjectClass-2
    C0205225
    NCI Thesaurus Property
    C25586
    UMLS 2011AA Property
    C0205314
    NCI Thesaurus Property-2
    C25161
    UMLS 2011AA Property-2
    C0008902
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    NCI Thesaurus ValueDomain-2
    C25526
    UMLS 2011AA ValueDomain-2
    C0205462
    Non-protocol Therapy
    Beschrijving

    Non-protocol Therapy

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

    Non-protocolTherapyCurrentPeriodAdministeredInd-2

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25471
    UMLS 2011AA Property-2
    C0521116
    NCI Thesaurus Property-3
    C25382
    UMLS 2011AA Property-3
    C1521801
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Non-Protocol Therapy Type (If yes,)
    Beschrijving

    Non-ProtocolTherapyAdministeredType

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-protocol bisphosphonate therapy, specify
    Beschrijving

    Non-ProtocolTherapeuticProcedureBiphosphonateAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C49236
    UMLS 2011AA ObjectClass
    C0087111
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C443
    UMLS 2011AA Property
    C0012544
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Specify agents, dose, schedule
    Beschrijving

    Non-ProtocolChemotherapyAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Other non-protocol therapy, specify
    Beschrijving

    Non-ProtocolTherapyOtherAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C17649
    UMLS 2011AA Property
    C0205394
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Non-protocol Therapy Start Date
    Beschrijving

    Non-protocolTherapyAdministeredBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Non-protocol Therapy Start Date
    Beschrijving

    Non-protocolTherapyAdministeredBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Non-protocol Therapy Start Date
    Beschrijving

    Non-protocolTherapyAdministeredBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Non-protocol Therapy End Date
    Beschrijving

    Non-protocolTherapyAdministeredEndDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-protocol Therapy End Date
    Beschrijving

    Non-protocolTherapyAdministeredEndDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-protocol Therapy End Date
    Beschrijving

    Non-protocolTherapyAdministeredEndDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Footer
    Beschrijving

    Footer

    Completed by
    Beschrijving

    Person Completing Form

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Date Form Originally Completed
    Beschrijving

    Form Completion Date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367

    Similar models

    No Instruction available.

    1. StudyEvent: CALGB 90202: Follow-Up Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    Ccrr Module For Calgb 90202: Skeletal Survey Form
    Form ID CALGB
    Item
    CALGB Form
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3262252 (UMLS CUI-1)
    C19464 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus ObjectClass-2)
    Protocol ID CALGB
    Item
    CALGB Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Trial subject ID CALGB
    Item
    CALGB Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Reporting Period Start Date
    Item
    Reporting Period Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C2361257 (UMLS CUI-1)
    C25651 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Reporting Period End Date
    Item
    Reporting Period End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2361259 (UMLS CUI-1)
    C25616 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25651 (NCI Thesaurus Property-2)
    Data amended
    Item
    Are data amended
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Medical Record Number
    Item
    Patient Medical Record No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Participating Group
    Item
    Participating Group
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Vital Status
    Item
    Patient Vital Status
    text
    C16960 (NCI Thesaurus ObjectClass)
    C3846084 (UMLS CUI-1)
    C18003 (NCI Thesaurus ValueDomain)
    C25688 (NCI Thesaurus ValueDomain-2)
    C25717 (NCI Thesaurus Property)
    Code List
    Patient Vital Status
    CL Item
    Alive (Alive)
    CL Item
    Dead (Dead)
    CL Item
    Lost To Follow-up (Lost to follow-up)
    Item
    Primary Cause of Death
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0007465 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C28554 (NCI Thesaurus Property)
    C25251 (NCI Thesaurus ValueDomain-2)
    Code List
    Primary Cause of Death
    CL Item
    Due To Other Cause (Due to other cause)
    CL Item
    Due To Protocol Treatment (Due to protocol treatment)
    CL Item
    Due To This Disease (Due to this disease)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Cause of Death, specify
    Item
    Describe cause of death
    text
    C25685 (NCI Thesaurus ValueDomain)
    C0007465 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1521902 (UMLS CUI-2)
    C28554 (NCI Thesaurus Property)
    Date last contact
    Item
    Date of Last Contact or Death
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0805839 (UMLS CUI-1)
    C25461 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Treatment Status
    Item
    Treatment Status (Mark one with an X)
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25688 (NCI Thesaurus ValueDomain)
    C0749659 (UMLS CUI-1)
    C25365 (NCI Thesaurus Property)
    Code List
    Treatment Status (Mark one with an X)
    CL Item
    Double-blinded (Double-blinded)
    CL Item
    Open Label (Open label)
    CL Item
    Follow-up, Off Protocol Therapy (Follow-up, off protocol therapy)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    TreatmentDescriptionSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    AndrogenSuppressionTherapyAdministrationInd-2
    Item
    Did patient receive androgen deprivation therapy? (during this report period)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C15676 (NCI Thesaurus ObjectClass-2)
    C1515985 (UMLS 2011AA ObjectClass)
    Item
    Type of Androgen Deprivation (If yes, - Mark one with an X)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C15676 (NCI Thesaurus ObjectClass-2)
    C1515985 (UMLS 2011AA ObjectClass)
    Code List
    Type of Androgen Deprivation (If yes, - Mark one with an X)
    CL Item
    Continuous (Continuous)
    C53279 (NCI Thesaurus)
    C0549178 (UMLS 2011AA)
    CL Item
    Intermittent (Intermittent)
    AndrogenSuppressionTherapyAdministrationBeginDate
    Item
    Start date of Androgen Deprivation (if not previously reported)
    date
    C15368 (NCI Thesaurus ObjectClass)
    C15676 (NCI Thesaurus ObjectClass-2)
    C1515985 (UMLS 2011AA ObjectClass)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    AndrogenSuppressionTherapyAdministrationEndDate
    Item
    End date of Androgen Deprivation (if not previously reported)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C15676 (NCI Thesaurus ObjectClass-2)
    C1515985 (UMLS 2011AA ObjectClass)
    Item Group
    Current Supplements
    CalciumNutritionalSupplementUseInd-3
    Item
    Calcium
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C331 (NCI Thesaurus ObjectClass)
    C0006675 (UMLS 2011AA ObjectClass)
    C1505 (NCI Thesaurus ObjectClass-2)
    C0242295 (UMLS 2011AA ObjectClass-2)
    C25340 (NCI Thesaurus Property)
    C0457083 (UMLS 2011AA Property)
    VitaminDNutritionalSupplementUseInd-3
    Item
    Vitamin D
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C1505 (NCI Thesaurus ObjectClass)
    C0242295 (UMLS 2011AA ObjectClass)
    C941 (NCI Thesaurus ObjectClass-2)
    C2936842 (UMLS 2011AA ObjectClass-2)
    C25340 (NCI Thesaurus Property)
    C0457083 (UMLS 2011AA Property)
    Concomitant Medication Daily Dose
    Item
    Total Daily Dose of Agent (or Drug) (If yes,)
    float
    C25473 (NCI Thesaurus ObjectClass)
    C2826638 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass-2)
    C25304 (NCI Thesaurus Property)
    C25256 (NCI Thesaurus Property-2)
    C25488 (NCI Thesaurus ValueDomain)
    C1708 (NCI Thesaurus ValueDomain-2)
    NutritionalSupplementWeekPillUseAverageCount
    Item
    Average number of pills per week
    float
    C0242295 (NCI Metathesaurus ObjectClass)
    C29844 (NCI Thesaurus Property)
    C0439230 (UMLS 2011AA Property)
    C25340 (NCI Thesaurus Property-2)
    C0457083 (UMLS 2011AA Property-2)
    C0994475 (NCI Metathesaurus Property)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C37917 (NCI Thesaurus ValueDomain-2)
    C1510992 (UMLS 2011AA ValueDomain-2)
    Item Group
    Notice Of Skeletal Related Event
    PatientSkeletalSystemEventInd-2
    Item
    Did patient experience any skeletal related event? (during this reporting period)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25499 (NCI Thesaurus Property)
    C0441471 (UMLS 2011AA Property)
    C12788 (NCI Thesaurus Property-2)
    C0037253 (UMLS 2011AA Property-2)
    Item
    Type of skeletal related event (Mark all that apply with an X)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25499 (NCI Thesaurus Property)
    C0441471 (UMLS 2011AA Property)
    C12788 (NCI Thesaurus Property-2)
    C0037253 (UMLS 2011AA Property-2)
    Code List
    Type of skeletal related event (Mark all that apply with an X)
    CL Item
    Radiation To Bone (radiation to bone)
    CL Item
    Clinical Fracture (Clinical fracture)
    CL Item
    Surgery To Bone (surgery to bone)
    CL Item
    Spinal Cord Compression (spinal cord compression)
    C3380 (NCI Thesaurus)
    C0037926 (UMLS 2011AA)
    CL Item
    Death Due To Prostate Cancer (Death due to prostate cancer)
    PatientSkeletalSystemEventDate
    Item
    Date of event
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25499 (NCI Thesaurus Property)
    C0441471 (UMLS 2011AA Property)
    C12788 (NCI Thesaurus Property-2)
    C0037253 (UMLS 2011AA Property-2)
    Item
    Clinical fracture (Mark all that apply with an X)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C3046 (NCI Thesaurus Property-2)
    C0016658 (UMLS 2011AA Property-2)
    C12788 (NCI Thesaurus Property-3)
    C0037253 (UMLS 2011AA Property-3)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    Clinical fracture (Mark all that apply with an X)
    CL Item
    Clinical Vertebral Fractures (Clinical vertebral fractures)
    CL Item
    Nonvertebral Fractures (Nonvertebral fractures)
    CL Item
    Hip Fractures (Hip fractures)
    CL Item
    Wrist Fractures (Wrist fractures)
    Item
    Clinical vertebral fractures (Select one:)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C3046 (NCI Thesaurus Property-2)
    C0016658 (UMLS 2011AA Property-2)
    C25715 (NCI Thesaurus Property-3)
    C0549207 (UMLS 2011AA Property-3)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Clinical vertebral fractures (Select one:)
    CL Item
    Pathological (Pathological)
    CL Item
    Traumatic (Traumatic)
    Item
    Nonvertebral fractures (Select one:)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus Property)
    C1518422 (UMLS 2011AA Property)
    C3046 (NCI Thesaurus Property-2)
    C0016658 (UMLS 2011AA Property-2)
    C25715 (NCI Thesaurus Property-3)
    C0549207 (UMLS 2011AA Property-3)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Nonvertebral fractures (Select one:)
    CL Item
    Pathological (Pathological)
    CL Item
    Traumatic (Traumatic)
    Item
    Hip fractures (Select one:)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C12767 (NCI Thesaurus Property-2)
    C0030797 (UMLS 2011AA Property-2)
    C3046 (NCI Thesaurus Property-3)
    C0016658 (UMLS 2011AA Property-3)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Hip fractures (Select one:)
    CL Item
    Pathological (Pathological)
    CL Item
    Traumatic (Traumatic)
    Item
    Wrist fractures (Select one:)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C3046 (NCI Thesaurus Property-2)
    C0016658 (UMLS 2011AA Property-2)
    C12688 (NCI Thesaurus Property-3)
    C0007285 (UMLS 2011AA Property-3)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Wrist fractures (Select one:)
    CL Item
    Pathological (Pathological)
    CL Item
    Traumatic (Traumatic)
    Item Group
    Disease Follow-up Status
    Documented clinical assessment for this cancer
    Item
    Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1522577 (UMLS CUI-1)
    C16033 (NCI Thesaurus Property)
    C0006826 (UMLS CUI-2)
    C9305 (NCI Thesaurus ObjectClass)
    C25365 (NCI Thesaurus Property-2)
    Follow-Up Date
    Item
    Date of Last Clinical Assessment
    date
    C9305 (NCI Thesaurus ObjectClass)
    C3694716 (UMLS CUI-1)
    C16033 (NCI Thesaurus Property)
    C25365 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Notice Of Progression
    BoneMetastasisBiochemicalDiseaseProgressionPresentInd-3
    Item
    Has the patient developed new bone metastases, a first biochemical progression, or developed an indication for radiation therapy to the bone that has not been previously reported? (NOTE: Three consecutive PSA rises must be documented on Form C-714 before switch to Open Label is initiated.)
    boolean
    C12366 (NCI Thesaurus ObjectClass)
    C0262950 (UMLS 2011AA ObjectClass)
    C25434 (NCI Thesaurus ObjectClass-2)
    C0205474 (UMLS 2011AA ObjectClass-2)
    C19151 (NCI Thesaurus ObjectClass-3)
    C0027627 (UMLS 2011AA ObjectClass-3)
    C17747 (NCI Thesaurus ObjectClass-4)
    C0242656 (UMLS 2011AA ObjectClass-4)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    BiochemicalProgressionFirstDate
    Item
    Date of First Biochemical Progression (PSA)
    date
    C25331 (NCI Thesaurus ObjectClass)
    C25434 (NCI Thesaurus ObjectClass-2)
    C0205474 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25509 (NCI Thesaurus ValueDomain-2)
    C1279901 (UMLS 2011AA ValueDomain-2)
    LaboratoryProcedureProstate-SpecificAntigenCancerProgressionOutcomeValue
    Item
    PSA Value at Progression
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C17525 (NCI Thesaurus Property)
    C0138741 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C19987 (NCI Thesaurus Property-3)
    C0242656 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    CancerProgressionBoneObservedDate
    Item
    Date of Bone Progression
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C12366 (NCI Thesaurus Property)
    C0262950 (UMLS 2011AA Property)
    C19987 (NCI Thesaurus ObjectClass)
    C0242656 (UMLS 2011AA ObjectClass)
    C25599 (NCI Thesaurus Property-2)
    C1441672 (UMLS 2011AA Property-2)
    Item Group
    Notice Of New Primary
    New primary cancer
    Item
    Has a new primary cancer or MDS been diagnosed that has not been previously reported?
    boolean
    C25180 (NCI Thesaurus ValueDomain)
    C0751623 (UMLS CUI-1)
    C25586 (NCI Thesaurus ObjectClass)
    C9305 (NCI Thesaurus ObjectClass-2)
    C15220 (NCI Thesaurus Property)
    NewCancerDiagnosisDate
    Item
    Date of diagnosis
    date
    C25586 (NCI Thesaurus ObjectClass)
    C0205314 (UMLS 2011AA ObjectClass)
    C9305 (NCI Thesaurus ObjectClass-2)
    C0006826 (UMLS 2011AA ObjectClass-2)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    NewCancerSiteText
    Item
    Site of New Primary
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25586 (NCI Thesaurus ObjectClass)
    C0205314 (UMLS 2011AA ObjectClass)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C9305 (NCI Thesaurus ObjectClass-2)
    C0006826 (UMLS 2011AA ObjectClass-2)
    PrimaryTumorNewHistologicCategory
    Item
    New Primary, Histologic type
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus ObjectClass-2)
    C0205225 (UMLS 2011AA ObjectClass-2)
    C25586 (NCI Thesaurus Property)
    C0205314 (UMLS 2011AA Property)
    C25161 (NCI Thesaurus Property-2)
    C0008902 (UMLS 2011AA Property-2)
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    C25526 (NCI Thesaurus ValueDomain-2)
    C0205462 (UMLS 2011AA ValueDomain-2)
    Item Group
    Non-protocol Therapy
    Non-protocolTherapyCurrentPeriodAdministeredInd-2
    Item
    Has the patient received any non-protocol cancer therapy during this reporting period?
    boolean
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25471 (NCI Thesaurus Property-2)
    C0521116 (UMLS 2011AA Property-2)
    C25382 (NCI Thesaurus Property-3)
    C1521801 (UMLS 2011AA Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    Item
    Non-Protocol Therapy Type (If yes,)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Code List
    Non-Protocol Therapy Type (If yes,)
    CL Item
    Biphosphonate (Bisphosphonate)
    C443 (NCI Thesaurus)
    C0012544 (UMLS 2011AA)
    CL Item
    Chemotherapy (Chemotherapy)
    C15632 (NCI Thesaurus)
    C0392920 (UMLS 2011AA)
    CL Item
    Other Non-protocol Therapy (Other non-protocol therapy)
    Non-ProtocolTherapeuticProcedureBiphosphonateAdministeredSpecify
    Item
    Non-protocol bisphosphonate therapy, specify
    text
    C49236 (NCI Thesaurus ObjectClass)
    C0087111 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C443 (NCI Thesaurus Property)
    C0012544 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Non-ProtocolChemotherapyAdministeredSpecify
    Item
    Specify agents, dose, schedule
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolTherapyOtherAdministeredSpecify
    Item
    Other non-protocol therapy, specify
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Non-protocolTherapyAdministeredBeginDate
    Item
    Non-protocol Therapy Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    Non-protocolTherapyAdministeredBeginDate
    Item
    Non-protocol Therapy Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    Non-protocolTherapyAdministeredBeginDate
    Item
    Non-protocol Therapy Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    Non-protocolTherapyAdministeredEndDate
    Item
    Non-protocol Therapy End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolTherapyAdministeredEndDate
    Item
    Non-protocol Therapy End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolTherapyAdministeredEndDate
    Item
    Non-protocol Therapy End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Item Group
    Footer
    Person Completing Form
    Item
    Completed by
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Date Form Originally Completed
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)

    Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

    Watch Tutorial