ID

6866

Beschreibung

Superficial Bladder Cancer - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A95F-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A95F-3FA4-E034-080020C9C0E0

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 08.01.15 08.01.15 - Martin Dugas
Hochgeladen am

8. Januar 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Superficial Bladder Cancer - Follow-Up Form - 2019332v2.31

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: Superficial Bladder Cancer - Follow-Up Form
    1. No Instruction available.
Crf Header
Beschreibung

Crf Header

Coordinating Group Protocol Number
Beschreibung

CoordinatingGroupProtocolNumber

Datentyp

text

Coordinating Group Code
Beschreibung

CoordinatingGroupCode

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Beschreibung

Protocol Title

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Beschreibung

PatientStudyID,CoordinatingGroup

Datentyp

text

Patient Study ID, Participating Group
Beschreibung

PatientStudyID,ParticipatingGroup

Datentyp

text

Participating Group Code
Beschreibung

ParticipatingGroupCode

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Beschreibung

InstitutionName

Datentyp

text

Affiliate Name
Beschreibung

AffiliateName

Datentyp

text

Patient Name, Last
Beschreibung

PatientName,Last

Datentyp

text

Patient Name, First
Beschreibung

PatientName,First

Datentyp

text

Patient Name, Middle
Beschreibung

PatientName,Middle

Datentyp

text

Bladder: Form Administration
Beschreibung

Bladder: Form Administration

Person Completing Form, Last Name
Beschreibung

PersonCompletingForm,LastName

Datentyp

text

Person Completing Form, First Name
Beschreibung

PersonCompletingForm,FirstName

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Amended Data Ind
Beschreibung

AmendedDataInd

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Bladder: Vital Status
Beschreibung

Bladder: Vital Status

Patient's Vital Status
Beschreibung

Patient'sVitalStatus

Datentyp

text

Death Reason
Beschreibung

DeathReason

Datentyp

text

Death Reason, Specify
Beschreibung

DeathReason,Specify

Datentyp

text

Death Date/Last Contact Date
Beschreibung

DeathDate/LastContactDate

Datentyp

date

Bladder: Disease Follow-up Status
Beschreibung

Bladder: Disease Follow-up Status

Cancer Follow-up Status Ind
Beschreibung

CancerFollow-upStatusInd

Datentyp

text

Cancer Follow-up Status Date
Beschreibung

CancerFollow-upStatusDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Bladder: Superficial Disease Follow-up Assessment
Beschreibung

Bladder: Superficial Disease Follow-up Assessment

Cytology Date
Beschreibung

CytologyDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
Cytology Result
Beschreibung

CytologyResult

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
Cytology Result, Other
Beschreibung

CytologyResult,Other

Datentyp

text

Cystoscopy Date
Beschreibung

CystoscopyDate

Datentyp

date

Cystoscopy, Lesions Identified Ind
Beschreibung

Cystoscopy,LesionsIdentifiedInd

Datentyp

text

Cystoscopy, Papillary Tumors Present Ind
Beschreibung

Cystoscopy,PapillaryTumorsPresentInd

Datentyp

text

T Stage, Papillary Tumor
Beschreibung

TStage,PapillaryTumor

Datentyp

text

Histologic Grade
Beschreibung

HistologicGrade

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25526
UMLS 2011AA ValueDomain
C0205462
NCI Thesaurus ValueDomain-2
C18000
UMLS 2011AA ValueDomain-2
C0919553
CIS Ind
Beschreibung

CISInd

Datentyp

text

Progression, Superficial Bladder, Treatment Applied
Beschreibung

Progression,SuperficialBladder,TreatmentApplied

Datentyp

text

Progression, Superficial Bladder, Other Surgery
Beschreibung

Progression,SuperficialBladder,OtherSurgery

Datentyp

text

Progression, Superficial Bladder, Other Treatment
Beschreibung

Progression,SuperficialBladder,OtherTreatment

Datentyp

text

Bladder: Notice Of Progression
Beschreibung

Bladder: Notice Of Progression

Progression Ind, Superficial Bladder
Beschreibung

ProgressionInd,SuperficialBladder

Datentyp

text

Progression Date, First Local
Beschreibung

ProgressionDate,FirstLocal

Datentyp

date

Progression Site, First Local
Beschreibung

ProgressionSite,FirstLocal

Datentyp

text

Progression Site, First Local, Other
Beschreibung

ProgressionSite,FirstLocal,Other

Datentyp

text

Progression, T Category Increase
Beschreibung

Progression,TCategoryIncrease

Datentyp

text

Progression Ind, Distant Metastatic
Beschreibung

ProgressionInd,DistantMetastatic

Datentyp

text

Progression Date, First Distant
Beschreibung

ProgressionDate,FirstDistant

Datentyp

date

Progression Site, First Distant
Beschreibung

ProgressionSite,FirstDistant

Datentyp

text

Lymph Nodes, Distant Location
Beschreibung

LymphNodes,DistantLocation

Datentyp

text

Progression Site, Other
Beschreibung

ProgressionSite,Other

Datentyp

text

Bladder: Notice Of New Primary
Beschreibung

Bladder: Notice Of New Primary

New Primary Cancer Ind
Beschreibung

NewPrimaryCancerInd

Datentyp

text

New Primary Cancer Date
Beschreibung

NewPrimaryCancerDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
New Primary Site
Beschreibung

NewPrimarySite

Datentyp

text

Bladder: Long-term Toxicity
Beschreibung

Bladder: Long-term Toxicity

Late Adverse Event Ind
Beschreibung

LateAdverseEventInd

Datentyp

text

Late Adverse Event Term
Beschreibung

LateAdverseEventTerm

Datentyp

text

Late Adverse Event Grade
Beschreibung

LateAdverseEventGrade

Datentyp

text

Late Adverse Event Onset Date
Beschreibung

LateAdverseEventOnsetDate

Datentyp

date

Allows Documentation Of Any Additional Cooments
Beschreibung

Allows Documentation Of Any Additional Cooments

Comments
Beschreibung

Comments

Datentyp

text

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1 Formulare
  1. StudyEvent: Superficial Bladder Cancer - Follow-Up Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Crf Header
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientName,Middle
Item
Patient Name, Middle
text
Item Group
Bladder: Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended Data Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Bladder: Vital Status
Item
Patient's Vital Status
text
CL.2
Code List
Patient's Vital Status
CL Item
Dead (Dead)
CL Item
Alive (Alive)
Item
Death Reason
text
CL.3
Code List
Death Reason
CL Item
Due To Other Cause (Due to other cause)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Due To This Disease (Due to this disease)
CL Item
Due To Protocol Treatment (Due to protocol treatment)
DeathReason,Specify
Item
Death Reason, Specify
text
DeathDate/LastContactDate
Item
Death Date/Last Contact Date
date
Item Group
Bladder: Disease Follow-up Status
Item
Cancer Follow-up Status Ind
text
CL.4
Code List
Cancer Follow-up Status Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CancerFollow-upStatusDate
Item
Cancer Follow-up Status Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Bladder: Superficial Disease Follow-up Assessment
CytologyDate
Item
Cytology Date
date
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
Item
Cytology Result
text
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL.5
Code List
Cytology Result
CL Item
Inflammatory Changes With Or Without Dyscariosis (Inflammatory changes with or without dyscariosis)
CL Item
Moderate Dysplasia Or Papillary Clusters (suspect) (Moderate dysplasia or papillary clusters (suspect))
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Normal Tissue (Normal exfoliated cells)
C33177 (NCI Thesaurus)
CL Item
Severe Dysplasia (Severe dysplasia)
C8364 (NCI Thesaurus)
C0334048 (UMLS 2011AA)
CL Item
Numerous Atypical And Malignant Cells (Numerous atypical and malignant cells)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CytologyResult,Other
Item
Cytology Result, Other
text
CystoscopyDate
Item
Cystoscopy Date
date
Item
Cystoscopy, Lesions Identified Ind
text
CL.6
Code List
Cystoscopy, Lesions Identified Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Cystoscopy, Papillary Tumors Present Ind
text
CL.7
Code List
Cystoscopy, Papillary Tumors Present Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
T Stage, Papillary Tumor
text
CL.8
Code List
T Stage, Papillary Tumor
CL Item
Tx (Tx)
CL Item
Ta (Ta)
CL Item
T0 (T0)
CL Item
T1 (T1)
C1179687 (NCI Metathesaurus)
CL Item
T2 (T2)
CL Item
T3 (T3)
CL Item
T4 (T4)
Item
Histologic Grade
text
C25526 (NCI Thesaurus ValueDomain)
C0205462 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)
CL.9
Code List
Histologic Grade
CL Item
Tumor Grade Cannot Be Assessed (grade cannot be assessed (GX))
CL Item
Well Differentiated (well differentiated (G1))
C14171 (NCI Thesaurus)
C0205615 (UMLS 2011AA)
CL Item
Poorly Differentiated (poorly differentiated (G3))
C14167 (NCI Thesaurus)
C0205617 (UMLS 2011AA)
CL Item
Moderately Differentiated (moderately differentiated (G2))
C14162 (NCI Thesaurus)
C0205616 (UMLS 2011AA)
Item
CIS Ind
text
CL.10
Code List
CIS Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Progression, Superficial Bladder, Treatment Applied
text
CL.11
Code List
Progression, Superficial Bladder, Treatment Applied
CL Item
Intravesical Chemotherapy Was Used To Treat Superficial Bladder Cancer Prior To Progression Or Diagnosis Of More Advanced Disease (intravesical chemotherapy)
CL Item
Intravesical Immunotherapy Was Used To Treat Superficial Bladder Cancer Prior To Progression Or Diagnosis Of More Advanced Disease (intravesical immunotherapy)
CL Item
Other Surgery Was Used To Treat Superficial Bladder Cancer Prior To Progression Or Diagnosis Of More Advanced Disease (surgery-other, specify)
CL Item
Another Treatment Was Used To Treat Superficial Bladder Cancer Prior To Progression Or Diagnosis Of More Advanced Disease (other, specify)
CL Item
Cystectomy Was Used To Treat Superficial Bladder Cancer Prior To Progression Or Diagnosis Of More Advanced Disease (surgery-cystectomy)
CL Item
No Treatment Was Given Prior To Progression Or Diagnosis Of More Advanced Disease (none)
Progression,SuperficialBladder,OtherSurgery
Item
Progression, Superficial Bladder, Other Surgery
text
Progression,SuperficialBladder,OtherTreatment
Item
Progression, Superficial Bladder, Other Treatment
text
Item Group
Bladder: Notice Of Progression
Item
Progression Ind, Superficial Bladder
text
CL.12
Code List
Progression Ind, Superficial Bladder
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ProgressionDate,FirstLocal
Item
Progression Date, First Local
date
Item
Progression Site, First Local
text
CL.13
Code List
Progression Site, First Local
CL Item
Local Progression To The Abdominal Wall (abdominal wall)
CL Item
Progression To Another Site, Specify Site (other, specify)
CL Item
Local Progression To The Pelvic Wall (pelvic wall)
CL Item
Local Spread To Peritoneal Tissue (peritoneum)
CL Item
Local Spread To The Vagina (vagina)
CL Item
Spread Of Cancer To Skin Or Subcutaneous Tissue Near To The Bladder (skin)
CL Item
Local Spread To The Ureter (ureter)
CL Item
Local Spread To The Urethra (urethra)
CL Item
Local Spread To The Uterus (uterus)
CL Item
Local Spread To The Prostate (prostate)
ProgressionSite,FirstLocal,Other
Item
Progression Site, First Local, Other
text
Item
Progression, T Category Increase
text
CL.14
Code List
Progression, T Category Increase
CL Item
T Stage Of Tumor Cannot Be Assessed (Tx)
CL Item
T2 (T2)
CL Item
T3 (T3)
CL Item
T4 (T4)
Item
Progression Ind, Distant Metastatic
text
CL.15
Code List
Progression Ind, Distant Metastatic
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ProgressionDate,FirstDistant
Item
Progression Date, First Distant
date
Item
Progression Site, First Distant
text
CL.16
Code List
Progression Site, First Distant
CL Item
Bone (bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Central Nervous System Or Brain (central nervous system/brain)
CL Item
Distant Lymph Nodes (distant nodes)
CL Item
Liver (liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Skin (skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Other, Specify (other)
CL Item
Peritoneum (peritoneum)
C12770 (NCI Thesaurus)
C0031153 (UMLS 2011AA)
CL Item
Pleura (pleura)
C12469 (NCI Thesaurus)
C0032225 (UMLS 2011AA)
CL Item
Lung (lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
LymphNodes,DistantLocation
Item
Lymph Nodes, Distant Location
text
ProgressionSite,Other
Item
Progression Site, Other
text
Item Group
Bladder: Notice Of New Primary
Item
New Primary Cancer Ind
text
CL.17
Code List
New Primary Cancer Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
NewPrimaryCancerDate
Item
New Primary Cancer Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
New Primary Site
text
Item Group
Bladder: Long-term Toxicity
Item
Late Adverse Event Ind
text
CL.18
Code List
Late Adverse Event Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Late Adverse Event Term
text
CL.19
Code List
Late Adverse Event Term
CL Item
Use Rtog/eortc Grading System (see Ctc Version 2.0. Http://ctep.info.nih.gov/ctc3/ctc.htm). (Use RTOG/EORTC grading system (See CTC version 2.0. http://ctep.info.nih.gov/CTC3/ctc.htm).)
LateAdverseEventGrade
Item
Late Adverse Event Grade
text
LateAdverseEventOnsetDate
Item
Late Adverse Event Onset Date
date
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
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