0 Bedömningar
ID

10632

Beskrivning

CALGB: 49808 RESPONSE/PROGRESSION FORM NCT00016276 Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab 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=9E35395C-867B-227A-E034-080020C9C0E0

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E35395C-867B-227A-E034-080020C9C0E0

Nyckelord

Versioner (3)
  1. 2012-08-26 2012-08-26 -
  2. 2015-05-22 2015-05-22 -
  3. 2015-06-03 2015-06-03 -
Uppladdad den

3 juni 2015

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

  • Senaste
  • Äldsta
  • Önskad
  • Senaste
    • Senaste
    • Äldsta
    • Önskad

    Inga kommentarer

    Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

    CALGB: 49808 RESPONSE/PROGRESSION FORM NCT00016276

    Engelsk

    No Instruction available.

    1 Formulär  
    1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
      1. No Instruction available.
    CALGB clinical trial administrative data
    Beskrivning

    CALGB clinical trial administrative data

    CALGB Form
    Beskrivning

    CALGBForm

    Datatyp

    text

    CALGB Study No
    Beskrivning

    CALGBProtocolNumber

    Datatyp

    text

    CALGB Patient ID
    Beskrivning

    CALGBPatientID

    Datatyp

    text

    From
    Beskrivning

    From

    Datatyp

    text

    To (Date of last contact or death)
    Beskrivning

    To

    Datatyp

    text

    Amended data?
    Beskrivning

    AmendedDataInd

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Patient clinical trial data
    Beskrivning

    Patient clinical trial data

    Patient's Name
    Beskrivning

    Patient'sName

    Datatyp

    text

    Participating Group
    Beskrivning

    ParticipatingGroup

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17005 (undefined)
    UMLS 2011AA ObjectClass
    C1257890 (Population Group)
    SNOMED
    389109008
    LOINC
    LA12078-4
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Patient Hospital Number
    Beskrivning

    PatientHospitalNumber

    Datatyp

    text

    Participating Group Protocol No.
    Beskrivning

    ParticipatingGroupProtocolNo.

    Datatyp

    text

    Main Member Institution/Adjunct
    Beskrivning

    MainMemberInstitution/Adjunct

    Datatyp

    text

    Participating Group Patient No.
    Beskrivning

    ParticipatingGroupPatientNo.

    Datatyp

    text

    Response Assessment (clinical/radiographic)
    Beskrivning

    Response Assessment (clinical/radiographic)

    Has the patient achieved a response (not previously reported)?
    Beskrivning

    Hasthepatientachievedaresponse(notpreviouslyreported)?

    Datatyp

    text

    Date overall partial response first documented
    Beskrivning

    Dateoverallpartialresponsefirstdocumented

    Datatyp

    text

    Date overall complete response first documented
    Beskrivning

    Dateoverallcompleteresponsefirstdocumented

    Datatyp

    text

    Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
    Beskrivning

    Hasthepatientbeendiagnosedwithanewprogressionduringthisreportingperiod(notpreviouslyreported)?

    Datatyp

    text

    Date response/stable disease last documented (IF NO:)
    Beskrivning

    Dateresponse/stablediseaselastdocumented

    Datatyp

    text

    Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
    Beskrivning

    Hasthepatientbeendiagnosedwithanewlocal-regionalrecurrencesincesubmissionofthelastfollow-upform?

    Datatyp

    text

    Date of new Local-Regional Recurrence
    Beskrivning

    DateofnewLocal-RegionalRecurrence

    Datatyp

    text

    Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
    Beskrivning

    Site(s)ofFirstLocal-RegionalRecurrence

    Datatyp

    text

    How was this recurrence information obtained?
    Beskrivning

    Howwasthisrecurrenceinformationobtained?

    Datatyp

    text

    Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
    Beskrivning

    Hasthepatientbeendiagnosedwithafirstdistantprogressionsincesubmissionofthelastfollow-upform?

    Datatyp

    text

    Date of First Distant Progression
    Beskrivning

    ProgressionDate,FirstDistant

    Datatyp

    date

    Site(s) of First Distant Progression
    Beskrivning

    Site(s)ofFirstDistantProgression

    Datatyp

    text

    How was this progression information obtained?
    Beskrivning

    Howwasthisprogressioninformationobtained?

    Datatyp

    text

    Comments
    Beskrivning

    Comments

    Comments
    Beskrivning

    Comments

    Datatyp

    text

    Tillbaka till toppen

    Similar models

    No Instruction available.

    1 Formulär
    1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    CALGB clinical trial administrative data
    CALGBForm
    Item
    CALGB Form
    text
    CALGBProtocolNumber
    Item
    CALGB Study No
    text
    CALGBPatientID
    Item
    CALGB Patient ID
    text
    From
    Item
    From
    text
    To
    Item
    To (Date of last contact or death)
    text
    Item
    Amended data?
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    CL.1
    Code List
    Amended data?
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item Group
    Patient clinical trial data
    Patient'sName
    Item
    Patient's Name
    text
    ParticipatingGroup
    Item
    Participating Group
    text
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientHospitalNumber
    Item
    Patient Hospital Number
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    MainMemberInstitution/Adjunct
    Item
    Main Member Institution/Adjunct
    text
    ParticipatingGroupPatientNo.
    Item
    Participating Group Patient No.
    text
    Item Group
    Response Assessment (clinical/radiographic)
    Item
    Has the patient achieved a response (not previously reported)?
    text
    CL.2
    Code List
    Has the patient achieved a response (not previously reported)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Dateoverallpartialresponsefirstdocumented
    Item
    Date overall partial response first documented
    text
    Dateoverallcompleteresponsefirstdocumented
    Item
    Date overall complete response first documented
    text
    Item
    Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
    text
    CL.3
    Code List
    Has the patient been diagnosed with a new progression during this reporting period (not previously reported)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Dateresponse/stablediseaselastdocumented
    Item
    Date response/stable disease last documented (IF NO:)
    text
    Item
    Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
    text
    CL.4
    Code List
    Has the patient been diagnosed with a new local-regional recurrence since submission of the last follow-up form? (IF YES:)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    DateofnewLocal-RegionalRecurrence
    Item
    Date of new Local-Regional Recurrence
    text
    Item
    Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
    text
    CL.5
    Code List
    Site(s) of First Local-Regional Recurrence (mark all that apply with an X)
    CL Item
    Ipsilateral Breast (Ipsilateral breast)
    CL Item
    Chest Wall (Chest wall)
    CL035093 (NCI Metathesaurus)
    C62484 (NCI Thesaurus)
    C0205076 (UMLS 2011AA)
    CL Item
    Axillary Nodes (Axillary nodes)
    CL Item
    Internal Mammary (Internal mammary)
    CL Item
    Supraclavicular Nodes (Supraclavicular nodes)
    CL Item
    Axilla (Axilla)
    C12674 (NCI Thesaurus)
    C0004454 (UMLS 2011AA)
    CL Item
    Infraclavicular Nodes (Infraclavicular nodes)
    Item
    How was this recurrence information obtained?
    text
    CL.6
    Code List
    How was this recurrence information obtained?
    CL Item
    Documented Clinical Assessment (Documented clinical assessment)
    CL Item
    Patient Self Report Only (Patient self report only)
    Item
    Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
    text
    CL.7
    Code List
    Has the patient been diagnosed with a first distant progression since submission of the last follow-up form? (IF YES, continued)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    ProgressionDate,FirstDistant
    Item
    Date of First Distant Progression
    date
    Site(s)ofFirstDistantProgression
    Item
    Site(s) of First Distant Progression
    text
    Item
    How was this progression information obtained?
    text
    CL.8
    Code List
    How was this progression information obtained?
    CL Item
    Documented Clinical Assessment (Documented clinical assessment)
    CL Item
    Patient Self Report Only (Patient self report only)
    Item Group
    Comments
    Comments
    Item
    Comments
    text
    Tillbaka till toppen 

    Hjälp

    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