0 Valutazioni
ID

688

Descrizione

CALGB: 49808 RESPONSE/PROGRESSION FORM 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

collegamento

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

Keywords

versioni (3)
  1. 26/08/12 26/08/12 -
  2. 22/05/15 22/05/15 -
  3. 03/06/15 03/06/15 -
Caricato su

26 agosto 2012

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
Commenti del modello :

Puoi commentare il modello dati qui. Tramite i fumetti nei gruppi di articoli e articoli è possibile aggiungere commenti a quelli in modo specifico.

Torna ai commenti del modello
Commenti del gruppo di articoli per :

Commenti dell'articolo per :

  • i più nuovi
  • i più vecchi
  • Popolare
  • i più nuovi
    • i più nuovi
    • i più vecchi
    • Popolare

    Non ci sono commenti

    Per scaricare i modelli di dati devi essere registrato. Per favore accesso o registrati GRATIS.

    Breast Cancer NCT00016276 Response - CALGB: 49808 RESPONSE/PROGRESSION FORM - 2032254v3.0

    Inglese

    No Instruction available.

    1 moduli  
    1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
      1. No Instruction available.
    Unnamed1
    Descrizione

    Unnamed1

    CALGB Form
    Descrizione

    CALGBForm

    Tipo di dati

    text

    CALGB Study No
    Descrizione

    CALGBProtocolNumber

    Tipo di dati

    text

    CALGB Patient ID
    Descrizione

    CALGBPatientID

    Tipo di dati

    text

    From
    Descrizione

    From

    Tipo di dati

    text

    To (Date of last contact or death)
    Descrizione

    To

    Tipo di dati

    text

    Amended data?
    Descrizione

    AmendedDataInd

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Unnamed2
    Descrizione

    Unnamed2

    Patient's Name
    Descrizione

    Patient'sName

    Tipo di dati

    text

    Participating Group
    Descrizione

    ParticipatingGroup

    Tipo di dati

    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
    Descrizione

    PatientHospitalNumber

    Tipo di dati

    text

    Participating Group Protocol No.
    Descrizione

    ParticipatingGroupProtocolNo.

    Tipo di dati

    text

    Main Member Institution/Adjunct
    Descrizione

    MainMemberInstitution/Adjunct

    Tipo di dati

    text

    Participating Group Patient No.
    Descrizione

    ParticipatingGroupPatientNo.

    Tipo di dati

    text

    Response Assessment (clinical/radiographic)
    Descrizione

    Response Assessment (clinical/radiographic)

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

    Hasthepatientachievedaresponse(notpreviouslyreported)?

    Tipo di dati

    text

    Date overall partial response first documented
    Descrizione

    Dateoverallpartialresponsefirstdocumented

    Tipo di dati

    text

    Date overall complete response first documented
    Descrizione

    Dateoverallcompleteresponsefirstdocumented

    Tipo di dati

    text

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

    Hasthepatientbeendiagnosedwithanewprogressionduringthisreportingperiod(notpreviouslyreported)?

    Tipo di dati

    text

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

    Dateresponse/stablediseaselastdocumented

    Tipo di dati

    text

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

    Hasthepatientbeendiagnosedwithanewlocal-regionalrecurrencesincesubmissionofthelastfollow-upform?

    Tipo di dati

    text

    Date of new Local-Regional Recurrence
    Descrizione

    DateofnewLocal-RegionalRecurrence

    Tipo di dati

    text

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

    Site(s)ofFirstLocal-RegionalRecurrence

    Tipo di dati

    text

    How was this recurrence information obtained?
    Descrizione

    Howwasthisrecurrenceinformationobtained?

    Tipo di dati

    text

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

    Hasthepatientbeendiagnosedwithafirstdistantprogressionsincesubmissionofthelastfollow-upform?

    Tipo di dati

    text

    Date of First Distant Progression
    Descrizione

    ProgressionDate,FirstDistant

    Tipo di dati

    date

    Site(s) of First Distant Progression
    Descrizione

    Site(s)ofFirstDistantProgression

    Tipo di dati

    text

    How was this progression information obtained?
    Descrizione

    Howwasthisprogressioninformationobtained?

    Tipo di dati

    text

    Comments
    Descrizione

    Comments

    Comments
    Descrizione

    Comments

    Tipo di dati

    text

    Ritorna all'inizio della pagina

    Similar models

    No Instruction available.

    1 moduli
    1. StudyEvent: CALGB: 49808 RESPONSE/PROGRESSION FORM
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Unnamed1
    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
    Unnamed2
    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
    Ritorna all'inizio della pagina 

    Aiuto

    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