ID

7240

Beschrijving

Pediatric Soft Tissue Sarcoma - On-Study Form Recurrent Treatment Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E4053EE1-90D1-2ED9-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E4053EE1-90D1-2ED9-E034-0003BA3F9857

Trefwoorden

20-09-12 20-09-12 -
09-01-15 09-01-15 - Martin Dugas
09-01-15 09-01-15 - Martin Dugas

Geüploaded op

9 januari 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

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On-Study - Pediatric Soft Tissue Sarcoma - On-Study Form Recurrent Treatment - 2292588v3.0

model
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StudyEvent: Pediatric Soft Tissue Sarcoma - On-Study Form Recurrent Treatment
1. No Instruction available.

Name

Type

Description | Question | Decode (Coded Value)

Datatype

Alias

CRF Header

Item Group

Crf Header

Protocol ID Coordinating Group

Item

Coordinating Group Protocol No.

text

C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Coordinating Group Code

Item

Coordinating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)

Protocol Title

Item

Protocol Title

text

C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)

Patient Study ID

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (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)

Trial subject ID Participating Group

Item

Other 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)

ParticipatingGroupIdentifierCode

Item

Participating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientName

Item

Patient Name (initials acceptable)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

Sarcoma: Form Administration

Item Group

Sarcoma: Form Administration

Person Completing Form

Item

Person Completing Form

text

C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)

Data amended

Item

Are data amended (If data are amended, please circle in red when using paper form)

boolean

C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)

Pediatric Soft Tissue Sarcoma: Recurrent Disease Description

Item Group

Pediatric Soft Tissue Sarcoma: Recurrent Disease Description

CancerInitialDiagnosisDate

Item

Date of Initial Pathologic Diagnosis (not relapse)

date

C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)

DiseaseRecurrenceDate

Item

Recurrence date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

BiopsyProcedure

Item

Biopsy Type (at time of relapse)

text

C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C25218 (NCI Thesaurus ValueDomain)
C1948041 (UMLS 2011AA ValueDomain)

CL.2

Code List

Biopsy Type (at time of relapse)

CL Item

Incisional (Incisional)

CL Item

Excisional (Excisional)

CL Item

Trucut Needle (TruCut needle)

CL Item

Large Bore Needle (Large bore needle)

CL Item

Other, Specify (Other specify)

BiopsyDescriptionSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

DiseaseSite

Item

Site(s) of Disease (check all that apply)

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

CL.3

Code List

Site(s) of Disease (check all that apply)

CL Item

Bone (Bone)

C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)

CL Item

Bone Marrow (Bone marrow)

C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)

CL Item

Soft Tissue (Soft tissue)

C12471 (NCI Thesaurus)
C0225317 (UMLS 2011AA)

CL Item

Cns/brain (CNS/brain)

CL Item

Lung (Lung)

C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)

CL Item

Chest Wall/ribs (Chest wall/ribs)

CL Item

Mediastinum (Mediastinum)

C12748 (NCI Thesaurus)
C0025066 (UMLS 2011AA)

CL Item

Pleura (Pleura)

C12469 (NCI Thesaurus)
C0032225 (UMLS 2011AA)

CL Item

Pericardium (Pericardium)

C13005 (NCI Thesaurus)
C0031050 (UMLS 2011AA)

CL Item

Liver (Liver)

C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)

CL Item

Abdominal Organs (Abdominal organs)

CL Item

Ascites (Ascites)

C2885 (NCI Thesaurus)
C0003962 (UMLS 2011AA)

CL Item

Peritoneum (Peritoneum)

C12770 (NCI Thesaurus)
C0031153 (UMLS 2011AA)

CL Item

Retroperitoneum (Retroperitoneum)

C12298 (NCI Thesaurus)
C0035359 (UMLS 2011AA)

CL Item

Skin (Skin)

C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)

CL Item

Lymph Nodes, Specify (Lymph nodes specify)

CL Item

Other, Specify (Other specify)

LymphNodeInvolvementSiteSpecify

Item

Lymph Nodes Specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)

DiseaseInvolvedSiteSpecify

Item

Other specify (If Yes,)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

DiseaseInvolvedSiteSpecify

Item

Other specify (If Yes,)

text

IntracranialTumorExtensionType

Item

Intracranial Tumor Extension (check all that apply)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25270 (NCI Thesaurus Property)
C0231448 (UMLS 2011AA Property)
C38236 (NCI Thesaurus ObjectClass-2)
C1522213 (UMLS 2011AA ObjectClass-2)

CL.4

Code List

Intracranial Tumor Extension (check all that apply)

CL Item

Intracranial Extension (Intracranial extension)

CL Item

Cranial Nerve Palsy (Cranial nerve palsy)

CL Item

Base Of Skull Erosion (Base of skull erosion)

CL Item

Other, Specify (Other specify)

IntracranialTumorExtensionSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25270 (NCI Thesaurus Property)
C0231448 (UMLS 2011AA Property)
C38236 (NCI Thesaurus ObjectClass-2)
C1522213 (UMLS 2011AA ObjectClass-2)

DiseasePrimaryRelapseInd-2

Item

Relapsed at primary site?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18265 (NCI Thesaurus Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

DiseaseRegionalRelapseInd-2

Item

Relapsed at regional site?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18265 (NCI Thesaurus Property)
C25643 (NCI Thesaurus Property-2)
C0205147 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

DiseaseDistantRelapseInd-2

Item

Relapsed at distant site?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18265 (NCI Thesaurus Property)
C25321 (NCI Thesaurus Property-2)
C0443203 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

RegionalLymphNodeExaminedCount

Item

Number of Regional Lymph Nodes Examined

float

C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25643 (NCI Thesaurus ObjectClass-2)
C0205147 (UMLS 2011AA ObjectClass-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)

LymphNodePositiveCount

Item

Number of Positive Lymph Nodes

float

C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)

RegionalLymphNodeInvolvedInd-3

Item

Regional lymph nodes

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25643 (NCI Thesaurus ObjectClass-2)
C0205147 (UMLS 2011AA ObjectClass-2)
C25547 (NCI Thesaurus Property)

CL.8

Code List

Regional lymph nodes

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

DistantLymphNodeInvolvedInd-3

Item

Distant lymph nodes

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25321 (NCI Thesaurus ObjectClass-2)
C0443203 (UMLS 2011AA ObjectClass-2)
C25547 (NCI Thesaurus Property)

CL.9

Code List

Distant lymph nodes

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

MalignantNeoplasmDistantMetastaticInvolvementInd-3

Item

Other distant or metastatic site?

text

C14174 (NCI Thesaurus ObjectClass)
C0036525 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C25321 (NCI Thesaurus Property-2)
C0443203 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)

CL.10

Code List

Other distant or metastatic site?

CL Item

Yes (YES)

CL Item

No (NO)

CL Item

Unknown (UNKNOWN)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Resection type primary tumor

Item

Status of Primary Tumor

text

C25284 (NCI Thesaurus ValueDomain)
C0449522 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C0677930 (UMLS CUI-2)
C25251 (NCI Thesaurus ObjectClass-2)
C15232 (NCI Thesaurus Property)

CL.11

Code List

Status of Primary Tumor

CL Item

Unresected (Unresected)

CL Item

Not Recurrent, Resected, No Residual Tumor (Not recurrent, resected, no residual tumor)

CL Item

Not Recurrent, Resected, Residual Tumor (Not recurrent, resected, residual tumor)

CL Item

Recurrent (Recurrent)

C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)

SarcomaHistologicCategory

Item

Histologic Type (check all that apply)

text

C9118 (NCI Thesaurus ObjectClass)
C1261473 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (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)

CL.12

Code List

Histologic Type (check all that apply)

CL Item

Embryonal Rhabdomyosarcoma (Embryonal rhabdomyosarcoma)

CL Item

Botryoid Rhabdomyosarcoma (Botryoid rhabdomyosarcoma)

CL Item

Spindle Cell Rhabdomyosarcoma (Spindle cell rhabdomyosarcoma)

CL Item

Alveolar Rhabdomyosarcoma (Alveolar rhabdomyosarcoma)

CL Item

Pleomorphic Rhabdomyosarcoma (Pleomorphic rhabdomyosarcoma)

CL Item

Rhabdomyosarcoma Nos (Rhabdomyosarcoma NOS)

CL Item

Extraskeletal Ewing's/pnet (Extraskeletal Ewing's/PNET)

CL Item

Synovial Sarcoma (Synovial sarcoma)

C3400 (NCI Thesaurus)
C0039101 (UMLS 2011AA)

CL Item

Maligant Peripheral Nerve Sheath Tumor (Malignant peripheral nerve sheath tumor)

CL Item

Infantile Fibrosarcoma (Infantile fibrosarcoma)

CL Item

Fibrosacoma, Nos (Fibrosacoma NOS)

CL Item

Dermatofibrosarcoma Protuberans (Dermatofibrosarcoma protuberans)

CL Item

Myxofibrosarcoma (Myxofibrosarcoma)

CL Item

Solitary Fibrous Tumor/hemangiopericytoma (Solitary fibrous tumor/hemangiopericytoma)

CL Item

Undifferentiated Pleomorphic Sarcoma/"mfh" (Undifferentiated pleomorphic sarcoma/"MFH")

CL Item

Well Differentiated Liposarcoma (Well differentiated liposarcoma)

CL Item

Dedifferentiated Liposarcoma (Dedifferentiated liposarcoma)

CL Item

Myxoid Liposarcoma (Myxoid liposarcoma)

CL Item

Pleomorphic Liposarcoma (Pleomorphic liposarcoma)

CL Item

Liposarcoma Nos (Liposarcoma NOS)

CL Item

Leiomyosarcoma (Leiomyosarcoma)

C3158 (NCI Thesaurus)
C0023269 (UMLS 2011AA)

CL Item

Gastrointestinal Stromal Tumor (gist) (Gastrointestinal stromal tumor (GIST))

CL Item

Extraskeletal Myxoid Chondrosarcoma (Extraskeletal myxoid chondrosarcoma)

CL Item

Extraskeletal Mesenchymal Chondrosarcoma (Extraskeletal mesenchymal chondrosarcoma)

CL Item

Extraskeletal Osteosarcoma (Extraskeletal osteosarcoma)

CL Item

Angiosarcoma (Angiosarcoma)

C3088 (NCI Thesaurus)
C0018923 (UMLS 2011AA)

CL Item

Kaposi Sarcoma (Kaposi sarcoma)

C9087 (NCI Thesaurus)
C0036220 (UMLS 2011AA)

CL Item

Epithelioid Sarcoma (Epithelioid sarcoma)

CL Item

Alveolar Soft Part Sarcoma (Alveolar soft part sarcoma)

CL Item

Clear Cell Sarcoma (mmsp) (Clear cell sarcoma (MMSP))

CL Item

Desmoplastic Small Cell Tumor (Desmoplastic small cell tumor)

CL Item

Malignant Mesenchymoma (Malignant mesenchymoma)

CL Item

Soft Tissue Sarcoma Nos (Soft tissue sarcoma NOS)

CL Item

Endometrial Stromal Sarcoma (Endometrial stromal sarcoma)

C8973 (NCI Thesaurus)
C0206630 (UMLS 2011AA)

CL Item

Uterine Leiomyosarcoma (Uterine leiomyosarcoma)

CL Item

Uterine Carcinosarcoma (mixed Mesodermal Sarcoma) (Uterine carcinosarcoma (mixed mesodermal sarcoma))

CL Item

Uterine Sarcoma Nos (Uterine sarcoma NOS)

CL Item

Undifferentiated Sarcoma (Undifferentiated sarcoma)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

CL Item

Other Specify (Other specify)

Histologic Type, other

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)

SarcomaHistologicSubcategorySpecify

Item

Histologic Subtype (specify)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C9118 (NCI Thesaurus ObjectClass)
C1261473 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25692 (NCI Thesaurus Property-2)
C1515010 (UMLS 2011AA Property-2)

SarcomaTumorFrenchClassificationHistologicGrade

Item

Histologic Grade, French System (check highest grade)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C9118 (NCI Thesaurus ObjectClass-2)
C1261473 (UMLS 2011AA ObjectClass-2)
C43854 (NCI Thesaurus Property)
C1556084 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25526 (NCI Thesaurus ValueDomain)
C0205462 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)

CL.13

Code List

Histologic Grade, French System (check highest grade)

CL Item

Grade I (Grade I)

CL Item

Grade Ii (Grade II)

CL Item

Grade Iii (Grade III)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Pediatric Soft Tissue Sarcoma: Prior Health History

Item Group

Pediatric Soft Tissue Sarcoma: Prior Health History

ChronicDiseaseDiagnosisInd-3

Item

Does the patient have a chronic disease associated with this cancer?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C14141 (NCI Thesaurus ObjectClass-2)
C0205191 (UMLS 2011AA ObjectClass-2)

PatientMedicalConditionCurrentType

Item

Current Medical Conditions (currently symptomatic or on medications for)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)

CL.15

Code List

Current Medical Conditions (currently symptomatic or on medications for)

CL Item

Cerebrovascular Disease (Cerebrovascular disease)

CL Item

Cardiac Disease (Cardiac disease)

CL Item

High Blood Pressure (High blood pressure)

CL Item

Deep Vein Thrombosis (Deep vein thrombosis)

CL Item

Peripheral Vascular Disease (Peripheral vascular disease)

CL Item

Gastrointestinal Disease (Gastrointestinal disease)

CL Item

Diabetes (Diabetes)

CL Item

Neurologic Disease (Neurologic disease)

CL Item

Respiratory Problems (Respiratory problems)

CL Item

Other Malignancies, Specify (Other malignancies specify)

CL Item

Other, Specify (Other specify)

MalignantDiseaseOtherPresentSpecify

Item

Other malignancies specify

text

C14143 (NCI Thesaurus ObjectClass)
C0205282 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

PatientMedicalConditionCurrentSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus ValueDomain-2)
C0521116 (UMLS 2011AA ValueDomain-2)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)

PatientCongenitalAbnormalityType

Item

Congenital abnormalities

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)

CL.16

Code List

Congenital abnormalities

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Downs Syndrome (Downs syndrome)

CL Item

Neurofibromatosis (Neurofibromatosis)

CL Item

Li-fraumeni Syndrome (Li-Fraumeni syndrome)

CL Item

Hemihypertrophy (Hemihypertrophy)

CL Item

Other, Specify (Other specify)

PatientCongenitalAbnormalitySpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)

NeurofibromatosisFamilyMedicalHistoryInd-3

Item

Family history of neurofibromatosis?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C6727 (NCI Thesaurus ObjectClass)
C0162678 (UMLS 2011AA ObjectClass)
C17726 (NCI Thesaurus Property)
C0241889 (UMLS 2011AA Property)

Sarcoma: Prior Treatment

Item Group

Sarcoma: Prior Treatment

CancerPriorTreatmentInd-3

Item

Prior Treatment?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property-2)

PriorChemotherapyAdministeredInd-3

Item

Prior Systemic Chemotherapy?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

PriorImmunotherapyAdministeredInd-3

Item

Prior Immunotherapy?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15262 (NCI Thesaurus ObjectClass)
C0021083 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

Prior Radiation Therapy

Item

Prior Radiation Therapy?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C0332152 (UMLS CUI-2)
C25629 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)

Prior Surgery

Item

Prior Surgery?

boolean

C38148 (NCI Thesaurus ValueDomain)
C0744961 (UMLS CUI-1)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)

PrimarySurgeryPriorPerformedText

Item

Type of Prior Primary Surgery

text

C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)

PrimarySurgeryPriorPerformedDate

Item

Prior Primary Surgery Date (MM DD YYYY)

date

C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

PriorTherapyOtherAdministeredInd-3

Item

Any Other Prior Therapy?

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)

PriorTherapyAdministeredSpecify

Item

Yes, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

Sarcoma: Prior Treatment - Systemic Regimens

Item Group

Sarcoma: Prior Treatment - Systemic Regimens

PriorTreatmentRegimenName

Item

Prior Treatment Regimen Name (Drug, Agent, Biologic)

text

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)

PriorTreatmentRegimenBeginDate

Item

Prior Treatment Regimen Start Date (MM DD YYYY)

date

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)

PriorTreatmentRegimenEndDate

Item

Prior Treatment Regimen End Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)

PriorTreatmentRegimenText

Item

Prior Treatment Regimen Type (Adjuvant, High Dose)

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)

Comments

Item Group

Comments

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

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On-Study - Pediatric Soft Tissue Sarcoma - On-Study Form Recurrent Treatment - 2292588v3.0

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