Description:

S1007 Supplementary Follow-Up Form (FUS1007) Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90C9DFFB-2463-84DB-E040-BB89AD437DC2

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90C9DFFB-2463-84DB-E040-BB89AD437DC2

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Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01272037 Follow-Up - S1007 Supplementary Follow-Up Form (FUS1007) - 3139763v1.0

Instructions: Please submit at each follow up after completion of treatment until recurrence, at time of recurrence, and at protocol specified intervals after recurrence. All dates are MONTH, DAY, YEAR. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form

Header
Iib - Local-regional Recurrence
Has the patient been diagnosed with a new invasive primary or recurrence in the opposite breast (contralateral since submission of last follow-up form)
Has the patient been diagnosed with first local-regional recurrence or progression (do not include DCIS since submission of last follow-up form)
Site of first local-regional recurrence (s select all that apply)
How was this progression information obtained?
Iic - Distance Recurrence
Has the patient been diagnosed with first distant recurrence/progression? (since submission of last follow-up form)
Site of First Distant Progression (s select all that apply)
How was this progression information obtained?
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