Description:

NSABP B-45 Worksheet for Postoperative Adjuvant Hormonal Therapy Form Studying Biological Markers of Fatigue in Women With Residual Invasive Breast Cancer Enrolled on Clinical Trial NSABP-B-45 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6461E18A-2098-98F1-E040-BB89AD4303E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6461E18A-2098-98F1-E040-BB89AD4303E7

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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 NCT00914043 On-Study - NSABP B-45 Worksheet for Postoperative Adjuvant Hormonal Therapy Form - 2846464v1.0

For women with ER and/or PgR positive tumors, the report should be submitted annually through 6 years on study, even if all postoperative adjuvant hormonal treatment is reported to have ended. If hormonal treatment ends and then resumes at a later date, a new Begin date should be reported for that hormonal agent. (Do not report hormonal therapy that was undertaken to treat breast cancer progression, recurrence, or second primary cancer.)

Header
Unnamed Module 1
Report Period
Since being entered on study, has the patient received any postoperative adjuvant hormonal treatment? (If yes, continue If no, omit the remaining questions)
New Data
Does this report contain any new data or has any data been changed from the last report?
Unnamed Module 2
Aromatase Inhibitor
Other Ht
Treatment Ended
Has all postoperative adjuvant hormonal treatment ended?
Reason Treatment Ended (Last Postoperative Adjuvant HT)
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