Description:

SOUTHWEST ONCOLOGY GROUP S0337 Prestudy Form Gemcitabine After Surgery in Treating Patients With Newly Diagnosed or Recurrent Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE24D648-5D97-43D5-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE24D648-5D97-43D5-E034-0003BA3F9857

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Versions (3) ▾
  1. 8/26/12
  2. 8/11/14
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT00445601 Pre-Study - SOUTHWEST ONCOLOGY GROUP S0337 Prestudy Form - 2388922v1.0

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  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0337 Prestudy Form
    1. No Instruction available.
Header
Disease Description
Performance Status
Histologic Grade (Current)
Clinical T Stage (Highest - at current diagnosis/depth of invasion)
Is the patient believed, based upon endoscopic inspection, to have urothelial cancer of the prostate or more distant urethra (or urethra at all in women)
Laboratory Values
1000/uL
g/dL
%
mg/dL
U/L
mg/dL
mg/dL
Risk Factors
Smoking Status
Family history of bladder cancer (select one)
Symptoms leading to current bladder cancer diagnosis (select all that apply)
Turbt History
Prior Treatment Related To This Bladder Cancer
Prior Intravesical Therapy
Type of Chemotherapy (select all that apply)
Comments