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ID

7485

Description

S0205 PAIN MEDICATION LOG S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E30D7C36-2312-0722-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E30D7C36-2312-0722-E034-0003BA12F5E7

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 11/26/14 11/26/14 - Martin Dugas
  3. 11/26/14 11/26/14 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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    Pancreatic Cancer NCT00075686 Treatment - S0205 PAIN MEDICATION LOG - 2291766v3.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: S0205 PAIN MEDICATION LOG
      1. No Instruction available.
    Administrative documentation
    Description

    Administrative documentation

    Alias
    UMLS CUI-1
    C1320722
    SWOG Patient ID
    Description

    Trial subject ID SWOG

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    SWOG Study No.
    Description

    Protocol ID SWOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Registration Step
    Description

    Registration Number

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Patient Initials (L, F M)
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution/Affiliate
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Physician
    Description

    Investigator Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Treatment Number
    Description

    PlannedAssessmentPeriodType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    Date Log Started
    Description

    DiaryMedicationPainBeginDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C3303
    UMLS 2011AA Property
    C0030193
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    Analgesics
    Description

    Analgesics

    Alias
    UMLS CUI-1
    C0002771
    Name of Pain Medication (Nurse and Patient)
    Description

    Analgesics

    Data type

    text

    Alias
    NCI Thesaurus Property
    C3303
    UMLS CUI-1
    C0002771
    NCI Thesaurus ObjectClass
    C459
    NCI Thesaurus ValueDomain
    C42614
    Medication Type
    Description

    MedicationPainAdministeredType

    Data type

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus Property
    C3303
    NCI Thesaurus ObjectClass
    C459
    UMLS CUI-1
    C0332307
    UMLS CUI-2
    C0030193
    UMLS CUI-3
    C0013227
    Analgesic Code (+)
    Description

    AnalgesicsMedicationPainType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C3303
    UMLS 2011AA Property
    C0030193
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    Dose (Units ^)
    Description

    Medication Dose

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25488
    UMLS CUI-1
    C3174092
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain-2
    C1708
    NCI Thesaurus Property
    C25382
    Number of pain meds taken at this dose Tallies (/)
    Description

    TotalMedicationPainText

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus Property
    C3303
    UMLS 2011AA Property
    C0030193
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    Number of pain meds taken at this dose Total
    Description

    TotalMedicationPainCount

    Data type

    float

    Alias
    NCI Thesaurus Property
    C3303
    UMLS 2011AA Property
    C0030193
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
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    No Instruction available.

    1 forms
    1. StudyEvent: S0205 PAIN MEDICATION LOG
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Administrative documentation
    C1320722 (UMLS CUI-1)
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    float
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Patient Initials
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    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)
    Investigator Name
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Item
    Treatment Number
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    CL.1
    Code List
    Treatment Number
    CL Item
    Prestudy (Prestudy)
    CL Item
    Week 5 (Week 5)
    CL Item
    Week 9 (Week 9)
    CL Item
    Week 13 (Week 13)
    CL Item
    Week 17 (Week 17)
    DiaryMedicationPainBeginDate
    Item
    Date Log Started
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3303 (NCI Thesaurus Property)
    C0030193 (UMLS 2011AA Property)
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    Item Group
    Analgesics
    C0002771 (UMLS CUI-1)
    Analgesics
    Item
    Name of Pain Medication (Nurse and Patient)
    text
    C3303 (NCI Thesaurus Property)
    C0002771 (UMLS CUI-1)
    C459 (NCI Thesaurus ObjectClass)
    C42614 (NCI Thesaurus ValueDomain)
    Item
    Medication Type
    integer
    C25284 (NCI Thesaurus ValueDomain)
    C3303 (NCI Thesaurus Property)
    C459 (NCI Thesaurus ObjectClass)
    C0332307 (UMLS CUI-1)
    C0030193 (UMLS CUI-2)
    C0013227 (UMLS CUI-3)
    CL.2
    Code List
    Medication Type
    CL Item
    Pill (1)
    CL Item
    Liquid (2)
    CL Item
    Pump (3)
    CL Item
    Patch (4)
    Item
    Analgesic Code (+)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C3303 (NCI Thesaurus Property)
    C0030193 (UMLS 2011AA Property)
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    CL.3
    Code List
    Analgesic Code (+)
    CL Item
    No Analgesic (No analgesic)
    CL Item
    Non-narcotic (Non-narcotic)
    CL Item
    Weak Opioid (Weak opioid)
    CL Item
    Strong Opioid (Strong opioid)
    Medication Dose
    Item
    Dose (Units ^)
    float
    C25488 (NCI Thesaurus ValueDomain)
    C3174092 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain-2)
    C25382 (NCI Thesaurus Property)
    TotalMedicationPainText
    Item
    Number of pain meds taken at this dose Tallies (/)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C3303 (NCI Thesaurus Property)
    C0030193 (UMLS 2011AA Property)
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    TotalMedicationPainCount
    Item
    Number of pain meds taken at this dose Total
    float
    C3303 (NCI Thesaurus Property)
    C0030193 (UMLS 2011AA Property)
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
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