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7534

Description

SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226) S0226 Anastrozole With or Without Fulvestrant as First-Line Therapy in Postmenopausal Women With Metastatic Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C322202A-32BF-25B7-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C322202A-32BF-25B7-E034-0003BA12F5E7

Mots-clés

Versions (3)
  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 25/03/2015 25/03/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Breast Cancer NCT00075764 Pre-Study - SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226) - 2173571v3.0

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226)
      1. No Instruction available.
    Header
    Description

    Header

    SWOG Patient ID
    Description

    Trial subject ID SWOG

    Type de données

    text

    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

    Type de données

    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

    Type de données

    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

    Type de données

    text

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

    Institution Name

    Type de données

    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 (Groups Other than SWOG)
    Description

    Investigator Name

    Type de données

    text

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

    Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Study No.
    Description

    Study Number Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Please refer to section 10.0 of the protocol for definitions. Choose all measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total to follow as target lesions. Record any remaining measurable lesions and all non-measurable lesions as non-terget lesions.)
    Description

    Trial subject ID Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Target Lesions
    Description

    Target Lesions

    Lesion Number
    Description

    LesionSiteNumber

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    Target Lesion Site
    Description

    LesionTargetSite

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25702
    UMLS 2011AA Property-2
    C1521840
    Longest Diameter (cm)
    Description

    Longest Diameter of Lesion

    Type de données

    float

    Unités de mesure
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C3824
    UMLS CUI-1
    C0221198
    NCI Thesaurus Property
    C25285
    UMLS CUI-2
    C1301886
    NCI Thesaurus Property-2
    C25558
    UMLS CUI-3
    C1522425
    NCI Thesaurus ValueDomain
    C25209
    NCI Thesaurus ValueDomain-2
    C25285
    cm
    Assessment Date
    Description

    AssessmentDate

    Type de données

    date

    Assessment Type
    Description

    Evaluation method

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2911685
    NCI Thesaurus ObjectClass
    C20989
    NCI Thesaurus Property
    C16847
    Non-target Disease
    Description

    Non-target Disease

    Lesion Number
    Description

    Lesion,ReferenceNumber

    Type de données

    float

    Assessment Date
    Description

    AssessmentDate

    Type de données

    date

    Assessment Type
    Description

    AssessmentType

    Type de données

    text

    Unnamed5 (Lesion site)
    Description

    Unnamed5(Lesionsite)

    Type de données

    text

    Extent
    Description

    Extent

    Type de données

    text

    Unnamed6
    Description

    Unnamed6

    Tests/studies
    Description

    Tests/studies

    Type de données

    text

    Assessment Date
    Description

    AssessmentDate

    Type de données

    date

    Comments
    Description

    Comments

    Comments
    Description

    Comments

    Type de données

    text

    Ccrr Module For Southwest Oncology Group Baseline Tumor Assessment Form (s0226)
    Description

    Ccrr Module For Southwest Oncology Group Baseline Tumor Assessment Form (s0226)

    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP BASELINE TUMOR ASSESSMENT FORM (S0226)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    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 (Groups Other than SWOG)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Participating Group
    Item
    Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Please refer to section 10.0 of the protocol for definitions. Choose all measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total to follow as target lesions. Record any remaining measurable lesions and all non-measurable lesions as non-terget lesions.)
    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)
    Item Group
    Target Lesions
    LesionSiteNumber
    Item
    Lesion Number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    LesionTargetSite
    Item
    Target Lesion Site
    text
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25702 (NCI Thesaurus Property-2)
    C1521840 (UMLS 2011AA Property-2)
    Longest Diameter of Lesion
    Item
    Longest Diameter (cm)
    float
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS CUI-1)
    C25285 (NCI Thesaurus Property)
    C1301886 (UMLS CUI-2)
    C25558 (NCI Thesaurus Property-2)
    C1522425 (UMLS CUI-3)
    C25209 (NCI Thesaurus ValueDomain)
    C25285 (NCI Thesaurus ValueDomain-2)
    AssessmentDate
    Item
    Assessment Date
    date
    Item
    Assessment Type
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2911685 (UMLS CUI-1)
    C20989 (NCI Thesaurus ObjectClass)
    C16847 (NCI Thesaurus Property)
    CL.1
    Code List
    Assessment Type
    CL Item
    Palpation (Palpation)
    CL Item
    Visualization (Visualization)
    CL Item
    Colposcopy (Colposcopy)
    CL Item
    Endoscopy (Endoscopy)
    CL Item
    Plain film/X-ray without contrast (Plain film/X-ray without contrast)
    CL Item
    Plain film/X-ray with contrast (Plain film/X-ray with contrast)
    CL Item
    Ct Scan (CT scan)
    CL Item
    Mri (MRI scan)
    CL Item
    Radioisotope scan (Radioisotope scan)
    CL Item
    Ultrasound (Ultrasound)
    C64384 (NCI Thesaurus)
    C1456803 (UMLS 2011AA)
    CL Item
    PET scan (PET scan)
    CL Item
    Spiral Ct Scan (Spiral CT scan)
    CL Item
    Cystoscopy (Cystoscopy)
    C16482 (NCI Thesaurus)
    C0010702 (UMLS 2011AA)
    CL Item
    Histology (Histologic confirmation)
    C16681 (NCI Thesaurus)
    C0019638 (UMLS 2011AA)
    CL Item
    Cytology (Cytologic confirmation)
    C16491 (NCI Thesaurus)
    C0010819 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Item Group
    Non-target Disease
    Lesion,ReferenceNumber
    Item
    Lesion Number
    float
    AssessmentDate
    Item
    Assessment Date
    date
    Item
    Assessment Type
    text
    CL.2
    Code List
    Assessment Type
    CL Item
    Palpation (Palpation)
    CL Item
    Visualization (Visualization)
    CL Item
    Colposcopy (Colposcopy)
    CL Item
    Endoscopy (Endoscopy)
    CL Item
    Plain film/X-ray without contrast (Plain film/X-ray without contrast)
    CL Item
    Plain film/X-ray with contrast (Plain film/X-ray with contrast)
    CL Item
    CT scan (CT scan)
    CL Item
    MRI scan (MRI scan)
    CL Item
    Radioisotope scan (Radioisotope scan)
    CL Item
    Ultrasound (Ultrasound)
    CL Item
    PET scan (PET scan)
    CL Item
    Spiral CT scan (Spiral CT scan)
    CL Item
    Cytoscopy (Cytoscopy)
    CL Item
    Histologic confirmation (Histologic confirmation)
    CL Item
    Cytologic confirmation (Cytologic confirmation)
    CL Item
    Other (Other)
    Unnamed5(Lesionsite)
    Item
    Unnamed5 (Lesion site)
    text
    Extent
    Item
    Extent
    text
    Item Group
    Unnamed6
    Tests/studies
    Item
    Tests/studies
    text
    AssessmentDate
    Item
    Assessment Date
    date
    Item Group
    Comments
    Comments
    Item
    Comments
    text
    Item Group
    Ccrr Module For Southwest Oncology Group Baseline Tumor Assessment Form (s0226)
    Retour au début de la page 

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