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ID

766

Beskrivning

Southwest Oncology Group PreStudy (S0230) Goserelin in Preventing Ovarian Failure in Women Receiving Chemotherapy for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BEA4AC4C-8AF5-037E-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BEA4AC4C-8AF5-037E-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2012-08-26 2012-08-26 -
  2. 2017-06-24 2017-06-24 - Martin Dugas
Uppladdad den

26 augusti 2012

DOI

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Creative Commons BY-NC 3.0
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    Breast Cancer NCT00068601 Pre-Study - Southwest Oncology Group PreStudy (S0230) - 2170510v3.0

    Engelsk

    Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section.

    1 Formulär  
    Disease Description
    Beskrivning

    Disease Description

    Date of Initial Diagnosis of Primary Tumor
    Beskrivning

    FirstPositiveBiopsyDate

    Datatyp

    date

    Stage
    Beskrivning

    BreastTumorStageGroupingStage

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass
    C12971
    UMLS 2011AA ObjectClass
    C0006141
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    NCI Thesaurus Property
    C38027
    UMLS 2011AA Property
    C1519504
    Date of last menses (Please fill in the following values if the Patient has not had regular menses within the past 6 weeks)
    Beskrivning

    Firstdayoflastmenstrualperiod

    Datatyp

    text

    Laboratory Tests
    Beskrivning

    Laboratory Tests

    FSH level: (IU/L)
    Beskrivning

    FSHvalue

    Datatyp

    text

    Laboratory lower limit for post menopausal FSH (IU/L)
    Beskrivning

    LaboratoryProcedureFollicleStimulatingHormoneResultLowerLimitofNormalValue

    Datatyp

    double

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property
    C2286
    UMLS 2011AA Property
    C0733758
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain
    C25555
    UMLS 2011AA ValueDomain
    C1518030
    Estradiol level (pg/mL)
    Beskrivning

    Estradiolpmol/L

    Datatyp

    text

    Laboratory upper limit for post menopausal estradiol (pg/mL)
    Beskrivning

    Laboratoryupperlimitforpostmenopausalestradiol

    Datatyp

    text

    Planned Chemotherapy regimen (select one)
    Beskrivning

    ClinicalTrialProtocolChemotherapyAdministeredType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Other anthracycline-based regimen, specify chemotherapy agents and duration
    Beskrivning

    Otheranthracycline-basedregimen,specifychemotherapyagentsandduration

    Datatyp

    text

    Other anthracycline-based regimen, specify chemotherapy agents and duration
    Beskrivning

    Otheranthracycline-basedregimen,specifychemotherapyagentsandduration

    Datatyp

    text

    Ccrr Module For Southwest Oncology Group Prestudy (s0230)
    Beskrivning

    Ccrr Module For Southwest Oncology Group Prestudy (s0230)

    SWOG Patient ID (L, F, M)
    Beskrivning

    PatientSouthwestOncologyGroupIdentifierNumber

    Datatyp

    double

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property
    C25699
    UMLS 2011AA Property
    C1519429
    Insitution/Affiliate
    Beskrivning

    CombinedInstitutionName

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS 2011AA ObjectClass
    C0205195
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ValueDomain
    C21541
    UMLS 2011AA ValueDomain
    C0018704
    Physician
    Beskrivning

    RegisteredInvestigatorName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C17089
    UMLS 2011AA ObjectClass
    C0035173
    NCI Thesaurus ObjectClass
    C25644
    Group Name
    Beskrivning

    ParticipatingGroupName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Study No.
    Beskrivning

    ProtocolParticipatingIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Pt. ID
    Beskrivning

    PatientParticipatingIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Height (cm)
    Beskrivning

    PatientHeightMeasurement

    Datatyp

    double

    Måttenheter
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25347
    UMLS 2011AA Property
    C0489786
    cm
    Height (cm)
    Beskrivning

    PatientHeightMeasurement

    Datatyp

    double

    Måttenheter
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25347
    UMLS 2011AA Property
    C0489786
    cm
    Performance Status
    Beskrivning

    PerformanceStatus

    Datatyp

    text

    Tillbaka till toppen

    Similar models

    Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section.

    1 Formulär
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Disease Description
    FirstPositiveBiopsyDate
    Item
    Date of Initial Diagnosis of Primary Tumor
    date
    Item
    Stage
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12971 (NCI Thesaurus ObjectClass)
    C0006141 (UMLS 2011AA ObjectClass)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    C38027 (NCI Thesaurus Property)
    C1519504 (UMLS 2011AA Property)
    CL.1
    Code List
    Stage
    CL Item
    T1*, N0, M0 (I)
    CL Item
    Ii, According To Current Ajcc Guidelines (II)
    CL Item
    T0, N2, M0 Or T1*, N2, M0 Or T2, N2, M0 Or T3, N1, M0 Or T3, N2, M0 (IIIA)
    Firstdayoflastmenstrualperiod
    Item
    Date of last menses (Please fill in the following values if the Patient has not had regular menses within the past 6 weeks)
    text
    Item Group
    Laboratory Tests
    FSHvalue
    Item
    FSH level: (IU/L)
    text
    LaboratoryProcedureFollicleStimulatingHormoneResultLowerLimitofNormalValue
    Item
    Laboratory lower limit for post menopausal FSH (IU/L)
    double
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C2286 (NCI Thesaurus Property)
    C0733758 (UMLS 2011AA Property)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25555 (NCI Thesaurus ValueDomain)
    C1518030 (UMLS 2011AA ValueDomain)
    Estradiolpmol/L
    Item
    Estradiol level (pg/mL)
    text
    Laboratoryupperlimitforpostmenopausalestradiol
    Item
    Laboratory upper limit for post menopausal estradiol (pg/mL)
    text
    Item
    Planned Chemotherapy regimen (select one)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.2
    Code List
    Planned Chemotherapy regimen (select one)
    CL Item
    Ac (AC)
    CL Item
    Caf (CAF)
    CL Item
    Tac (TAC)
    CL Item
    Cef (CEF)
    CL Item
    Ac Followed By A Taxane (AC followed by a Taxane)
    Otheranthracycline-basedregimen,specifychemotherapyagentsandduration
    Item
    Other anthracycline-based regimen, specify chemotherapy agents and duration
    text
    Otheranthracycline-basedregimen,specifychemotherapyagentsandduration
    Item
    Other anthracycline-based regimen, specify chemotherapy agents and duration
    text
    Item Group
    Ccrr Module For Southwest Oncology Group Prestudy (s0230)
    PatientSouthwestOncologyGroupIdentifierNumber
    Item
    SWOG Patient ID (L, F, M)
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25699 (NCI Thesaurus Property)
    C1519429 (UMLS 2011AA Property)
    CombinedInstitutionName
    Item
    Insitution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C0205195 (UMLS 2011AA ObjectClass)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ValueDomain)
    C0018704 (UMLS 2011AA ValueDomain)
    RegisteredInvestigatorName
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C17089 (NCI Thesaurus ObjectClass)
    C0035173 (UMLS 2011AA ObjectClass)
    C25644 (NCI Thesaurus ObjectClass)
    ParticipatingGroupName
    Item
    Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ProtocolParticipatingIdentifierNumber
    Item
    Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientParticipatingIdentifierNumber
    Item
    Pt. ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientHeightMeasurement
    Item
    Height (cm)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25347 (NCI Thesaurus Property)
    C0489786 (UMLS 2011AA Property)
    PatientHeightMeasurement
    Item
    Height (cm)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25347 (NCI Thesaurus Property)
    C0489786 (UMLS 2011AA Property)
    Item
    Performance Status
    text
    CL.4
    Code List
    Performance Status
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    Tillbaka till toppen 

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