ID

7763

Description

ACOSOG-Z4099 On-Study Form Surgery With or Without Internal Radiation Therapy Compared With Stereotactic Body Radiation Therapy in Treating Patients With High-Risk Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=990BA4F9-52BF-85C0-E040-BB89AD433BEA

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=990BA4F9-52BF-85C0-E040-BB89AD433BEA

Keywords

Versions (6)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 8/11/14 8/11/14 - Martin Dugas
  4. 8/11/14 8/11/14 - Martin Dugas
  5. 8/11/14 8/11/14 - Martin Dugas
  6. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT01336894 On-Study - ACOSOG-Z4099 On-Study Form - 3181084v1.0

English

ALL ITEMS MUST BE COMPLETED

1 forms  
  1. StudyEvent: ACOSOG-Z4099 On-Study Form
    1. ALL ITEMS MUST BE COMPLETED
Header Module
Description

Header Module

Protocol Number
Description

Protocol ID ACOSOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1515944
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C19712
Patient ID
Description

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
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 Number
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Institution
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Are data amended (check one if data amended, please circle in red when using paper forms)
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Visit
Description

Visit

Visit
Description

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19712
UMLS 2011AA ObjectClass
C1515944
NCI Thesaurus ObjectClass-2
C25716
UMLS 2011AA ObjectClass-2
C0545082
Histologic Information
Description

Histologic Information

Diagnosis Date (dd MMM yyyy)
Description

Diagnosis Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2316983
NCI Thesaurus Property
C25626
NCI Thesaurus ObjectClass
C15220
Histologic Type (check one)
Description

Histologic Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS CUI-1
C0449574
NCI Thesaurus ObjectClass-2
C12468
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25161
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus ValueDomain-2
C25526
Specify Other Histologic Type
Description

Histologic Type, other

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C1299220
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25161
Histologic grade (Differentiation check one)
Description

NotOtherwiseSpecifiedHistopathologicGradeGradeBasicHistologicGradeGradeVD

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C19594
UMLS 2011AA ObjectClass
C1518425
NCI Thesaurus ObjectClass-2
C18000
UMLS 2011AA ObjectClass-2
C0919553
NCI Thesaurus Property
C48309
UMLS 2011AA Property
C0441800
Patient Information
Description

Patient Information

Patient residing (check one)
Description

PatientResidenceType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25273
UMLS 2011AA Property
C0237096
Other, specify
Description

PatientResidenceSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25273
UMLS 2011AA Property
C0237096
Current oxygen use (check one)
Description

PatientOxygenUseInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C722
UMLS 2011AA Property
C0030054
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
Oxygen Use Type (If yes check one)
Description

PatientOxygenUseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C722
UMLS 2011AA Property
C0030054
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
Number of hospitalizations within the last year
Description

PatientHospitalizationYearCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C29848
UMLS 2011AA ValueDomain
C0439234
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
NCI Thesaurus Property
C25179
UMLS 2011AA Property
C0019993
Baseline Pet Findings
Description

Baseline Pet Findings

Pre-treatment PET-SUV MAX
Description

StandardUptakeValuePositronEmissionTomographyAssessmentMaximumMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass-2
C44275
UMLS 2011AA ObjectClass-2
C1442989
NCI Metathesaurus ObjectClass
C0243144
NCI Thesaurus ObjectClass-3
C25712
UMLS 2011AA ObjectClass-3
C1522609
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain-2
C25564
UMLS 2011AA ValueDomain-2
C0806909
Surgery Risk Factors
Description

Surgery Risk Factors

Major (check one)
Description

PersonRiskSurgicalProcedureMajorPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C15329
UMLS 2011AA Property-2
C0543467
NCI Thesaurus Property-3
C17102
UMLS 2011AA Property-3
C0035647
NCI Thesaurus Property-4
C45368
UMLS 2011AA Property-4
C0205164
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
FEV1 <= 50 % predicted (If Yes)
Description

LungForcedExpiratoryVolume1MajorDecreasedForcedExpiratoryVolumeLaboratoryProcedureInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C38084
UMLS 2011AA Property-2
C0849974
NCI Thesaurus Property-3
C50524
UMLS 2011AA Property-3
C0520837
NCI Thesaurus Property-4
C45368
UMLS 2011AA Property-4
C0205164
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
DLCO <= 50 % predicted (If Yes)
Description

LungCarbonMonoxideDiffusingCapabilityTestMajorDecreasedCarbonMonoxideDiffusingCapacityLaboratoryProcedureInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C78229
UMLS 2011AA Property
C1697788
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus Property-3
C38083
UMLS 2011AA Property-3
C1516251
NCI Thesaurus Property-4
C45368
UMLS 2011AA Property-4
C0205164
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Minor (check one)
Description

PersonRiskSurgicalProcedureMinorPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C15329
UMLS 2011AA Property-2
C0543467
NCI Thesaurus Property-3
C17102
UMLS 2011AA Property-3
C0035647
NCI Thesaurus Property-4
C45367
UMLS 2011AA Property-4
C0205165
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Age >= 75 (If Yes)
Description

PatientAgeEligibilityDeterminationInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25150
UMLS 2011AA Property
C0001779
NCI Thesaurus Property-2
C25171
UMLS 2011AA Property-2
C0013893
FEV1 51-60 % predicted (If Yes)
Description

LungForcedExpiratoryVolume1MinorDecreasedForcedExpiratoryVolumeLaboratoryProcedureInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C45367
UMLS 2011AA Property-2
C0205165
NCI Thesaurus Property-3
C38084
UMLS 2011AA Property-3
C0849974
NCI Thesaurus Property-4
C50524
UMLS 2011AA Property-4
C0520837
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
DLCO 51-60 % predicted (If Yes)
Description

LungCarbonMonoxideDiffusingCapabilityTestMinorDecreasedCarbonMonoxideDiffusingCapacityLaboratoryProcedureInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C78229
UMLS 2011AA Property
C1697788
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus Property-3
C45367
UMLS 2011AA Property-3
C0205165
NCI Thesaurus Property-4
C38083
UMLS 2011AA Property-4
C1516251
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Pulmonary hypertension as estimated by echocardiography or right heart catherization (If Yes defined as a pulmonary artery systolic pressure greater than 40mmHg)
Description

PulmonaryHypertensionPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C3120
UMLS 2011AA ObjectClass
C0020542
Poor left ventricular function (If Yes defined as an ejection fraction or 40% or less)
Description

HeartLeftVentricularEjectionFractionReducedFunctionIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25640
UMLS 2011AA Property
C0392756
NCI Thesaurus Property-2
C25518
UMLS 2011AA Property-2
C0542341
NCI Thesaurus Property-3
C37946
UMLS 2011AA Property-3
C2700377
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Resting or Exercise Arterial pO2 <= 55 mm Hg or SpO2 <= 88% (If Yes)
Description

LaboratoryProcedurePartialPressureofOxygenMeasurementArterialBloodGasMeasurementReducedOutcomeInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25640
UMLS 2011AA Property
C0392756
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus Property-3
C71251
UMLS 2011AA Property-3
C0202155
NCI Thesaurus Property-4
C71252
UMLS 2011AA Property-4
C0150411
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Modified Medical Research Council (MMRC) Dyspnea Scale >= 3 (If Yes)
Description

PersonMedicalResearchCouncilDyspneaScaleOutcomeInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C21157
UMLS 2011AA Property-2
C1513061
Clinical Stage
Description

Clinical Stage

T Stage (check one in each row)
Description

LungTumorClinicalTStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12468
UMLS 2011AA ObjectClass-2
C0024109
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25728
UMLS 2011AA Property-2
C0475455
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
N Stage (check one in each row)
Description

LungTumorClinicalNStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12468
UMLS 2011AA ObjectClass-2
C0024109
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25580
UMLS 2011AA Property-2
C0456532
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
M Stage (check one in each row)
Description

LungTumorClinicalMStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12468
UMLS 2011AA ObjectClass-2
C0024109
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25727
UMLS 2011AA Property-2
C0456533
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
Pft's
Description

Pft's

Pulmonary function tests performed? (check one)
Description

LungPulmonaryFunctionAssessmentInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C13304
UMLS 2011AA Property-2
C2709248
NCI Thesaurus Property-3
C25518
UMLS 2011AA Property-3
C0542341
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Forced Expiratory Volume 1 (FEV1) (mL)
Description

LungForcedExpiratoryVolume1TestSpecifiedValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C38084
UMLS 2011AA Property-2
C0849974
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain-2
C38024
UMLS 2011AA ValueDomain-2
C0205369
Forced Expiratory Volume 1 (%Predicted FEV1) (%)
Description

LungForcedExpiratoryVolume1TestPercentageValue

Data type

float

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C38084
UMLS 2011AA Property-2
C0849974
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
%
Carbon Monoxide Diffusion (% predicted DLCO) (%)
Description

LungCarbonMonoxideDiffusingCapabilityTestAssessmentPredictiveValuePercentageValue

Data type

float

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C38083
UMLS 2011AA Property-2
C1516251
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
NCI Thesaurus ValueDomain-3
C16238
UMLS 2011AA ValueDomain-3
C1514307
%
Forced Vital Capacity (FVC1) (mL)
Description

VitalLungCapacityTestSpecifiedValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus ObjectClass-2
C18003
UMLS 2011AA ObjectClass-2
C0442732
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C25443
UMLS 2011AA Property-2
C1516240
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Forced Vital Capacity (% predicted FVC1) (%)
Description

VitalLungCapacityTestPercentageValue

Data type

float

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus ObjectClass-2
C18003
UMLS 2011AA ObjectClass-2
C0442732
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C25443
UMLS 2011AA Property-2
C1516240
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
%
Smoking Status
Description

Smoking Status

Have you smoked at least 100 cigarettes in your entire life? (check one)
Description

Smoking history

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C1519384
NCI Thesaurus ObjectClass
C17934
NCI Thesaurus Property
C18772
How old were you when you first started to smoke regularly? (If yes Age)
Description

AgeBeganSmokinginYears

Data type

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
NCI Thesaurus Property-2
C18270
UMLS 2011AA Property-2
C0700219
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C29848
UMLS 2011AA ValueDomain-2
C0439234
NCI Thesaurus ValueDomain-3
C25150
UMLS 2011AA ValueDomain-3
C0001779
On average, how many cigarettes do/did you smoke per day
Description

CigaretteAverageDailyUseCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C1802
UMLS 2011AA ObjectClass
C0677453
NCI Thesaurus Property
C25473
UMLS 2011AA Property
C0332173
NCI Thesaurus Property-2
C37917
UMLS 2011AA Property-2
C1510992
NCI Thesaurus Property-3
C25340
UMLS 2011AA Property-3
C0457083
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Do you now smoke cigarettes? (smoked in the past 30 days check one)
Description

CurrentSmokingHistoryType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25471
UMLS 2011AA ObjectClass
C0521116
NCI Thesaurus ObjectClass-2
C17934
UMLS 2011AA ObjectClass-2
C0453996
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
Number of years smoked cigarettes (If No years)
Description

CigarettesSmokingYearNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C1802
UMLS 2011AA ObjectClass
C0677453
NCI Thesaurus ValueDomain-2
C29848
UMLS 2011AA ValueDomain-2
C0439234
NCI Thesaurus Property
C17934
UMLS 2011AA Property
C0453996
Estimated date of last use (cigarettes dd MMM yyyy)
Description

CigaretteUse-StopDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C1802
UMLS 2011AA ObjectClass
C0677453
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
Cigar (check one)
Description

CigarSmokingUseIndicator

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C1813
UMLS 2011AA ObjectClass
C0182504
NCI Thesaurus ObjectClass-2
C17934
UMLS 2011AA ObjectClass-2
C0453996
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
Pipe (check one)
Description

Current Smoker

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C3241966
NCI Thesaurus Property
C25471
NCI Thesaurus ObjectClass
C17934
NCI Metathesaurus Property
C0449865
Snuff (check one)
Description

PatientSnuffTobaccoPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property-2
C63733
UMLS 2011AA Property-2
C0037390
Chewing tobacco (check one)
Description

ChewingTobaccoCurrentUseInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus ObjectClass
C361
UMLS 2011AA ObjectClass
C0008038
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
Other (check one)
Description

PatientSmokingAssessmentScale

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0037369
Other, specify (If yes)
Description

TobaccoTypeDescriptiveShortText

Data type

text

Alias
NCI Thesaurus ObjectClass
C891
UMLS 2011AA ObjectClass
C0040329
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ValueDomain-2
C25365
UMLS 2011AA ValueDomain-2
C0678257
NCI Thesaurus ValueDomain-3
C25249
UMLS 2011AA ValueDomain-3
C1806781
For how many years (If Yes, years)
Description

Smoking Duration

Data type

float

Alias
NCI Thesaurus ValueDomain
C25463
UMLS CUI-1
C3694955
NCI Thesaurus ObjectClass
C17934
NCI Thesaurus Property
C25330
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Similar models

ALL ITEMS MUST BE COMPLETED

1 forms
  1. StudyEvent: ACOSOG-Z4099 On-Study Form
    1. ALL ITEMS MUST BE COMPLETED
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Protocol ID ACOSOG
Item
Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1515944 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C19712 (NCI Thesaurus Property-2)
Patient Study ID
Item
Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-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 Number
Item
Institution Number
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Institution Name
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (check one if data amended, please circle in red when using paper forms)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Visit
Item
Visit
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
CL.2
Code List
Visit
CL Item
Registration (Registration)
C25646 (NCI Thesaurus)
C1514821 (UMLS 2011AA)
Item Group
Histologic Information
Diagnosis Date
Item
Diagnosis Date (dd MMM yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C2316983 (UMLS CUI-1)
C25626 (NCI Thesaurus Property)
C15220 (NCI Thesaurus ObjectClass)
Item
Histologic Type (check one)
text
C3262 (NCI Thesaurus ObjectClass)
C0449574 (UMLS CUI-1)
C12468 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
C25372 (NCI Thesaurus ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
CL.3
Code List
Histologic Type (check one)
CL Item
Squamous Cell Carcinoma (Squamous cell carcinoma)
C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)
CL Item
Bronchoalveolar (bac) (Bronchoalveolar carcinoma (BAC))
CL Item
Adenocarcinoma (Adenocarcinoma)
C2852 (NCI Thesaurus)
C0001418 (UMLS 2011AA)
CL Item
Non-small Cell Lung Cancer (nsclc), Nos (Non-small cell lung cancer NOS)
CL Item
Large Cell Undifferentiated (Large cell undifferentiated)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C17649 (NCI Thesaurus-3)
C0205394 (UMLS 2011AA-4)
Histologic Type, other
Item
Specify Other Histologic Type
text
C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
Item
Histologic grade (Differentiation check one)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C19594 (NCI Thesaurus ObjectClass)
C1518425 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ObjectClass-2)
C0919553 (UMLS 2011AA ObjectClass-2)
C48309 (NCI Thesaurus Property)
C0441800 (UMLS 2011AA Property)
CL.4
Code List
Histologic grade (Differentiation check one)
CL Item
Well Differentiated (G1)
C14171 (NCI Thesaurus)
C0205615 (UMLS 2011AA)
CL Item
Moderately Differentiated (G2)
C14162 (NCI Thesaurus)
C0205616 (UMLS 2011AA)
CL Item
Poorly Differentiated (G3)
C14167 (NCI Thesaurus)
C0205617 (UMLS 2011AA)
CL Item
Undifferentiated (G4)
C14176 (NCI Thesaurus)
C0205618 (UMLS 2011AA)
CL Item
Cannot Be Assessed (GX)
C48657 (NCI Thesaurus)
C1707258 (UMLS 2011AA)
Item Group
Patient Information
Item
Patient residing (check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)
CL.5
Code List
Patient residing (check one)
CL Item
Home (Home)
C18002 (NCI Thesaurus)
C0442519 (UMLS 2011AA)
CL Item
Assisted Living (Assisted living)
CL Item
Extended Care (Extended care)
CL Item
Hospital (Hospital)
C16696 (NCI Thesaurus)
C0019994 (UMLS 2011AA)
CL Item
Homeless (Homeless)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PatientResidenceSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25273 (NCI Thesaurus Property)
C0237096 (UMLS 2011AA Property)
PatientOxygenUseInd-2
Item
Current oxygen use (check one)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C722 (NCI Thesaurus Property)
C0030054 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
Item
Oxygen Use Type (If yes check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C722 (NCI Thesaurus Property)
C0030054 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
CL.7
Code List
Oxygen Use Type (If yes check one)
CL Item
Continuous (Continuous)
C53279 (NCI Thesaurus)
C0549178 (UMLS 2011AA)
CL Item
Intermittent (Intermittent)
C71325 (NCI Thesaurus)
C0205267 (UMLS 2011AA)
PatientHospitalizationYearCount
Item
Number of hospitalizations within the last year
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
Item Group
Baseline Pet Findings
StandardUptakeValuePositronEmissionTomographyAssessmentMaximumMeasurement
Item
Pre-treatment PET-SUV MAX
float
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C44275 (NCI Thesaurus ObjectClass-2)
C1442989 (UMLS 2011AA ObjectClass-2)
C0243144 (NCI Metathesaurus ObjectClass)
C25712 (NCI Thesaurus ObjectClass-3)
C1522609 (UMLS 2011AA ObjectClass-3)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25564 (NCI Thesaurus ValueDomain-2)
C0806909 (UMLS 2011AA ValueDomain-2)
Item Group
Surgery Risk Factors
PersonRiskSurgicalProcedureMajorPresentInd-2
Item
Major (check one)
boolean
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property-2)
C0543467 (UMLS 2011AA Property-2)
C17102 (NCI Thesaurus Property-3)
C0035647 (UMLS 2011AA Property-3)
C45368 (NCI Thesaurus Property-4)
C0205164 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
LungForcedExpiratoryVolume1MajorDecreasedForcedExpiratoryVolumeLaboratoryProcedureInd-2
Item
FEV1 <= 50 % predicted (If Yes)
boolean
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C38084 (NCI Thesaurus Property-2)
C0849974 (UMLS 2011AA Property-2)
C50524 (NCI Thesaurus Property-3)
C0520837 (UMLS 2011AA Property-3)
C45368 (NCI Thesaurus Property-4)
C0205164 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
LungCarbonMonoxideDiffusingCapabilityTestMajorDecreasedCarbonMonoxideDiffusingCapacityLaboratoryProcedureInd-2
Item
DLCO <= 50 % predicted (If Yes)
boolean
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C78229 (NCI Thesaurus Property)
C1697788 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C38083 (NCI Thesaurus Property-3)
C1516251 (UMLS 2011AA Property-3)
C45368 (NCI Thesaurus Property-4)
C0205164 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PersonRiskSurgicalProcedureMinorPresentInd-2
Item
Minor (check one)
boolean
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property-2)
C0543467 (UMLS 2011AA Property-2)
C17102 (NCI Thesaurus Property-3)
C0035647 (UMLS 2011AA Property-3)
C45367 (NCI Thesaurus Property-4)
C0205165 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientAgeEligibilityDeterminationInd-2
Item
Age >= 75 (If Yes)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C25171 (NCI Thesaurus Property-2)
C0013893 (UMLS 2011AA Property-2)
LungForcedExpiratoryVolume1MinorDecreasedForcedExpiratoryVolumeLaboratoryProcedureInd-2
Item
FEV1 51-60 % predicted (If Yes)
boolean
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C45367 (NCI Thesaurus Property-2)
C0205165 (UMLS 2011AA Property-2)
C38084 (NCI Thesaurus Property-3)
C0849974 (UMLS 2011AA Property-3)
C50524 (NCI Thesaurus Property-4)
C0520837 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
LungCarbonMonoxideDiffusingCapabilityTestMinorDecreasedCarbonMonoxideDiffusingCapacityLaboratoryProcedureInd-2
Item
DLCO 51-60 % predicted (If Yes)
boolean
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C78229 (NCI Thesaurus Property)
C1697788 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C45367 (NCI Thesaurus Property-3)
C0205165 (UMLS 2011AA Property-3)
C38083 (NCI Thesaurus Property-4)
C1516251 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PulmonaryHypertensionPresentInd-2
Item
Pulmonary hypertension as estimated by echocardiography or right heart catherization (If Yes defined as a pulmonary artery systolic pressure greater than 40mmHg)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C3120 (NCI Thesaurus ObjectClass)
C0020542 (UMLS 2011AA ObjectClass)
HeartLeftVentricularEjectionFractionReducedFunctionIndicator
Item
Poor left ventricular function (If Yes defined as an ejection fraction or 40% or less)
boolean
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25640 (NCI Thesaurus Property)
C0392756 (UMLS 2011AA Property)
C25518 (NCI Thesaurus Property-2)
C0542341 (UMLS 2011AA Property-2)
C37946 (NCI Thesaurus Property-3)
C2700377 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
LaboratoryProcedurePartialPressureofOxygenMeasurementArterialBloodGasMeasurementReducedOutcomeInd-2
Item
Resting or Exercise Arterial pO2 <= 55 mm Hg or SpO2 <= 88% (If Yes)
boolean
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25640 (NCI Thesaurus Property)
C0392756 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C71251 (NCI Thesaurus Property-3)
C0202155 (UMLS 2011AA Property-3)
C71252 (NCI Thesaurus Property-4)
C0150411 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PersonMedicalResearchCouncilDyspneaScaleOutcomeInd-2
Item
Modified Medical Research Council (MMRC) Dyspnea Scale >= 3 (If Yes)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C21157 (NCI Thesaurus Property-2)
C1513061 (UMLS 2011AA Property-2)
Item Group
Clinical Stage
Item
T Stage (check one in each row)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C0024109 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.19
Code List
T Stage (check one in each row)
CL Item
Tumor <=3 Cm In Greatest Dimension, Surrounded By Lung Or Visceral Pleura, Without Bronchoscopic Evidence Of Invasion More Proximal Than The Lobar Bronchus (i.e., Not In The Main Bronchus) (T1)
CL Item
Tumor <=2 Cm In Greatest Dimension (T1a)
CL Item
Tumor > 2 Cm But <=3 Cm In Greatest Dimension (T1b)
CL Item
Tumor > 3 Cm But <=7 Cm Involves Main Bronchus, >=2 Cm Distal To The Carina Invades Visceral Pleura (pl1 Or Pl2) Associated With Atelectasis Or Obstructive Pneumonitis That Extends To The Hilar Region But Does Not Involve The Entire Lung (T2)
CL Item
Tumor > 3 Cm But <=5 Cm In Greatest Dimension (T2a)
CL Item
Tumor > 5 Cm But <=7 Cm In Greatest Dimension (T2b)
CL Item
Tumor > 7 Cm Or One That Directly Invades Any Of The Following: Parietal Pleural (pl3) Chest Wall (including Superior Sulcus Tumors), Diaphragm, Phrenic Nerve, Mediastinal Pleura, Parietal Pericardium; Or Tumor In The Main Bronchus (T3)
CL Item
Tumor Of Any Size That Invades Any Of The Following: Mediastinum, Heart, Great Vessels, Trachea, Recurrent Laryngeal Nerve, Esophagus, Vertebral Body, Carina, Separate Tumor Nodule(s) In A Different Ipsilateral Lobe (T4)
Item
N Stage (check one in each row)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C0024109 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.20
Code List
N Stage (check one in each row)
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis In Ipsilateral Peribronchial And/or Ipsilateral Hilar Lymph Nodes And Intrapulmonary Nodes, Including Involvement By Direct Extension (N1)
CL Item
Metastasis In Ipsilateral Mediastinal And/or Subcarinal Lymph Node(s) (N2)
CL Item
Metastasis In Contralateral Mediastinal, Contralateral Hilar, Ipsilateral Or Contralateral Scalene, Or Supraclavicular Lymph Node(s) (N3)
Item
M Stage (check one in each row)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C0024109 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property-2)
C0456533 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.21
Code List
M Stage (check one in each row)
CL Item
No Distant Metastasis (no Pathologic M0; Use Clinical M To Complete Stage Group) (M0)
CL Item
Distant Metastasis (M1)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
C18206 (NCI Thesaurus-3)
C1269798 (UMLS 2011AA-4)
CL Item
Separate Tumor Nodule(s) In A Contralateral Lobe; Tumor With Pleural Nodules Or Malignant Pleural (or Pericardial) Effusion (M1a)
CL Item
Distant Metastasis (M1b)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
C18206 (NCI Thesaurus-3)
C1269798 (UMLS 2011AA-4)
Item Group
Pft's
LungPulmonaryFunctionAssessmentInd-3
Item
Pulmonary function tests performed? (check one)
boolean
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C13304 (NCI Thesaurus Property-2)
C2709248 (UMLS 2011AA Property-2)
C25518 (NCI Thesaurus Property-3)
C0542341 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
LungForcedExpiratoryVolume1TestSpecifiedValue
Item
Forced Expiratory Volume 1 (FEV1) (mL)
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C38084 (NCI Thesaurus Property-2)
C0849974 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C0205369 (UMLS 2011AA ValueDomain-2)
LungForcedExpiratoryVolume1TestPercentageValue
Item
Forced Expiratory Volume 1 (%Predicted FEV1) (%)
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C38084 (NCI Thesaurus Property-2)
C0849974 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
LungCarbonMonoxideDiffusingCapabilityTestAssessmentPredictiveValuePercentageValue
Item
Carbon Monoxide Diffusion (% predicted DLCO) (%)
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C38083 (NCI Thesaurus Property-2)
C1516251 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C16238 (NCI Thesaurus ValueDomain-3)
C1514307 (UMLS 2011AA ValueDomain-3)
VitalLungCapacityTestSpecifiedValue
Item
Forced Vital Capacity (FVC1) (mL)
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C18003 (NCI Thesaurus ObjectClass-2)
C0442732 (UMLS 2011AA ObjectClass-2)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C25443 (NCI Thesaurus Property-2)
C1516240 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
VitalLungCapacityTestPercentageValue
Item
Forced Vital Capacity (% predicted FVC1) (%)
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C18003 (NCI Thesaurus ObjectClass-2)
C0442732 (UMLS 2011AA ObjectClass-2)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C25443 (NCI Thesaurus Property-2)
C1516240 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
Item Group
Smoking Status
Item
Have you smoked at least 100 cigarettes in your entire life? (check one)
text
C25180 (NCI Thesaurus ValueDomain)
C1519384 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C18772 (NCI Thesaurus Property)
CL.23
Code List
Have you smoked at least 100 cigarettes in your entire life? (check one)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
AgeBeganSmokinginYears
Item
How old were you when you first started to smoke regularly? (If yes Age)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C18270 (NCI Thesaurus Property-2)
C0700219 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C29848 (NCI Thesaurus ValueDomain-2)
C0439234 (UMLS 2011AA ValueDomain-2)
C25150 (NCI Thesaurus ValueDomain-3)
C0001779 (UMLS 2011AA ValueDomain-3)
CigaretteAverageDailyUseCount
Item
On average, how many cigarettes do/did you smoke per day
float
C1802 (NCI Thesaurus ObjectClass)
C0677453 (UMLS 2011AA ObjectClass)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-2)
C1510992 (UMLS 2011AA Property-2)
C25340 (NCI Thesaurus Property-3)
C0457083 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Do you now smoke cigarettes? (smoked in the past 30 days check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus ObjectClass)
C0521116 (UMLS 2011AA ObjectClass)
C17934 (NCI Thesaurus ObjectClass-2)
C0453996 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
CL.24
Code List
Do you now smoke cigarettes? (smoked in the past 30 days check one)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CigarettesSmokingYearNumber
Item
Number of years smoked cigarettes (If No years)
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C1802 (NCI Thesaurus ObjectClass)
C0677453 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain-2)
C0439234 (UMLS 2011AA ValueDomain-2)
C17934 (NCI Thesaurus Property)
C0453996 (UMLS 2011AA Property)
CigaretteUse-StopDate
Item
Estimated date of last use (cigarettes dd MMM yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C1802 (NCI Thesaurus ObjectClass)
C0677453 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
CigarSmokingUseIndicator
Item
Cigar (check one)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1813 (NCI Thesaurus ObjectClass)
C0182504 (UMLS 2011AA ObjectClass)
C17934 (NCI Thesaurus ObjectClass-2)
C0453996 (UMLS 2011AA ObjectClass-2)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
Current Smoker
Item
Pipe (check one)
boolean
C38148 (NCI Thesaurus ValueDomain)
C3241966 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C17934 (NCI Thesaurus ObjectClass)
C0449865 (NCI Metathesaurus Property)
PatientSnuffTobaccoPersonalMedicalHistoryInd-2
Item
Snuff (check one)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C63733 (NCI Thesaurus Property-2)
C0037390 (UMLS 2011AA Property-2)
ChewingTobaccoCurrentUseInd-2
Item
Chewing tobacco (check one)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C361 (NCI Thesaurus ObjectClass)
C0008038 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
PatientSmokingAssessmentScale
Item
Other (check one)
boolean
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0037369 (NCI Metathesaurus Property)
TobaccoTypeDescriptiveShortText
Item
Other, specify (If yes)
text
C891 (NCI Thesaurus ObjectClass)
C0040329 (UMLS 2011AA ObjectClass)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus ValueDomain-2)
C0678257 (UMLS 2011AA ValueDomain-2)
C25249 (NCI Thesaurus ValueDomain-3)
C1806781 (UMLS 2011AA ValueDomain-3)
Smoking Duration
Item
For how many years (If Yes, years)
float
C25463 (NCI Thesaurus ValueDomain)
C3694955 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus Property)
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