ID
7767
Beschreibung
CALGB 40503 TREATMENT FORM Tamoxifen or Letrozole With or Without Bevacizumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2407A0C1-E943-0D00-E044-0003BA3F9857
Link
Stichworte
Versionen (3)
- 26.08.12 26.08.12 -
- 09.01.15 09.01.15 - Martin Dugas
- 16.06.15 16.06.15 -
Hochgeladen am
9. Januar 2015
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00601900 Treatment - CALGB 40503 TREATMENT FORM - 2551867v1.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice.
Beschreibung
Unnamed2
Beschreibung
Patient Initials
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Beschreibung
Medical Record Number
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Beschreibung
Institution Name
Datentyp
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
Beschreibung
Participating Group
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Beschreibung
Study Number Participating Group
Datentyp
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
Beschreibung
Trial subject ID Participating Group
Datentyp
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
Beschreibung
Bevacizumab/placebo
Beschreibung
Bevacizumab/placebo
Beschreibung
Agent
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain
- C1708
- NCI Thesaurus ValueDomain-2
- C42614
Beschreibung
Patient Weight
Datentyp
float
Maßeinheiten
- Kg
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005910
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25208
Beschreibung
Agent dose prescribed
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C28180
- UMLS CUI-1
- C0678766
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS CUI-2
- C0278329
- NCI Thesaurus Property
- C25256
- NCI Thesaurus ValueDomain
- C25488
- NCI Thesaurus ValueDomain-2
- C1708
Beschreibung
TotalAgentActualCourseDose
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C25304
- UMLS 2011AA ObjectClass
- C0439810
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25379
- UMLS 2011AA Property
- C0750729
- NCI Thesaurus Property-2
- C25274
- UMLS 2011AA Property-2
- C0237400
- NCI Thesaurus ValueDomain
- C25488
- UMLS 2011AA ValueDomain
- C0178602
- NCI Thesaurus ValueDomain-2
- C25274
- UMLS 2011AA ValueDomain-2
- C0237400
Beschreibung
DoseDelayedInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25477
- NCI Thesaurus ObjectClass
- C25488
- UMLS 2011AA ObjectClass
- C0178602
Beschreibung
TreatmentInterruptionDayDuration
Datentyp
float
Alias
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ValueDomain-2
- C25330
- UMLS 2011AA ValueDomain-2
- C0449238
- NCI Thesaurus Property
- C25542
- UMLS 2011AA Property
- C1512900
Beschreibung
TreatmentDelayedReasonText
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschreibung
PlaceboBevacizumabAgentDiscontinuedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C753
- UMLS 2011AA ObjectClass
- C0032042
- NCI Thesaurus ObjectClass-2
- C2039
- UMLS 2011AA ObjectClass-2
- C0796392
- NCI Thesaurus ObjectClass-3
- C1708
- UMLS 2011AA ObjectClass-3
- C0450442
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
PlaceboBevacizumabAgentDiscontinuedDate
Datentyp
date
Alias
- NCI Thesaurus ObjectClass
- C753
- UMLS 2011AA ObjectClass
- C0032042
- NCI Thesaurus ObjectClass-2
- C2039
- UMLS 2011AA ObjectClass-2
- C0796392
- NCI Thesaurus ObjectClass-3
- C1708
- UMLS 2011AA ObjectClass-3
- C0450442
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschreibung
Bevacizumab/placebo
Beschreibung
Agent
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain
- C1708
- NCI Thesaurus ValueDomain-2
- C42614
Beschreibung
Protocol Treatment Arm
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C42651
- UMLS CUI-1
- C1522541
- NCI Thesaurus Property
- C32141
- NCI Thesaurus Property-2
- C25426
- NCI Thesaurus ValueDomain
- C25284
Beschreibung
Agent dose prescribed
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C28180
- UMLS CUI-1
- C0678766
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS CUI-2
- C0278329
- NCI Thesaurus Property
- C25256
- NCI Thesaurus ValueDomain
- C25488
- NCI Thesaurus ValueDomain-2
- C1708
Beschreibung
TotalAgentActualCourseDose
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C25304
- UMLS 2011AA ObjectClass
- C0439810
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25379
- UMLS 2011AA Property
- C0750729
- NCI Thesaurus Property-2
- C25274
- UMLS 2011AA Property-2
- C0237400
- NCI Thesaurus ValueDomain
- C25488
- UMLS 2011AA ValueDomain
- C0178602
- NCI Thesaurus ValueDomain-2
- C25274
- UMLS 2011AA ValueDomain-2
- C0237400
Beschreibung
DoseDelayedInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25477
- NCI Thesaurus ObjectClass
- C25488
- UMLS 2011AA ObjectClass
- C0178602
Beschreibung
TreatmentInterruptionDayDuration
Datentyp
float
Alias
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ValueDomain-2
- C25330
- UMLS 2011AA ValueDomain-2
- C0449238
- NCI Thesaurus Property
- C25542
- UMLS 2011AA Property
- C1512900
Beschreibung
TreatmentDelayedReasonText
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschreibung
Comments
Beschreibung
Person Completing Form
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Beschreibung
Form Completion Date
Datentyp
date
Alias
- NCI Thesaurus ObjectClass
- C19464
- UMLS CUI-1
- C1549507
- NCI Thesaurus Property
- C25250
- NCI Thesaurus Property-2
- C25604
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice.
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
C3274381 (UMLS CUI-1)
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C25379 (NCI Thesaurus Property)
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C0806020 (UMLS CUI-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2045829 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property-2)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0678766 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass-2)
C0278329 (UMLS CUI-2)
C25256 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ValueDomain-2)
C0439810 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C25379 (NCI Thesaurus Property)
C0750729 (UMLS 2011AA Property)
C25274 (NCI Thesaurus Property-2)
C0237400 (UMLS 2011AA Property-2)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C25274 (NCI Thesaurus ValueDomain-2)
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C1512699 (UMLS 2011AA ValueDomain)
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C0439228 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus ValueDomain-2)
C0449238 (UMLS 2011AA ValueDomain-2)
C25542 (NCI Thesaurus Property)
C1512900 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0032042 (UMLS 2011AA ObjectClass)
C2039 (NCI Thesaurus ObjectClass-2)
C0796392 (UMLS 2011AA ObjectClass-2)
C1708 (NCI Thesaurus ObjectClass-3)
C0450442 (UMLS 2011AA ObjectClass-3)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0032042 (UMLS 2011AA ObjectClass)
C2039 (NCI Thesaurus ObjectClass-2)
C0796392 (UMLS 2011AA ObjectClass-2)
C1708 (NCI Thesaurus ObjectClass-3)
C0450442 (UMLS 2011AA ObjectClass-3)
C25484 (NCI Thesaurus Property)
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C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C1521826 (UMLS CUI-1)
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C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C42651 (NCI Thesaurus ObjectClass-2)
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C25426 (NCI Thesaurus Property-2)
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C0246421 (UMLS 2011AA)
C0039286 (UMLS 2011AA)
C0678766 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass-2)
C0278329 (UMLS CUI-2)
C25256 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ValueDomain-2)
C0439810 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C25379 (NCI Thesaurus Property)
C0750729 (UMLS 2011AA Property)
C25274 (NCI Thesaurus Property-2)
C0237400 (UMLS 2011AA Property-2)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C25274 (NCI Thesaurus ValueDomain-2)
C0237400 (UMLS 2011AA ValueDomain-2)
C1512699 (UMLS 2011AA ValueDomain)
C25477 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ObjectClass)
C0178602 (UMLS 2011AA ObjectClass)
C0439228 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus ValueDomain-2)
C0449238 (UMLS 2011AA ValueDomain-2)
C25542 (NCI Thesaurus Property)
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C1527021 (UMLS 2011AA ValueDomain)
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