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Fel:
ID
781
Beskrivning
CALGB: Follow-up Solid Tumor Evaluation Form Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D1896-B650-4751-E034-0003BA0B1A09
Länk
Nyckelord
Versioner (3)
- 2012-08-26 2012-08-26 -
- 2015-07-08 2015-07-08 -
- 2015-07-08 2015-07-08 -
Uppladdad den
26 augusti 2012
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053339 Response - CALGB: Follow-up Solid Tumor Evaluation Form - 2054391v3.0
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. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.
- StudyEvent: CALGB: Follow-up Solid Tumor Evaluation Form
Similar models
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. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.
- StudyEvent: CALGB: Follow-up Solid Tumor Evaluation Form
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
Item
Amended data?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
AffiliateName
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientID
Item
Participating Group Patient No.
text
IntervalReportFromDate
Item
From
date
IntervalReportToDate
Item
To
date
Lesion,ReferenceNumber
Item
Lesion Number (unnamed)
double
Lesion,AnatomicSite,New
Item
Site
text
AssessmentDate
Item
Date of Evaluation
date
CL Item
Clinical Examination (clinical examination)
CL Item
Chest X-ray (chest x-ray)
CL Item
Ct Scan (CT scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
C1456803 (UMLS 2011AA)
CL Item
Bone Scan (Bone scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
C0203668 (UMLS 2011AA)
CL Item
Not Evaluated (not evaluated)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
CL Item
complete response (CR) (complete response (CR))
CL Item
partial response (PR) (partial response (PR))
CL Item
stable disease (SD) (stable disease (SD))
CL Item
progressive disease (PD) (progressive disease (PD))
CL Item
insufficient evaluation to determine response status (insufficient evaluation to determine response status)
Lesion,TumorDiameter
Item
Longest Diameter (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Lesion,Diameter,LongestSum
Item
Sum of Longest Diameteres of All Target lesions (cm)
double
CL Item
Complete Response (complete response (CR))
CL Item
Partial Response (partial response (PR))
C18212 (NCI Thesaurus)
CL Item
Incomplete Response Or Stable Disesase (stable disease (SD))
CL Item
Partial Response; At Least A 30% Decrease In The Sum Of Ld Of Target Lesions Taking As Reference The Baseline Sum Ld (progressive disease (PD))
CL Item
Insufficient Evaluation (insufficient evaluation to determine response status)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
Lesion,ReferenceNumber
Item
Lesion Number (unnamed)
double
Lesion,AnatomicSite,Nontarget
Item
Site
text
AssessmentDate
Item
Date of Evaluation
date
CL Item
Clinical Examination (clinical examination)
CL Item
Chest X-ray (chest x-ray)
CL Item
Ct Scan (CT scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
C1456803 (UMLS 2011AA)
CL Item
Bone Scan (Bone scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
C0203668 (UMLS 2011AA)
CL Item
Not Evaluated (not evaluated)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
CL Item
complete response (CR) (complete response (CR))
CL Item
partial response (PR) (partial response (PR))
CL Item
stable disease (SD) (stable disease (SD))
CL Item
progressive disease (PD) (progressive disease (PD))
CL Item
insufficient evaluation to determine response status (insufficient evaluation to determine response status)
CL Item
Complete Response (complete response (CR))
CL Item
Partial Response (partial response (PR))
C18212 (NCI Thesaurus)
CL Item
Incomplete Response Or Stable Disesase (stable disease (SD))
CL Item
Partial Response; At Least A 30% Decrease In The Sum Of Ld Of Target Lesions Taking As Reference The Baseline Sum Ld (progressive disease (PD))
CL Item
Insufficient Evaluation (insufficient evaluation to determine response status)
Item
Was the appearance of any new lesions documented since the baseline evaluation?
text
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
Lesion,ReferenceNumber
Item
Lesion Number (unnamed)
double
Lesion,AnatomicSite,New
Item
Site
text
AssessmentDate
Item
Date of Evaluation
date
CL Item
Clinical Examination (clinical examination)
CL Item
Chest X-ray (chest x-ray)
CL Item
Ct Scan (CT scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Mri (MRI (NMR))
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
C1456803 (UMLS 2011AA)
CL Item
Bone Scan (Bone scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
C0203668 (UMLS 2011AA)
CL Item
Not Evaluated (not evaluated)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
CL Item
complete response (CR) (complete response (CR))
CL Item
partial response (PR) (partial response (PR))
CL Item
stable disease (SD) (stable disease (SD))
CL Item
progressive disease (PD) (progressive disease (PD))
CL Item
insufficient evaluation to determine response status (insufficient evaluation to determine response status)
PersonCompletingForm,FirstName
Item
Completed by
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormCompletionDate,Original
Item
Date completed
date