ID
7850
Description
NSABP B-45 Worksheet for Sunitinib/Placebo Treatment Form Studying Biological Markers of Fatigue in Women With Residual Invasive Breast Cancer Enrolled on Clinical Trial NSABP-B-45 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=61BA6471-86CD-B427-E040-BB89AD43714B
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Mots-clés
Versions (2)
- 27/08/2012 27/08/2012 -
- 09/01/2015 09/01/2015 - 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 NCT00914043 Treatment - NSABP B-45 Worksheet for Sunitinib/Placebo Treatment Form - 2830664v1.0
This paper worksheet may be completed to facilitate the entry of treatment information in NSABP Coordinator Online. Partially completed worksheets may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. While patient is taking Sunitinib/Placebo, treatment information will be collected for each of the following 7 Reporting Periods listed below. Form T does not apply to a patient who did not initiate Sunitinib/Placebo. If Sunitinib/Placebo is discontinued early, and the date Sunitinib/Placebo ended has been reported on a previous Form T, additional treatment forms will not be expected
- StudyEvent: NSABP B-45 Worksheet for Sunitinib/Placebo Treatment Form
Description
Reporting Period
Description
Clinical Trial Period
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2347804
- NCI Thesaurus ObjectClass
- C25214
- NCI Thesaurus Property
- C25616
- NCI Thesaurus ObjectClass-2
- C25651
Description
Section 1. Sunitinib/placebo For All Patients
Description
Agent Start Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1521826
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS CUI-2
- C0808070
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Description
Treatment Modification
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1299575
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25572
Description
Dose Modification Status
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-1
- C1707811
- NCI Thesaurus ValueDomain
- C25688
- NCI Thesaurus Property
- C25572
Description
Agent End Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-2
- C0806020
- NCI Thesaurus Property
- C25275
Description
Agent End Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-2
- C0806020
- NCI Thesaurus Property
- C25275
Description
NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C15818
- UMLS 2011AA ObjectClass
- C1513905
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
NationalSurgicalAdjuvantBreastandBowelProjectTherapyNotAdministeredSpecify
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C15818
- UMLS 2011AA ObjectClass
- C1513905
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Estimate Of Patient Compliance
Description
PillsTakenStatus
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25394
- UMLS 2011AA ObjectClass
- C0994475
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C25701
- UMLS 2011AA Property
- C1883727
Description
PillsEstimateRemainingQuantityTechniqueSource
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25394
- UMLS 2011AA ObjectClass
- C0994475
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
- NCI Thesaurus Property-2
- C25498
- UMLS 2011AA Property-2
- C0750572
- NCI Thesaurus Property-3
- C25256
- UMLS 2011AA Property-3
- C1265611
- NCI Thesaurus Property-4
- C25649
- UMLS 2011AA Property-4
- C1527428
- NCI Thesaurus ValueDomain
- C25683
- UMLS 2011AA ValueDomain
- C0449416
Description
Section 2. Adjuvant Hormonal Therapy During Sunitinib/placebo Treatment
Description
HormoneTherapyReportPeriodAdministeredInd-3
Type de données
boolean
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25375
- UMLS 2011AA Property-2
- C0684224
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
HormoneTherapyDiscontinuedInd-2
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
Description
HormoneTherapyLastAdministeredDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25551
- UMLS 2011AA Property
- C1517741
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
Description
HormoneTherapyDiscontinuedType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
Description
HormoneTherapyDiscontinuedSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
Description
HormoneTherapyDiscontinuedIndicator
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
Description
NationalSurgicalAdjuvantBreastandBowelProjectTreatmentNotAdministeredReason
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C15818
- UMLS 2011AA ObjectClass
- C1513905
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
NationalSurgicalAdjuvantBreastandBowelProjectTherapyNotAdministeredSpecify
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C15818
- UMLS 2011AA ObjectClass
- C1513905
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Footer
Description
Research Comments
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0947611
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
Description
Person Completing Form
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Description
Date Form Completed
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
Similar models
This paper worksheet may be completed to facilitate the entry of treatment information in NSABP Coordinator Online. Partially completed worksheets may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. While patient is taking Sunitinib/Placebo, treatment information will be collected for each of the following 7 Reporting Periods listed below. Form T does not apply to a patient who did not initiate Sunitinib/Placebo. If Sunitinib/Placebo is discontinued early, and the date Sunitinib/Placebo ended has been reported on a previous Form T, additional treatment forms will not be expected
- StudyEvent: NSABP B-45 Worksheet for Sunitinib/Placebo Treatment Form
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
C2347804 (UMLS CUI-1)
C25214 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C25651 (NCI Thesaurus ObjectClass-2)
C0205448 (UMLS 2011AA)
C1521826 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C1299575 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
C1707811 (UMLS CUI-1)
C25688 (NCI Thesaurus ValueDomain)
C25572 (NCI Thesaurus Property)
C1707814 (UMLS 2011AA)
C49505 (NCI Thesaurus-3)
C1707814 (UMLS 2011AA-4)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C0806020 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C0806020 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C0011065 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0994475 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25701 (NCI Thesaurus Property)
C1883727 (UMLS 2011AA Property)
C0994475 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25498 (NCI Thesaurus Property-2)
C0750572 (UMLS 2011AA Property-2)
C25256 (NCI Thesaurus Property-3)
C1265611 (UMLS 2011AA Property-3)
C25649 (NCI Thesaurus Property-4)
C1527428 (UMLS 2011AA Property-4)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
C0279025 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25375 (NCI Thesaurus Property-2)
C0684224 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C0039286 (UMLS 2011AA)
C0593802 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C1522602 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C0011065 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1513905 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)