ID

809

Descripción

SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Palabras clave

Versiones (3)
  1. 26/8/12 26/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 5/7/15 5/7/15 -
Subido en

26 de agosto de 2012

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00070564 Off Treatment - SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE - 2050111v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Unnamed1
Descripción

Unnamed1

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Patient Initials (L, F M)
Descripción

PatientInitialsName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution / Affiliate
Descripción

MainMemberInstitution/AffiliateNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Physician (Groups other than SWOG)
Descripción

RegisteredInvestigator

Tipo de datos

text

Group Name (Groups other than SWOG)
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No. (Groups other than SWOG)
Descripción

Particip.GroupProtocolNumber

Tipo de datos

double

Pt. ID (Groups other than SWOG)
Descripción

PatientStudyID,ParticipatingGroup

Tipo de datos

text

Unnamed2
Descripción

Unnamed2

Treatment Start Date
Descripción

TreatmentStartDate

Tipo de datos

date

Treatment End Date
Descripción

TreatmentEndDate

Tipo de datos

date

Regimen or Procedure or Site(s)
Descripción

RegimenorProcedureorSite(s)

Tipo de datos

text

Unnamed3
Descripción

Unnamed3

Off Treatment Reason (select one)
Descripción

OffTreatmentReason

Tipo de datos

text

Patient refused, due to toxicity, specify
Descripción

OffTreatmentReason,Toxicity

Tipo de datos

text

Patient refused, due to toxicity, specify
Descripción

OffTreatmentReason,Toxicity

Tipo de datos

text

Progression or relapse. Sites
Descripción

ProgressionSite

Tipo de datos

text

Other, specify (Off Treatment Date)
Descripción

OffTreatmentReason,Other

Tipo de datos

text

Other, specify (Off Treatment Date)
Descripción

OffTreatmentReason,Other

Tipo de datos

text

Date of completion, progression, death or decision to discontinue therapy
Descripción

OffTreatmentDate

Tipo de datos

date

Unnamed4
Descripción

Unnamed4

Will patient receive further treatment?
Descripción

FurtherTreatmentInd

Tipo de datos

text

Yes, specify
Descripción

TreatmentType,Specify

Tipo de datos

text

Unnamed5
Descripción

Unnamed5

Date of Last Contact (or death)
Descripción

DeathDate/LastContactDate

Tipo de datos

date

Vital Status
Descripción

Patient'sVitalStatus

Tipo de datos

text

Notes
Descripción

Notes

Comments
Descripción

Comments

Tipo de datos

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice
Descripción

Ccrr Module For Southwest Oncology Group Off Treatment Notice

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed1
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitialsName
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
MainMemberInstitution/AffiliateNumber
Item
Institution / Affiliate
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name (Groups other than SWOG)
text
Particip.GroupProtocolNumber
Item
Study No. (Groups other than SWOG)
double
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Groups other than SWOG)
text
Item Group
Unnamed2
TreatmentStartDate
Item
Treatment Start Date
date
TreatmentEndDate
Item
Treatment End Date
date
RegimenorProcedureorSite(s)
Item
Regimen or Procedure or Site(s)
text
Item Group
Unnamed3
Item
Off Treatment Reason (select one)
text
CL.1
Code List
Off Treatment Reason (select one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Medically required, due to toxicity, specify (Medically required, due to toxicity, specify)
CL Item
Patient refused, due to toxicity, specify (Patient refused, due to toxicity, specify)
CL Item
Patient refused, other than toxicity, specify (Patient refused, other than toxicity, specify)
CL Item
Progression or relapse. Sites (Progression or relapse. Sites)
CL Item
Death (Death)
CL Item
Other, Specify (Other, specify)
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
ProgressionSite
Item
Progression or relapse. Sites
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentDate
Item
Date of completion, progression, death or decision to discontinue therapy
date
Item Group
Unnamed4
Item
Will patient receive further treatment?
text
CL.2
Code List
Will patient receive further treatment?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TreatmentType,Specify
Item
Yes, specify
text
Item Group
Unnamed5
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
CL.3
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Notes
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Off Treatment Notice
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