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ID

8136

Description

QF RTOG Phase III-Multiple Brain Mets Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA4A0B-63F5-6417-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA4A0B-63F5-6417-E034-0003BA12F5E7

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

Modèle Commentaires :

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    Lung Cancer NCT00096265 Quality of Life - QF RTOG Phase III-Multiple Brain Mets - 2277089v3.0

    No Instruction available.

    1. StudyEvent: QF RTOG Phase III-Multiple Brain Mets
      1. No Instruction available.
    Header
    Description

    Header

    [RTOG Study No.]
    Description

    Protocol ID RTOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Case #
    Description

    Case#

    Type de données

    text

    Institution
    Description

    Institution Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Institution No.
    Description

    Institution Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Participant's Initials
    Description

    Patient Initials

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Participant's I.D. No.
    Description

    Patient Study ID

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Date Form Completed
    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
    Module 1
    Description

    Module 1

    Mobility (Please circle one statement in each group below which best describes your health today.)
    Description

    QOLMobilityAssessmentStatus

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Metathesaurus Property
    C0449580
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    Description

    QOLSelf-careStatusType

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    Description

    QOLPhyscialActivityAssessmentStatus

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C17708
    UMLS 2011AA Property-2
    C0026606
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    Description

    QOLPainAssessmentStatus

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    Description

    QOLAnxietyAssessmentStatus

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C26696
    UMLS 2011AA Property-2
    C0003467
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Module 2
    Description

    Module 2

    Date
    Description

    ResponsiblePersonSignatureDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS 2011AA ObjectClass-2
    C1273518
    NCI Thesaurus Property
    C25678
    UMLS 2011AA Property
    C1519316
    Your own health state today
    Description

    Yourownhealthstatetoday

    Type de données

    text

    Patient's signature
    Description

    Patient'ssignature

    Type de données

    text

    Similar models

    No Instruction available.

    1. StudyEvent: QF RTOG Phase III-Multiple Brain Mets
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Item
    [RTOG Study No.]
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Code List
    [RTOG Study No.]
    CL Item
    RTOG Study 0320 (RTOG Study 0320)
    Case#
    Item
    Case #
    text
    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)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Participant's Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient Study ID
    Item
    Participant's I.D. No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Date Form Completed
    Item
    Date Form Completed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1115437 (UMLS CUI-1)
    C40988 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Module 1
    Item
    Mobility (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C0449580 (NCI Metathesaurus Property)
    Code List
    Mobility (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems In Walking About (I have no problems in walking about)
    CL Item
    I Have Some Problems In Walking About (I have some problems in walking about)
    CL Item
    I Am Confined To Bed (I am confined to bed)
    Item
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Self-Care (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems With Self-care (I have no problems with self-care)
    CL Item
    I Have Some Problems Washing Or Dressing Myself (I have some problems washing or dressing myself)
    CL Item
    I Am Unable To Wash Or Dress Myself (I am unable to wash or dress myself)
    Item
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C17708 (NCI Thesaurus Property-2)
    C0026606 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Usual Activities (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Problems With Performing My Usual Activities (I have no problems with performing my usual activities)
    CL Item
    I Have Some Problems With Performing My Usual Activities (I have some problems with performing my usual activities)
    CL Item
    I Am Unable To Perform My Usual Activities (I am unable to perform my usual activities)
    Item
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Pain/Discomfort (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Have No Pain Or Discomfort (I have no pain or discomfort)
    CL Item
    I Have Moderate Pain Or Discomfort (I have moderate pain or discomfort)
    CL Item
    I Have Extreme Pain Or Discomfort (I have extreme pain or discomfort)
    Item
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus Property-2)
    C0003467 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    Anxiety/Depression (Please circle one statement in each group below which best describes your health today.)
    CL Item
    I Am Not Anxious Or Depressed (I am not anxious or depressed)
    CL Item
    I Am Moderately Anxious Or Depressed (I am moderately anxious or depressed)
    CL Item
    I Am Extremely Anxious Or Depressed (I am extremely anxious or depressed)
    Item Group
    Module 2
    ResponsiblePersonSignatureDate
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1273518 (UMLS 2011AA ObjectClass-2)
    C25678 (NCI Thesaurus Property)
    C1519316 (UMLS 2011AA Property)
    Yourownhealthstatetoday
    Item
    Your own health state today
    text
    Patient'ssignature
    Item
    Patient's signature
    text

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