Gynecologic Cancer - Follow-Up Form Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Gynecologic Cancer - Follow-Up Form - 2019334v3.0

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  1. StudyEvent: Gynecologic Cancer - Follow-Up Form
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Crf Header
Sarcoma: Follow-up Reporting Period
Are data amended (If amended, please circle the changed data in red when using paper form)
Sarcoma: Vital Status
Patient's Vital Status
Primary Cause of Death (check only one)
Sarcoma: Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Status of Most Recent Clinical Assessment
Result of second-look or debulking surgery
Has the patient developed a first progression (or relapse) that has not been previously reported?
Site of Progression (s - mark all that apply)
How was this progression information obtained?
Was salvage therapy performed prior to progression?
Is the site of recurrence within the field previously treated by radiation therapy? (or progression)
Sarcoma: Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Gyn: Long-term Toxicity
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity that has not been previously reported (or is continuing)
Late Adverse Event Status
Lung: Non-protocol Therapy
Is the patient receiving any non-protocol cancer therapy not previously reported?
Non-Protocol Surgery?
Non-Protocol Chemotherapy
Non-Protocol Hormonal Therapy?
Non-Protocol Immunotherapy?
Non-Protocol Radiation Therapy?
Other Non-Protocol Therapy
Allows Documentation Of Any Additional Cooments

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