Lung Cancer - Advanced Disease Follow Up Form Source Form: NCI FormBuilder:


Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

No DOI assigned. To request one please log in.
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Follow-Up - Lung Cancer - Advanced Disease Follow Up Form - 2019424v2.31

(Information contained in this section is optional and may be included at the discretion of the group; for example: preprinted labels or electronically populated fields may be used)

Crf Header
Vital Status
Primary Cause of Death
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Has the patient developed a first progression (or relapse) that has not been previously reported?
Lung: Non-protocol Therapy
Is the patient receiving any non-protocol cancer therapy not previously reported?
Non-Protocol Hormonal Therapy? (includes medical and surgical)
Non-Protocol Chemotherapy
Non-Protocol Immunotherapy?
Non-Protocol Biologic Response Modifier?
Non-Protocol High Dose Chemotherapy/Autologous Stem Cell Transplant
Non-Protocol Radiation Therapy?
Non-Protocol Surgery?
Other Non-Protocol Therapy
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
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
Allows Documentation Of Any Additional Cooments

Similar models