Description:

A0 OPEN Form - 1005 Higher-Dose Radiation Therapy or Standard Radiation Therapy in Treating Patients With Early-Stage Breast Cancer That Was Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9DA9F360-A112-1EA4-E040-BB89AD432FA2

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9DA9F360-A112-1EA4-E040-BB89AD432FA2

Keywords:
Versions (2) ▾
  1. 12/18/14
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01349322 Demographic - A0 OPEN Form - 1005 - 3198937v1.0

No Instruction available.

  1. StudyEvent: A0 OPEN Form - 1005
    1. No Instruction available.
Module 1
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Race
Any care at VA or military hospital
Module 1
Have you obtained the patient's consent for her tissue to be kept for use in research to learn about, prevent, treat, or cure cancer?
Have you obtained the patient's consent for her blood to be kept for use in research to learn about, prevent, treat, or cure cancer?
Have you obtained the patient's consent for her tissue to be kept for use in research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Have you obtained the patient's consent for her blood to be kept for use in research about other health problems (for example: diabetes, Alzheimer's disease, or heart disease)?
Have you obtained the patient's consent to allow someone from this institution to contact her in the future to take part in more research?
Patient has consented to participate in the cosmesis study
If no, provide reason
Age
Intention to receive chemotherapy
ER Status
Histologic Grade
Patient
Radiation Therapy Technique

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