Description:

NSABP PROTOCOL C-09: REGISTRATION FORM Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7DB4A4-172A-4E9B-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7DB4A4-172A-4E9B-E034-0003BA3F9857

Keywords:
Versions (2) ▾
  1. 8/27/12
  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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Colorectal Cancer NCT00268463 Registration - NSABP PROTOCOL C-09: REGISTRATION FORM - 2319554v3.0

Refer to patient entry guidelines in the Members' Area of the NSABP Web site

  1. StudyEvent: NSABP PROTOCOL C-09: REGISTRATION FORM
    1. Refer to patient entry guidelines in the Members' Area of the NSABP Web site
Unnamed 1
Unnamed2
Unnamed3
Race (more than one may be marked)
Method of Payment (mark primary method only)
Ethnicity
Country of Residence (if not USA)
Unnamed4
Your blood and tissues samples may be kept by the NSABP for use in future research to learn about, prevent, detect, or treat cancer.
Your blood and tissue samples may be used for research about other health problems (for example: causes of heart disease, osteoporosis, diabetes)
Your study doctor may contact you in the future to ask you to take part in more research. (or someone he or she chooses)
Stratification Factors
Intended Method for Removal of Hepatic Metastases
Adjuvant Chemotherapy for Colorectal Cancer
Certification Of Eligibility
In the opinion of the investigator, is the patient eligible
Did patient complete the baseline QOL form
Unnamed5
Has the patient authorized the release of Protected Health Information to the NSABP
Unnamed6
Was the primary colorectal tumor resected prior to randomization (If yes, provide date of resection.)
Instructions
Unnamed 8
Is the patient also enrolled in another NSABP protocol?

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