Description:

Z1041: Early Termination of Follow-up (ETFU) Combination Chemotherapy and Paclitaxel Plus Trastuzumab in Treating Women With Palpable Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=211E6516-FD7F-6E79-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=211E6516-FD7F-6E79-E044-0003BA3F9857

Keywords:

Follow-Up Studies

Breast Neoplasms

8/26/12 8/26/12 -
1/9/15 1/9/15 - Martin Dugas

Uploaded on:

January 9, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00513292 Follow-Up - Z1041: Early Termination of Follow-up (ETFU) - 2533765v1.0

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StudyEvent: Z1041: Early Termination of Follow-up (ETFU)
1. No Instruction available.

Header Module

Visit

Baseline (Baseline)

30 Days Post Surgery (30 Days post surgery)

C1d21 (C1D21)

C2d21 (C2D21)

18 more items in the detailed view.

Patient ID (Pt. ID issued during registration or previously issued patient ID)

Patient Initials (F M L)

Institution No.

Institution Name

Header

Date of Early Termination of Follow-up

Reason for early termination of patient follow-up (mark only one)

Patient Withdrew Consent. (Patient withdrew consent)

Lost Contact With Patient (Lost contact with patient)

Patient Refusal For Further Study Follow-up (Patient refusal for further study follow-up)

Other (Other)

Other, specify

Footer Module

Completed by

Date Form Completed

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