ID
8896
Description
RTOG 1010 Demographic Data Form (A5) Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8666BB88-BFD1-08B9-E040-BB89AD434AC6
Lien
Mots-clés
Versions (4)
- 26/08/2012 26/08/2012 -
- 11/08/2014 11/08/2014 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le
9 janvier 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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Adenocarcinoma of the Gastroesophageal Junction NCT01196390 Demographic - RTOG 1010 Demographic Data Form (A5) - 3085100v1.0
INSTRUCTIONS: Submit this form at patient's entry on study. Complete the information by filling in boxes or blanks as requested. See separate page for instructions
- StudyEvent: RTOG 1010 Demographic Data Form (A5)
Description
Unnamed2
Description
FormCompletionDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C40988
- UMLS 2011AA ObjectClass
- C1516308
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
Description
Data amended
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Description
ResponsiblePersonDescriptionType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS 2011AA ObjectClass-2
- C1273518
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
Racial Group
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Description
Ethnic Group
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0015031
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C16564
Description
PersonHighestEducationType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C16529
- UMLS 2011AA Property
- C0013622
- NCI Thesaurus Property-2
- C25525
- UMLS 2011AA Property-2
- C1522410
Description
PersonHighestEducationSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C16529
- UMLS 2011AA Property
- C0013622
- NCI Thesaurus Property-2
- C25525
- UMLS 2011AA Property-2
- C1522410
Description
PersonPediatricReligionName
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C39299
- UMLS 2011AA Property
- C0231335
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
- NCI Thesaurus Property-2
- C17085
- UMLS 2011AA Property-2
- C0035039
Description
PersonPediatricReligionSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C39299
- UMLS 2011AA Property
- C0231335
- NCI Thesaurus Property-2
- C17085
- UMLS 2011AA Property-2
- C0035039
Description
MaritalStatusDescriptionType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25188
- UMLS 2011AA ObjectClass
- C0024819
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
PersonBirthCountryType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25464
- UMLS 2011AA Property
- C0454664
- NCI Thesaurus Property-2
- C25155
- UMLS 2011AA Property-2
- C0005615
Description
PatientBirthStateSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C30010
- UMLS 2011AA Property
- C1301808
- NCI Thesaurus Property-2
- C25155
- UMLS 2011AA Property-2
- C0005615
Description
PersonBirthCountryIndividualSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25464
- UMLS 2011AA Property
- C0454664
- NCI Thesaurus Property-2
- C25155
- UMLS 2011AA Property-2
- C0005615
Description
PatientLongestDurationResidenceType
Type de données
text
Alias
- NCI Metathesaurus ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property-2
- C25330
- UMLS 2011AA Property-2
- C0449238
- NCI Thesaurus Property-3
- C25273
- UMLS 2011AA Property-3
- C0237096
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
PatientStateLongestDurationResidenceCode
Type de données
text
Alias
- NCI Metathesaurus ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property-2
- C30010
- UMLS 2011AA Property-2
- C1301808
- NCI Thesaurus Property-3
- C25330
- UMLS 2011AA Property-3
- C0449238
- NCI Thesaurus Property-4
- C25273
- UMLS 2011AA Property-4
- C0237096
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ValueDomain-2
- C30010
- UMLS 2011AA ValueDomain-2
- C1301808
Description
PatientCountryLongestDurationResidenceName
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25558
- UMLS 2011AA Property
- C1522425
- NCI Thesaurus Property-2
- C25464
- UMLS 2011AA Property-2
- C0454664
- NCI Thesaurus Property-3
- C25330
- UMLS 2011AA Property-3
- C0449238
- NCI Thesaurus Property-4
- C25273
- UMLS 2011AA Property-4
- C0237096
- NCI Thesaurus ValueDomain
- C25464
- UMLS 2011AA ValueDomain
- C0454664
- NCI Thesaurus ValueDomain-2
- C42614
- UMLS 2011AA ValueDomain-2
- C0027365
Description
Cigarette History
Description
Smoked at least 100 cigarettes during lifetime (5 packs)
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
- UMLS CUI-1
- C1519384
Description
Patient Initial Cigarette Smoking Age Year Count
Type de données
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
- NCI Thesaurus Property-2
- C18270
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS CUI-1
- C1519384
Description
Cigarettes Smoking Year Number
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C1802
- NCI Thesaurus ValueDomain-2
- C29848
- NCI Thesaurus Property
- C17934
- UMLS CUI-1
- C1519384
Description
Smoking Use Average Number
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C17934
- NCI Thesaurus Property
- C25340
- UMLS CUI-1
- C1519384
Description
Patient Smoking Cessation Age Year
Type de données
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain-2
- C25463
- NCI Metathesaurus Property
- C0085134
- UMLS CUI-1
- C1519384
Description
Other Disease Diagnosis Type
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass-2
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Description
Other Disease Diagnosis Specify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass-2
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Description
Family History
Description
BrotherPatientFamilyMembersAssessmentNumber
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25289
- UMLS 2011AA ObjectClass-2
- C0337527
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
SisterPatientFamilyMembersAssessmentNumber
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25680
- UMLS 2011AA ObjectClass-2
- C0337514
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
SonPatientFamilyMembersAssessmentNumber
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25205
- UMLS 2011AA ObjectClass-2
- C0037683
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
DaughterPatientFamilyMembersAssessmentNumber
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25165
- UMLS 2011AA ObjectClass-2
- C0011011
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Metathesaurus Property
- C0086282
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
PatientAdoptedInd-3
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25290
- UMLS 2011AA Property
- C0425382
Description
RelativeFamilyCancerHistoryType
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25173
- UMLS 2011AA ObjectClass
- C0015576
- NCI Thesaurus ObjectClass-2
- C21480
- UMLS 2011AA ObjectClass-2
- C0080103
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-2
- C18772
- UMLS 2011AA Property-2
- C0262926
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
PersonFirstCancerDiagnosisAgeYearCount
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-2
- C25509
- UMLS 2011AA Property-2
- C1279901
- NCI Thesaurus Property-3
- C15220
- UMLS 2011AA Property-3
- C0011900
- NCI Thesaurus Property-4
- C25150
- UMLS 2011AA Property-4
- C0001779
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
CancerSiteType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
Description
CancerSiteSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
Description
CancerPreventionTrialKnowledgeDocumentedInd-2
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
- NCI Thesaurus Property
- C25356
- UMLS 2011AA Property
- C1301725
- NCI Metathesaurus Property
- C0376554
Description
CancerPreventionTrialParticipationScale
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
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INSTRUCTIONS: Submit this form at patient's entry on study. Complete the information by filling in boxes or blanks as requested. See separate page for instructions
- StudyEvent: RTOG 1010 Demographic Data Form (A5)
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C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25680 (NCI Thesaurus ObjectClass-2)
C0337514 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25205 (NCI Thesaurus ObjectClass-2)
C0037683 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25165 (NCI Thesaurus ObjectClass-2)
C0011011 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0086282 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25290 (NCI Thesaurus Property)
C0425382 (UMLS 2011AA Property)
C0015576 (UMLS 2011AA ObjectClass)
C21480 (NCI Thesaurus ObjectClass-2)
C0080103 (UMLS 2011AA ObjectClass-2)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0015671 (UMLS 2011AA)
C0026591 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property-2)
C15220 (NCI Thesaurus Property-3)
C0011900 (UMLS 2011AA Property-3)
C25150 (NCI Thesaurus Property-4)
C0001779 (UMLS 2011AA Property-4)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0332307 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C0024109 (UMLS 2011AA)
C0006141 (UMLS 2011AA)
C0009368 (UMLS 2011AA)
C0033572 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus Property)
C1301725 (UMLS 2011AA Property)
C0376554 (NCI Metathesaurus Property)
C0349674 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C0205448 (UMLS 2011AA)
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