ID
8896
Beskrivning
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
Länk
Nyckelord
Versioner (4)
- 2012-08-26 2012-08-26 -
- 2014-08-11 2014-08-11 - Martin Dugas
- 2015-01-09 2015-01-09 - Martin Dugas
- 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den
9 januari 2015
DOI
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Licens
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)
Beskrivning
Unnamed2
Beskrivning
FormCompletionDate
Datatyp
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
Beskrivning
Data amended
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Beskrivning
ResponsiblePersonDescriptionType
Datatyp
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
Beskrivning
Racial Group
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Beskrivning
Ethnic Group
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0015031
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C16564
Beskrivning
PersonHighestEducationType
Datatyp
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
Beskrivning
PersonHighestEducationSpecify
Datatyp
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
Beskrivning
PersonPediatricReligionName
Datatyp
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
Beskrivning
PersonPediatricReligionSpecify
Datatyp
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
Beskrivning
MaritalStatusDescriptionType
Datatyp
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
Beskrivning
PersonBirthCountryType
Datatyp
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
Beskrivning
PatientBirthStateSpecify
Datatyp
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
Beskrivning
PersonBirthCountryIndividualSpecify
Datatyp
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
Beskrivning
PatientLongestDurationResidenceType
Datatyp
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
Beskrivning
PatientStateLongestDurationResidenceCode
Datatyp
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
Beskrivning
PatientCountryLongestDurationResidenceName
Datatyp
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
Beskrivning
Cigarette History
Beskrivning
Smoked at least 100 cigarettes during lifetime (5 packs)
Datatyp
integer
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
- UMLS CUI-1
- C1519384
Beskrivning
Patient Initial Cigarette Smoking Age Year Count
Datatyp
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
Beskrivning
Cigarettes Smoking Year Number
Datatyp
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C1802
- NCI Thesaurus ValueDomain-2
- C29848
- NCI Thesaurus Property
- C17934
- UMLS CUI-1
- C1519384
Beskrivning
Smoking Use Average Number
Datatyp
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ObjectClass
- C17934
- NCI Thesaurus Property
- C25340
- UMLS CUI-1
- C1519384
Beskrivning
Patient Smoking Cessation Age Year
Datatyp
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain-2
- C25463
- NCI Metathesaurus Property
- C0085134
- UMLS CUI-1
- C1519384
Beskrivning
Other Disease Diagnosis Type
Datatyp
integer
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass-2
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Beskrivning
Other Disease Diagnosis Specify
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C17649
- NCI Thesaurus ObjectClass-2
- C2991
- NCI Thesaurus Property
- C15220
- UMLS CUI-1
- C2359476
Beskrivning
Family History
Beskrivning
BrotherPatientFamilyMembersAssessmentNumber
Datatyp
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
Beskrivning
SisterPatientFamilyMembersAssessmentNumber
Datatyp
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
Beskrivning
SonPatientFamilyMembersAssessmentNumber
Datatyp
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
Beskrivning
DaughterPatientFamilyMembersAssessmentNumber
Datatyp
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
Beskrivning
PatientAdoptedInd-3
Datatyp
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
Beskrivning
RelativeFamilyCancerHistoryType
Datatyp
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
Beskrivning
PersonFirstCancerDiagnosisAgeYearCount
Datatyp
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
Beskrivning
CancerSiteType
Datatyp
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
Beskrivning
CancerSiteSpecify
Datatyp
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
Beskrivning
CancerPreventionTrialKnowledgeDocumentedInd-2
Datatyp
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
Beskrivning
CancerPreventionTrialParticipationScale
Datatyp
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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C2359476 (UMLS CUI-1)
C0030705 (UMLS 2011AA ObjectClass)
C25289 (NCI Thesaurus ObjectClass-2)
C0337527 (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)
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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