Description:

CALGB-40903 OPEN Registration Worksheet Letrozole in Treating Postmenopausal Women With Ductal Carcinoma in Situ Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B163AFA0-47EE-9956-E040-BB89AD4304B2

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B163AFA0-47EE-9956-E040-BB89AD4304B2
Keywords:
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01439711 Registration - CALGB-40903 OPEN Registration Worksheet - 3302958v1.0

Phase II Study of Neoadjuvant Letrozole for Postmenopausal Women with Estrogen Receptor Positive Ductal Carcinoma In Situ (DCIS) NOTE: In the 'Create New' screen of the OPEN application, select the optional Embedded Companion studies (CALGB-151008 and/or CALGB-61105) to which the patient has consented.

Protocol Administration
Pre-treatment Characteristics
Performance Status
cm
Kg
Certification Of Eligibility
In the opinion of the investigator, is the patient eligible
Protocol Design (stratification Factors)
Is the institution pre-qualified by ACRIN for breast MRI acquisition
Notes:
Companion Study Calgb - 150714
I choose to take part in the Quality of Life study and agree to complete the QOL assessments (consent question #1)
Initial Patient Consent For Specimen Use
I agree that my tissue may be used for the research described in the protocol. (consent question #2 - must be Yes for participation in 151008)
In the opinion of the investigator, is the patient eligible
Initial Patient Consent For Specimen Use
Patient's initial consent given for specimen use for genetic research relating to the study treatment (consent question #3 - must be Yes for participation in 61105)
In the opinion of the investigator, is the patient eligible
Initial Patient Consent For Specimen Use
My specimens may be kept for future unknown use in research to learn about, prevent, treat, or cure cancer (consent question #4)
My specimens may be kept for use in research about other health problems (for example: diabetes, Alzheimer's disease, or heart disease). (consent question #5)
In the opinion of the investigator, is the patient eligible
My doctor or someone may contact me in the future to ask me to take part in more research (consent question #6)

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