Description:

NSABP B-45 Worksheet for Radiation Therapy (Form RT) Studying Biological Markers of Fatigue in Women With Residual Invasive Breast Cancer Enrolled on Clinical Trial NSABP-B-45 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=612CCF23-383A-C0A1-E040-BB89AD434751

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=612CCF23-383A-C0A1-E040-BB89AD434751

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  1. 8/26/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00914043 Treatment - NSABP B-45 Worksheet for Radiation Therapy (Form RT) - 2829524v1.0

This paper worksheet may be completed to facilitate the entry of RT treatment information in NSABP Coordinator Online. Partially completed worksheets may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. If RT was administered after randomization, enter the data when RT complications have been assessed 4- 8 weeks after the last RT dose. If RT was administered before randomization, or RT will not be administered, enter the data within one month following randomization

Header
Section A - Radiation Therapy (rt) -- All Patients
Did the patient receive radiation therapy? (If no, the remaining questions do not apply. If yes, continue)
Region irradiated (mark all that apply)
Was a Boost given?
Was brachytherapy used?
Were there any unscheduled interruptions in radiation therapy?
Was RT interruption possibly, probably, or definitely due to RT toxicity? (if yes)
Assessment Of Rt Complications For Patients Who Received Rt After Randomization
CTC Adverse Event Short Name (Dermatology/Skin v3.0)
CTCAE Select Term (v3.0)
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