Description:

CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1) PET Scan Imaging in Assessing Response in Patients With Esophageal Cancer Receiving Combination Chemotherapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE28FF1D-7C5B-BC14-E040-BB89AD43491A

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE28FF1D-7C5B-BC14-E040-BB89AD43491A

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Versions (2) ▾
  1. 8/26/12
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
No DOI assigned. To request one pleaselog in.
License:
Creative Commons BY-NC 3.0 Legacy
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Adenocarcinoma of the Gastroesophageal Junction NCT01333033 Registration - CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1) - 3287859v1.0

Randomized Phase II Trial of PET-Scan Directed Combined Modality Therapy in Esophageal Cancer

  1. StudyEvent: CALGB-80803 OPEN Registration/Randomization Worksheet (Step 1)
    1. Randomized Phase II Trial of PET-Scan Directed Combined Modality Therapy in Esophageal Cancer
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)
Initial Patient Consent For Specimen Use
I agree that my blood and tissue may be used for the research described in the protocol (consent question #1 - must be Yes for participation in 151007)
My specimens may be kept for future unknown use in research to learn about, prevent, treat, or cure cancer (consent question #2)
My specimens may be kept for use in research about other health problems (for example: diabetes, Alzheimer's disease, or heart disease). (consent question #3)
My doctor or someone from CALGB may contact me in the future to ask me to take part in more research (consent question #4)
In the opinion of the investigator, is the patient eligible
Companion Study Calgb - 150714
I choose to take part in the Quality of Life study and agree to complete the QOL assessments
In the opinion of the investigator, is the patient eligible