PatientFirstInitialsName
Item
First initial
text
PatientLastInitialsName
Item
Last initial
text
EligibilityDeterminationChecklistCompleteEligibilityInd-2
Item
Has the eligibility checklist been completed
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25171 (NCI Thesaurus ObjectClass)
C0013893 (UMLS 2011AA ObjectClass)
C49073 (NCI Thesaurus Property-2)
C1707357 (UMLS 2011AA Property-2)
PatientAgeValue
Item
Age
float
PersonEasternCooperativeOncologyGroupSequenceDeidentificationNumber
Item
Patient's ECOG sequence number
text
QualityofLifeContactPersonIdentifierName
Item
QOL contact person
text
QualityofLifeContactPersonTelephoneNumber
Item
Phone
text
QualityofLifeContactPersonE-mailAddressText
Item
Email address
text
PersonEasternCooperativeOncologyGroupSequenceDeidentificationNumber
Item
Patient's ECOG sequence number
text
InstitutionRadiationTherapyAdministrationName
Item
Name of the institution that will administered the radiation therapy
text
Eligibility for trial
Item
In the opinion of the investigator, is the patient eligible?
boolean
C38148 (NCI Thesaurus ValueDomain)
C1302261 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
Item
Karnofsky Performance Status Score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
Code List
Karnofsky Performance Status Score
CL Item
Normal, No Complaints, No Evidence Of Disease (100)
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
Item
Race (check all that apply)
text
Code List
Race (check all that apply)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Europe, The Middle East, Or North Africa. (White)
CL Item
A Person Having Origins In Any Of The Black Racial Groups Of Africa. Terms Such As "haitian" Or "negro" Can Be Used In Addition To "black Or African American." (Black or African American)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Hawaii, Guam, Samoa, Or Other Pacific Islands. (Native Hawaiian or other Pacific Islander)
CL Item
A Person Having Origins In Any Of The Original Peoples Of The Far East, Southeast Asia, Or The Indian Subcontinent Including, For Example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, And Vietnam. (Asian)
CL Item
A Person Having Origins In Any Of The Original Peoples Of North And South America (including Central America), And Who Maintains Tribal Affiliation Or Community Attachment. (American Indian or Alaska Native)
CL Item
Not Provided Or Available (Not Reported)
CL Item
Could Not Be Determined Or Unsure (Unknown)
PatientBirthDate
Item
Birthdate (mm/yy)
date
AddressPostalCodeIdentifier
Item
ZIP Code
text
Item
Patient Ethnicity
text
Code List
Patient Ethnicity
CL Item
A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race. (Hispanic or Latino)
CL Item
A Person Not Meeting The Definition For Hispanic Or Latino. (Not Hispanic or Latino)
CL Item
Not Provided Or Available (Not reported)
CL Item
Could Not Be Determined Or Unsure (Unknown)
PatientMedicalRecordNumber
Item
Patient Hospital No.
text
PatientSSNNumber
Item
Patient Social Security Number
text
Item
Method of payment (check one)
text
Code List
Method of payment (check one)
CL Item
Private Insurance (Private Insurance)
CL Item
Medicare (Medicare)
CL Item
Medicare And Private Insurance (Medicare and Private Insurance)
CL Item
Medicaid (Medicaid)
CL Item
Medicaid And Medicare (Medicaid and Medicare)
CL Item
Military Or Veterans Sponsored Nos (Military or Veterans Sponsored, Not Otherwise Specified (NOS))
CL Item
Military Sponsored (including Champus & Tricare) (Military Sponsored (including CHAMPUS & TRICARE))
CL Item
Veterans Sponsored (Veterans Sponsored)
CL Item
Self Pay (no Insurance) (Self Pay (No Insurance))
CL Item
No Means Of Payment (no Insurance) (No means of payment (no insurance))
CL Item
Unknown (Unknown)
AttendingPhysicianIdentifierIndividualsName
Item
Attending Physician
text
InstitutionContactPersonName
Item
Institution contact
text
ProtocolRegistrarName
Item
Registrar
text
Item
Country of Residence (if not USA)
text
Code List
Country of Residence (if not USA)
CL Item
Ascension Island (AC)
CL Item
United Arab Emirates (AE)
CL Item
Antigua And Barbuda (AG)
CL Item
Netherland Antilles (AN)
CL Item
American Samoa (AS)
CL Item
Bosnia-herzegovina (BA)
CL Item
Burkina Faso (BF)
CL Item
Brunei Darussalam (BN)
CL Item
Bouvet Island (BV)
CL Item
Rep. Dem. Congo (CD)
CL Item
Central African Rep. (CF)
CL Item
Cook Islands (CK)
CL Item
Christmas Island (CX)
CL Item
Czech Republic (CZ)
CL Item
Dominican Republic (DO)
CL Item
Western Sahara (EH)
CL Item
Falkland Isl. (FK)
CL Item
Faroe Islands (FO)
CL Item
France (european Ter.) (FX)
CL Item
Great Britain (GB)
CL Item
Guiana (fr.) (GF)
CL Item
Guadeloupe (fr.) (GP)
CL Item
Equatorial Guinea (GQ)
CL Item
South Georgia And South Sandwich Islands (GS)
CL Item
Guinea Bissau (GW)
CL Item
Heard & Mcdonald Isl. (HM)
CL Item
British Indian O. Ter. (IO)
CL Item
Kyrgyz Republic (KG)
CL Item
St. Kitts Nevis Anguilla (KN)
CL Item
Korea (north) (KP)
CL Item
Korea (south) (KR)
CL Item
Cayman Islands (KY)
CL Item
Liechtenstein (LI)
CL Item
Marshall Islands (MH)
CL Item
Northern Mariana Isl. (MP)
CL Item
Martinique (fr.) (MQ)
CL Item
New Caledonia (fr.) (NC)
CL Item
Norfolk Island (NF)
CL Item
Polynesia (fr.) (PF)
CL Item
Papua New Guinea (PG)
CL Item
St. Pierre & Miquelon (PM)
CL Item
Reunion (fr.) (RE)
CL Item
Russian Federation (RU)
CL Item
Saudi Arabia (SA)
CL Item
Solomon Islands (SB)
CL Item
Svalbard & Jan Mayen Isl. (SJ)
CL Item
Sierra Leone (SL)
CL Item
St. Tome And Principe (ST)
CL Item
Soviet Union (SU)
CL Item
Turks & Caicos Islands (TC)
CL Item
French Southern Terr. (TF)
CL Item
Turkmenistan (TM)
CL Item
Trinidad & Tobago (TT)
CL Item
United Kingdom (UK)
CL Item
Us Minor Outlying Isl. (UM)
CL Item
Vatican City State (VA)
CL Item
St. Vincent & Grenadines (VC)
CL Item
Virgin Islands (brit) (VG)
CL Item
Virgin Islands (us) (VI)
CL Item
Wallis & Futuna Islands (WF)
CL Item
Western Samoa (WS)
CL Item
South Africa (ZA)
CL Item
Dem. Rep. Of Congo (ZR)
ResearchCommentsText
Item
Comments
text