Description:

NSABP B-45 Worksheet for Follow-up Form 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=612CCF23-375D-C0A1-E040-BB89AD434751

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=612CCF23-375D-C0A1-E040-BB89AD434751

Keywords:
Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00914043 Follow-Up - NSABP B-45 Worksheet for Follow-up Form - 2829422v1.0

This paper worksheet may be completed to faciliate the entry of the information in NSABP Coordinator Online. Partially completed forms may be saved in Coordinator Online.

Header
Vital Status
Patient's Vital Status
Source of Survival Information (if alive)
Primary Cause of Death (if dead)
Was there evidence of recurrence at the time of death
Cancer Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the last follow-up form)
First Local-regional Recurrence
Has the patient been diagnosed with first local-regional recurrence (since submission of the last follow-up form)
Site(s) of First Local-Regional Recurrence (mark all ipsilateral sites that apply)
First Distant Recurrence
Has the patient been diagnosed with first distant recurrence/progression?
New Primary Cancer Or Mds
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
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