Description:

NSABP Protocol B-43 Worksheet for Menopausal Status Form Radiation Therapy With or Without Trastuzumab in Treating Women With Ductal Carcinoma In Situ Who Have Undergone Lumpectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39688272-F98B-5199-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39688272-F98B-5199-E044-0003BA3F9857

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Versions (2) ▾
  1. 8/27/12
  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 NCT00769379 Follow-Up - NSABP Protocol B-43 Worksheet for Menopausal Status Form - 2677537v1.0

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  1. StudyEvent: NSABP Protocol B-43 Worksheet for Menopausal Status Form
    1. No Instruction available.
Header
Menopausal Assessment
Menstrual period within the last 12 months?
Hysterectomy since being entered on study?
Does patient have at least one ovary?
Tamoxifen treatment since being entered on study?
Aromatase inhibitor treatment since being entered on study?
LHRH agonist treatment since being entered on study?
Pregnant at any time during last 12 months?
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