ID

9130

Descrizione

SOUTHWEST ONCOLOGY GROUP S0227 ADVANCED CERVICAL CARCINOMA PRESTUDY FORM S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C2988B-9167-372F-E034-0003BA12F5E7

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C2988B-9167-372F-E034-0003BA12F5E7

Keywords

versioni (2)
  1. 27/08/12 27/08/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
Caricato su

9 gennaio 2015

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Pre-Study - SOUTHWEST ONCOLOGY GROUP S0227 ADVANCED CERVICAL CARCINOMA PRESTUDY FORM - 2056878v3.0

Inglese

No Instruction available.

1 moduli  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 ADVANCED CERVICAL CARCINOMA PRESTUDY FORM
    1. No Instruction available.
Header
Descrizione

Header

SWOG Patient ID
Descrizione

SWOGPatientID

Tipo di dati

text

SWOG Study No.
Descrizione

SWOGStudyNo.

Tipo di dati

text

Registration Step
Descrizione

RegistrationStep

Tipo di dati

text

Patient Initials (L, F M)
Descrizione

Patient Initials

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution / Affiliate
Descrizione

InstitutionName

Tipo di dati

text

Physician (Groups Other than SWOG)
Descrizione

RegisteredInvestigator

Tipo di dati

text

Group Name
Descrizione

ParticipatingGroupName

Tipo di dati

text

Study No.
Descrizione

Particip.GroupProtocolNumber

Tipo di dati

float

Pt. ID (Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section at the end of the form. Place an X in appropriate boxes. Circle AMENDED items in red.)
Descrizione

PatientStudyID,ParticipatingGroup

Tipo di dati

text

Disease Description At Diagnosis
Descrizione

Disease Description At Diagnosis

Date of definitive histologic diagnosis of primary tumor
Descrizione

PrimaryTumorDiagnosisDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Stage at diagnosis (FIGO, select one)
Descrizione

StageGrouping

Tipo di dati

text

Histologic grade at diagnosis (check highest grade)
Descrizione

HistologicGrade

Tipo di dati

text

Histologic type at diagnosis (check all that apply)
Descrizione

HistologicType

Tipo di dati

text

Other, specify
Descrizione

HistologicType,OtherVariant

Tipo di dati

text

Prior Treatment Related To This Cancer
Descrizione

Prior Treatment Related To This Cancer

Primary Surgery
Descrizione

PriorSurgeryInd

Tipo di dati

boolean

Primary Surgery Date
Descrizione

PrimarySurgeryDate

Tipo di dati

date

Radiation therapy
Descrizione

PriorRTInd

Tipo di dati

boolean

Persistent disease after radiation therapy
Descrizione

ResidualDiseaseStatus

Tipo di dati

boolean

Persistent disease after radiation therapy
Descrizione

ResidualDiseaseStatus

Tipo di dati

boolean

Prior Chemotherapy
Descrizione

PriorChemotherapyInd

Tipo di dati

text

Yes, specify agents
Descrizione

Non-ProtocolChemotherapyType

Tipo di dati

text

Other treatment, specify
Descrizione

PriorChemotherapyRegimen,OtherAgent

Tipo di dati

text

Disease Description At Study Entry
Descrizione

Disease Description At Study Entry

Disease status at study entry (If recurrent disease)
Descrizione

DiseaseStatus

Tipo di dati

text

date of first recurrence
Descrizione

ProgressionDate,First

Tipo di dati

date

Site of disease at study entry (check all that apply)
Descrizione

DiseaseSite

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass-2
C12971
UMLS 2011AA ObjectClass-2
C0006141
Lymph nodes, specify
Descrizione

DiseaseSite,LymphNodes

Tipo di dati

text

Other, specify
Descrizione

PrimarySite,Other

Tipo di dati

text

Clinical size of tumor at study entry (if microscopic, enter 0)
Descrizione

PrimaryTumorSize

Tipo di dati

float

Comments
Descrizione

Comments

Comments
Descrizione

Comments

Tipo di dati

text

Ccrr Module For Southwest Oncology Group S0227 Advanced Cervical Carcinoma Prestudy Form
Descrizione

Ccrr Module For Southwest Oncology Group S0227 Advanced Cervical Carcinoma Prestudy Form

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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 ADVANCED CERVICAL CARCINOMA PRESTUDY FORM
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Header
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician (Groups Other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
Particip.GroupProtocolNumber
Item
Study No.
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section at the end of the form. Place an X in appropriate boxes. Circle AMENDED items in red.)
text
Item Group
Disease Description At Diagnosis
PrimaryTumorDiagnosisDate
Item
Date of definitive histologic diagnosis of primary tumor
date
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Item
Stage at diagnosis (FIGO, select one)
text
CL.1
Code List
Stage at diagnosis (FIGO, select one)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IA)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IB)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IIA)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IIB)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IIIA)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IIIB)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IVA)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (IVB)
Item
Histologic grade at diagnosis (check highest grade)
text
CL.2
Code List
Histologic grade at diagnosis (check highest grade)
CL Item
Grade 1-well Differentiated (1)
CL Item
Grade 2-moderately Differentiated (2)
CL Item
Grade 3-poorly Differentiated (3)
CL Item
Grade Unknown (unknown)
Item
Histologic type at diagnosis (check all that apply)
text
CL.3
Code List
Histologic type at diagnosis (check all that apply)
CL Item
Adenosquamous (Adenosquamous)
CL Item
Squamous Cell Carcinoma (Squamous cell carcinoma)
C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)
CL Item
Adenocarcinoma, Unspecified (Adenocarcinoma, unspecified)
CL Item
Other, Specify (Other, specify)
HistologicType,OtherVariant
Item
Other, specify
text
Item Group
Prior Treatment Related To This Cancer
PriorSurgeryInd
Item
Primary Surgery
boolean
PrimarySurgeryDate
Item
Primary Surgery Date
date
PriorRTInd
Item
Radiation therapy
boolean
ResidualDiseaseStatus
Item
Persistent disease after radiation therapy
boolean
ResidualDiseaseStatus
Item
Persistent disease after radiation therapy
boolean
Item
Prior Chemotherapy
text
CL.8
Code List
Prior Chemotherapy
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify agents)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Non-ProtocolChemotherapyType
Item
Yes, specify agents
text
PriorChemotherapyRegimen,OtherAgent
Item
Other treatment, specify
text
Item Group
Disease Description At Study Entry
Item
Disease status at study entry (If recurrent disease)
text
CL.9
Code List
Disease status at study entry (If recurrent disease)
CL Item
Metastatic disease at presentation (Metastatic disease at presentation)
CL Item
Recurrent disease following complete response to primary surgery and/or RT (Recurrent disease following complete response to primary surgery and/or RT)
CL Item
Primary Gyn Disease Continues To Be Present Following Initial Treatment (Persistent disease despite primary surgery and/or RT)
ProgressionDate,First
Item
date of first recurrence
date
Item
Site of disease at study entry (check all that apply)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12971 (NCI Thesaurus ObjectClass-2)
C0006141 (UMLS 2011AA ObjectClass-2)
CL.10
Code List
Site of disease at study entry (check all that apply)
CL Item
Bladder (Bladder)
C12414 (NCI Thesaurus)
C0005682 (UMLS 2011AA)
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Cervix (Cervix)
C12311 (NCI Thesaurus)
C0007874 (UMLS 2011AA)
CL Item
Colon (Colon)
C12382 (NCI Thesaurus)
C0009368 (UMLS 2011AA)
CL Item
Cns/brain (CNS/Brain)
CL Item
Endometrium (Endometrium)
C12313 (NCI Thesaurus)
C0014180 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Ovary (Ovary)
C12404 (NCI Thesaurus)
C0029939 (UMLS 2011AA)
CL Item
Peritoneum (Peritoneum)
C12770 (NCI Thesaurus)
C0031153 (UMLS 2011AA)
CL Item
Pleura (Pleura)
C12469 (NCI Thesaurus)
C0032225 (UMLS 2011AA)
CL Item
Skin (Skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Uterus (Uterus)
C12405 (NCI Thesaurus)
C0042149 (UMLS 2011AA)
CL Item
Ascites (Ascites)
C2885 (NCI Thesaurus)
C0003962 (UMLS 2011AA)
CL Item
Parametrial Involvement (Parametrial involvement)
CL Item
Pleural Effusion (Pleural effusion)
C3331 (NCI Thesaurus)
C0021071 (UMLS 2011AA)
CL Item
Lymph Nodes, Specify (Lymph nodes, specify)
CL Item
Other, Specify (Other, specify)
DiseaseSite,LymphNodes
Item
Lymph nodes, specify
text
PrimarySite,Other
Item
Other, specify
text
PrimaryTumorSize
Item
Clinical size of tumor at study entry (if microscopic, enter 0)
float
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0227 Advanced Cervical Carcinoma Prestudy Form
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