Description:

Follow-Up Form, GOG-0212, Form Q Paclitaxel or Polyglutamate Paclitaxel or Observation in Treating Patients With Stage III or Stage IV Ovarian Epithelial or Peritoneal Cancer or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E7488E3D-0DD6-4AC5-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E7488E3D-0DD6-4AC5-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 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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Fallopian Tube Cancer NCT00108745 Follow-Up - Follow-Up Form, GOG-0212, Form Q - 2296326v3.0

No Instruction available.

  1. StudyEvent: Follow-Up Form, GOG-0212, Form Q
    1. No Instruction available.
Header Module
Vital Status
Patient's vital status
Primary cause of death
Is the patient lost to follow-up?
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)
Method of assessment (s)
Notice Of Progression/recurrence
Has the patient been diagnosed with a new progression?
What was the method used to determine progression?
Ca125 And Other Biomarkers
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Late Adverse Event
Has the patient experienced (prior to diagnosis of recurrence or second primary) any toxicity that has not been previously reported?
CTC adverse event attribution code (Adverse Event Attribution Codes 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
Non-protocol Therapy
Is the patient receiving any non-protocol cancer therapy not previously reported?
Comments
Footer Module

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