ID

9139

Description

SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT 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=A9C28ABD-653E-36E3-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C28ABD-653E-36E3-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Follow-Up - SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM - 2056737v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM
    1. No Instruction available.
Header
Description

Header

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

Patient Initials (L, F M)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Date form completed
Description

FormCompletionDate,Original

Data type

date

Institution / Affiliate
Description

InstitutionName

Data type

text

Physician (Groups Other than SWOG)
Description

RegisteredInvestigator

Data type

text

Group Name
Description

ParticipatingGroupName

Data type

text

Study No.
Description

Particip.GroupProtocolNumber

Data type

float

Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Lesion and site numbers L1, S1, etc. should correspond to the same lesions and sites of disease as indicated on the baseline tumor assessment form. If a target lesion was assessed but measurements were not obtainable, complete assessment type and assessment date, and state lesion number and reason measurement was not obtained in Comments section on page 2. Record site of any new lesions since baseline in the New Lesions section. Place an X in appropriate boxes.)
Description

PatientStudyID,ParticipatingGroup

Data type

text

Target Lesions
Description

Target Lesions

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Data type

float

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Data type

text

Longest Diameter (cm)
Description

Lesion,TumorDiameter

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

Non-target Disease
Description

Non-target Disease

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Data type

float

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Data type

text

Extent
Description

Lesion,Follow-upStatus

Data type

text

Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

New Lesions
Description

New Lesions

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Data type

float

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Data type

text

Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

Assessment Date
Description

AssessmentDate

Data type

date

Symptomatic deterioration
Description

SymptomaticDeteriorationInd

Data type

boolean

Comments
Description

Comments

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form
Description

Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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)
FormCompletionDate,Original
Item
Date form completed
date
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: Record the requested information for all target lesions and all sites of other disease. Lesion and site numbers L1, S1, etc. should correspond to the same lesions and sites of disease as indicated on the baseline tumor assessment form. If a target lesion was assessed but measurements were not obtainable, complete assessment type and assessment date, and state lesion number and reason measurement was not obtained in Comments section on page 2. Record site of any new lesions since baseline in the New Lesions section. Place an X in appropriate boxes.)
text
Item Group
Target Lesions
Lesion,ReferenceNumber
Item
Unnamed2 (Lesion number)
float
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Lesion,TumorDiameter
Item
Longest Diameter (cm)
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
Item Group
Non-target Disease
Lesion,ReferenceNumber
Item
Unnamed2 (Lesion number)
float
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Item
Extent
text
CL.2
Code List
Extent
CL Item
Complete disappearance (Complete disappearance)
CL Item
Present (Present)
CL Item
Clear increase (Clear increase)
CL Item
Not assessed (Not assessed)
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
Item Group
New Lesions
Lesion,ReferenceNumber
Item
Unnamed2 (Lesion number)
float
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
AssessmentDate
Item
Assessment Date
date
SymptomaticDeteriorationInd
Item
Symptomatic deterioration
boolean
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form
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