ID

9139

Descrição

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

Palavras-chave

Versões (2)
  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Transferido a

9 de janeiro de 2015

DOI

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Licença

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

Inglês

No Instruction available.

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

Header

SWOG Patient ID
Descrição

SWOGPatientID

Tipo de dados

text

SWOG Study No.
Descrição

SWOGStudyNo.

Tipo de dados

text

Registration Step
Descrição

RegistrationStep

Tipo de dados

text

Patient Initials (L, F M)
Descrição

Patient Initials

Tipo de dados

text

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

FormCompletionDate,Original

Tipo de dados

date

Institution / Affiliate
Descrição

InstitutionName

Tipo de dados

text

Physician (Groups Other than SWOG)
Descrição

RegisteredInvestigator

Tipo de dados

text

Group Name
Descrição

ParticipatingGroupName

Tipo de dados

text

Study No.
Descrição

Particip.GroupProtocolNumber

Tipo de dados

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.)
Descrição

PatientStudyID,ParticipatingGroup

Tipo de dados

text

Target Lesions
Descrição

Target Lesions

Unnamed2 (Lesion number)
Descrição

Lesion,ReferenceNumber

Tipo de dados

float

Unnamed3 (Lesion site)
Descrição

Lesion,AnatomicSite

Tipo de dados

text

Longest Diameter (cm)
Descrição

Lesion,TumorDiameter

Tipo de dados

float

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

AssessmentType

Tipo de dados

text

Assessment Date
Descrição

AssessmentDate

Tipo de dados

date

Non-target Disease
Descrição

Non-target Disease

Unnamed2 (Lesion number)
Descrição

Lesion,ReferenceNumber

Tipo de dados

float

Unnamed3 (Lesion site)
Descrição

Lesion,AnatomicSite

Tipo de dados

text

Extent
Descrição

Lesion,Follow-upStatus

Tipo de dados

text

Assessment Type
Descrição

AssessmentType

Tipo de dados

text

Assessment Date
Descrição

AssessmentDate

Tipo de dados

date

New Lesions
Descrição

New Lesions

Unnamed2 (Lesion number)
Descrição

Lesion,ReferenceNumber

Tipo de dados

float

Unnamed3 (Lesion site)
Descrição

Lesion,AnatomicSite

Tipo de dados

text

Assessment Type
Descrição

AssessmentType

Tipo de dados

text

Assessment Date
Descrição

AssessmentDate

Tipo de dados

date

Assessment Date
Descrição

AssessmentDate

Tipo de dados

date

Symptomatic deterioration
Descrição

SymptomaticDeteriorationInd

Tipo de dados

boolean

Comments
Descrição

Comments

Comments
Descrição

Comments

Tipo de dados

text

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

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

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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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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