Description:

NSABP Protocol B-42 Follow-Up Form Worksheet Letrozole in Treating Postmenopausal Women Who Have Received Hormone Therapy for Hormone Receptor-Positive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=17ADCB3C-0478-2F7E-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=17ADCB3C-0478-2F7E-E044-0003BA3F9857
Keywords:
Versions (2)
  1. 8/26/12 8/26/12 -
  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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Breast Cancer NCT00382070 Registration - NSABP Protocol B-42 Follow-Up Form Worksheet - 2494051v1.0

English
Details

This paper worksheet may be completed to faciliate the entry of the information in NSABP Coordinator Online. Partially completed forms may be saved in Coordinator Online.

1 forms  
Header
Vital Status
Patient's Vital Status
Source of Survival Information (if alive)
Primary Cause of Death
Was there evidence of recurrence at the time of death
Cancer Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the last follow-up form)
First Local-regional Recurrence
Has the patient been diagnosed with first local-regional recurrence
Site(s) of First Local-Regional Recurrence (mark all ipsilateral sites that apply)
3 more items in the detailed view.
First Distant Recurrence
Has the patient been diagnosed with first distant recurrence/progression?
New Primary Cancer Or Contralateral Breast Cancer (cbc)
Has a new primary cancer or contralateral breast cancer been diagnosed that has not been previously reported (CBC)
Has a new primary cancer or contralateral breast cancer been diagnosed that has not been previously reported (CBC)
Osteoporosis Evaluation
Was height and weight measured
cm
Kg
Site
Occurrence
Has the patient had a Bone Mineral Density test (since the previous follow-up report)
Has the patient begun any new prescribed bone density medication
What drug
Late Thrombotic Event
Adverse Event
4 more items in the detailed view.
Grade
Patient Compliance
What percentage of the patient study pills did she take (Select the item that best describes her compliance during the latest 6-month period)
3 more items in the detailed view.
How was this percentage determined?
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