Description:

NSABP PROTOCOL C-09: FOLLOW-UP FORM Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7DA612-18CD-4443-E034-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7DA612-18CD-4443-E034-0003BA3F9857
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Versions (2)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

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License :
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00268463 Follow-Up - NSABP PROTOCOL C-09: FOLLOW-UP FORM - 2319472v3.0

English
Details

Submit every 6 months from date of randomization for the first 5 years; yearly thereafter, and when a protocol event occurs. Fax Form F to 412-622-2111

1 forms  
Header
Are data amended (check box if yes, and circle amended items)
Vital Status
Patient's Vital Status
Source of Survival Information (if alive)
Primary Cause of Death (if dead)
Was there evidence of recurrence at the time of death
Type of Evidence (if yes,)
Cancer Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the last follow-up form)
First Hepatic Recurrence Since Randomization
Has the patient been diagnosed with first HEPATIC recurrence that has not been previously reported (since randomization)
First Non-hepatic Recurrence
Has the patient been diagnosed with first non-hepatic recurrence that has not been previously reported? (See protocol, "Diagnosis of New Colorectal Cancer Recurrence.")
New Primary Cancer Or Mds
Has a new primary cancer or MDS been diagnosed that has not been previously reported
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