ID
9209
Description
Form 5S - Post Progression Follow-Up Report Gefitinib in Treating Patients With Non-Small Cell Lung Cancer That Has Been Surgically Removed Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0E053B5-CFD0-32A7-E034-080020C9C0E0
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 7/3/15 7/3/15 -
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00049543 Follow-Up - Form 5S - Post Progression Follow-Up Report - 2034925v3.0
No Instruction available.
- StudyEvent: Form 5S - Post Progression Follow-Up Report
Description
2. Month Of Report
Description
VisitReportMonthCount
Data type
text
Alias
- NCI Thesaurus Property
- C29846
- UMLS 2011AA Property
- C0439231
- NCI Thesaurus ObjectClass
- C25375
- UMLS 2011AA ObjectClass
- C0684224
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus ObjectClass-2
- C25716
- UMLS 2011AA ObjectClass-2
- C0545082
Description
VisitReportMonthSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C29846
- UMLS 2011AA Property
- C0439231
- NCI Thesaurus ObjectClass
- C25375
- UMLS 2011AA ObjectClass
- C0684224
- NCI Thesaurus ObjectClass-2
- C25716
- UMLS 2011AA ObjectClass-2
- C0545082
Description
CancerFollow-upStatusDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
3. Disease Status
Description
4. Notice Of New Primary
Description
NewPrimaryCancerInd
Data type
boolean
Description
NewPrimaryCancerDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
NewPrimarySite
Data type
text
Description
NewPrimaryDetail
Data type
text
Description
Ncic Ctg Use
Description
Ncic Ctg Use Only
Description
LoggedEntryInitials
Data type
text
Description
LoggedEntryDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
CoordinatorReviewInitials
Data type
text
Description
CoordinatorReviewDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
PhysicianReviewInitials
Data type
text
Description
DataEntryInitials
Data type
text
Description
DataVerificationInitials
Data type
text
Description
Header
Description
5. Treatment Given Since Last Report To Ncic Ctg
Description
Non-ProtocolTherapyInd
Data type
boolean
Description
Non-ProtocolHormonalTherapyInd
Data type
boolean
Description
Non-ProtocolChemotherapyInd
Data type
boolean
Description
Non-ProtocolImmunotherapyInd
Data type
boolean
Description
Non-ProtocolBRMInd
Data type
boolean
Description
Non-ProtocolHDC/ASCTInd
Data type
boolean
Description
Non-ProtocolRTInd
Data type
boolean
Description
Non-protocolSurgeryPerformedInd-3
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
Description
OtherTherapyInd
Data type
boolean
Description
OtherNon-ProtocolTherapyName
Data type
text
Description
Non-ProtocolFirstChemotherapyAgentName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass-2
- C2167
- UMLS 2011AA ObjectClass-2
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
Non-ProtocolFirstChemotherapyBeginDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Description
Non-ProtocolSecondChemotherapyAgentName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass-2
- C2167
- UMLS 2011AA ObjectClass-2
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
Non-ProtocolSecondChemotherapyBeginDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
6. Long Term Toxicity
Description
LateAdverseEventInd
Data type
boolean
Description
CTCAdverseEventTerm
Data type
text
Description
CTCAdverseEventCategory
Data type
text
Description
CTCAdverseEventGrade
Data type
text
Description
CTCAdverseEventAttributionCode
Data type
text
Description
Unnamed2
Description
7. Comments
Description
9. Investigator Signature
Description
InvestigatorSignature
Data type
text
Alias
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Description
PersonCompletingForm,LastName
Data type
text
Description
FormCompletionDate,Original
Data type
date
Description
Ccrr Module For Form 5s - Post Progression Follow-up Report
Description
PersonCompletingForm,FirstName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
Non-ProtocolEpidermalGrowthFactorReceptorTyrosineKinaseInhibitorAdministeredInd-3
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass-2
- C2167
- UMLS 2011AA ObjectClass-2
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
CTCAdverseEventTerm,Other
Data type
text
Similar models
No Instruction available.
- StudyEvent: Form 5S - Post Progression Follow-Up Report
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C0439231 (UMLS 2011AA Property)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
C1521902 (UMLS 2011AA ValueDomain)
C29846 (NCI Thesaurus Property)
C0439231 (UMLS 2011AA Property)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass-2)
C1443775 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass-2)
C1443775 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C0003123 (UMLS 2011AA)
C0008031 (UMLS 2011AA)
C0009806 (UMLS 2011AA)
C0042963 (UMLS 2011AA)
C0015672 (UMLS 2011AA)
C0027497 (UMLS 2011AA)
C0033774 (UMLS 2011AA)
C0013404 (UMLS 2011AA)
C0445356 (UMLS 2011AA)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1512699 (UMLS 2011AA ValueDomain)
C25590 (NCI Thesaurus ObjectClass)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass-2)
C1443775 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)