Información:
Error:
ID
9289
Descripción
S0205 CETUXIMAB SKIN TOXICITIES FORM S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A66332D9-9FC0-48D9-E034-0003BA0B1A09
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Versiones (2)
- 20/9/12 20/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
Subido en
9 de enero de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Pancreatic Cancer NCT00075686 Toxicity - S0205 CETUXIMAB SKIN TOXICITIES FORM - 2049859v3.0
Instructions: Please complete if skin toxicities (Rash/desquamation, Pruritus, Erythema multiforme, Dry skin) are noted on the S0205 Toxicity and Dosage Form.
- StudyEvent: S0205 CETUXIMAB SKIN TOXICITIES FORM
Similar models
Instructions: Please complete if skin toxicities (Rash/desquamation, Pruritus, Erythema multiforme, Dry skin) are noted on the S0205 Toxicity and Dosage Form.
- StudyEvent: S0205 CETUXIMAB SKIN TOXICITIES FORM
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
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)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution
text
AffiliateName
Item
Affiliate
text
RegisteredInvestigator
Item
Physician
text
CL Item
Sk11 (SK11)
CL Item
Sk16 (SK16)
CL Item
Sk20 (SK20)
CL Item
Sk80 (SK80)
CL Item
Rash/desquamation (Rash/desquamation)
CL Item
Pruritus (Pruritus)
CL Item
Erythema multiforme (Erythema multiforme)
CL Item
Dry skin (Dry skin)
CL Item
Other, specify (Other, specify)
CTCAdverseEventTerm,Other
Item
Other, specify
text
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
Dose Held (dose held)
CL Item
Dose Reduced (dose reduced)
C49505 (NCI Thesaurus)
C1707814 (UMLS 2011AA)
C1707814 (UMLS 2011AA)
CL Item
Dose Discontinued (dose discontinued)
CTCAdverseEventReportBeginDate
Item
Onset
date
CTCAdverseEventReportEndDate
Item
Resolved
date
Ifongoing,checkbox
Item
If ongoing, check box
text
Item Group
Concurrent Therapy/procedures For Cetuximab Skin Toxicities
Checkboxiftherearenone
Item
Check box if there are none
text
Drug/Procedure
Item
Drug/Procedure
text
TreatmentStartDate
Item
Started
date
Completed
Item
Completed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Ifongoing,checkbox
Item
If ongoing, check box
text
Comments
Item
Comments
text