ID

9296

Descrizione

SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678C302-20D3-50A8-E034-0003BA0B1A09

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678C302-20D3-50A8-E034-0003BA0B1A09

Keywords

versioni (3)
  1. 26/08/12 26/08/12 -
  2. 20/03/14 20/03/14 - Martin Dugas
  3. 09/01/15 09/01/15 - Martin Dugas
Caricato su

9 gennaio 2015

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00070564 Follow-Up - SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM - 2050216v3.0

Inglese

No Instruction available.

1 moduli  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM
    1. No Instruction available.
Administrative documentation
Descrizione

Administrative documentation

Alias
UMLS CUI
C1320722
SWOG Patient ID
Descrizione

SWOGPatientID

Tipo di dati

text

SWOG Study No.
Descrizione

SWOGStudyNo.

Tipo di dati

text

Registration Step
Descrizione

RegistrationStep

Tipo di dati

text

Patient Initials (L, F M)
Descrizione

Patient Initials

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution / Affiliate
Descrizione

InstitutionName

Tipo di dati

text

Physician
Descrizione

RegisteredInvestigator

Tipo di dati

text

Participating Group Name
Descrizione

ParticipatingGroupName

Tipo di dati

text

Participating Group Study No.
Descrizione

ParticipatingGroupProtocolNumber

Tipo di dati

float

Participating Group Patient ID
Descrizione

Trial subject ID Participating Group

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Vital Status
Descrizione

Vital Status

Vital Status
Descrizione

Vital Status

Tipo di dati

integer

Alias
UMLS CUI
C1148433
Date of last contact or death
Descrizione

Last Contact Date

Tipo di dati

date

Alias
UMLS CUI
C0585085
Disease Follow Up Status
Descrizione

Disease Follow Up Status

Has the patient had a documented clinical assessment for this cancer since submission of the previous follow-up form?
Descrizione

CancerFollow-upStatusInd

Tipo di dati

boolean

Date of Last Clinical Assessment
Descrizione

CancerFollow-upStatusDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Notice Of Progression - Adjuvant
Descrizione

Notice Of Progression - Adjuvant

Has the patient developed a first relapse or progression that has not been previously reported
Descrizione

DiseaseRelapseProgressionInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C38155
UMLS 2011AA Property
C0277556
NCI Thesaurus Property-2
C15220
UMLS 2011AA Property-2
C0011900
NCI Thesaurus Property-3
C19987
UMLS 2011AA Property-3
C0242656
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
If Yes, Date of Relapse or Progression:
Descrizione

IfYes,DateofRelapseorProgression:

Tipo di dati

text

Site(s) of relapse or progression
Descrizione

DiseaseProgressionRelapseSiteText

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C18265
NCI Thesaurus ObjectClass
C17747
UMLS 2011AA ObjectClass
C0242656
Notice Of New Primary
Descrizione

Notice Of New Primary

Has a new primary cancer, opposite breast cancer, or myelodysplastic syndrome (MDS) been diagnosed that has not been previously reported?
Descrizione

NewPrimaryCancerInd

Tipo di dati

boolean

Date of Diagnosis
Descrizione

NewPrimaryCancerDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
New Primary Site
Descrizione

NewPrimarySite

Tipo di dati

text

Non-protocol Treatment
Descrizione

Non-protocol Treatment

Alias
UMLS CUI
C1518384
Has the patient received any non-protocol cancer therapy (prior to progression/relapse) not previously reported?
Descrizione

Non-Protocol Therapy

Tipo di dati

boolean

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25590
NCI Thesaurus Property
C25629
NCI Thesaurus Property-2
C19987
NCI Thesaurus Property-3
C25409
NCI Thesaurus ValueDomain
C38148
UMLS CUI
C1518384
Date of First Non-Protocol Therapy (If Yes,)
Descrizione

Non-ProtocolTherapyFirstAdministeredDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25590
UMLS 2011AA ObjectClass
C1518384
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Agent
Descrizione

Agent Name

Tipo di dati

string

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
UMLS CUI
C0729502
Long Term Toxicity
Descrizione

Long Term Toxicity

Has the patient experienced any severe long term toxicity that has not been previously reported?
Descrizione

LateAdverseEventInd

Tipo di dati

boolean

Toxicities and Grades
Descrizione

CTCAdverseEventTerm

Tipo di dati

text

Comments
Descrizione

Comments

Alias
UMLS CUI
C0947611
Comments
Descrizione

Comments

Tipo di dati

string

Alias
UMLS CUI
C0947611
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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 FOLLOW UP FORM
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative documentation
C1320722 (UMLS CUI)
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)
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician
text
ParticipatingGroupName
Item
Participating Group Name
text
ParticipatingGroupProtocolNumber
Item
Participating Group Study No.
float
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Vital Status
Item
Vital Status
integer
C1148433 (UMLS CUI)
CL.1
Code List
Vital Status
CL Item
Alive (1)
CL Item
Dead (0)
Last Contact Date
Item
Date of last contact or death
date
C0585085 (UMLS CUI)
Item Group
Disease Follow Up Status
CancerFollow-upStatusInd
Item
Has the patient had a documented clinical assessment for this cancer since submission of the previous follow-up form?
boolean
CancerFollow-upStatusDate
Item
Date of Last Clinical Assessment
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Notice Of Progression - Adjuvant
DiseaseRelapseProgressionInd-3
Item
Has the patient developed a first relapse or progression that has not been previously reported
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C19987 (NCI Thesaurus Property-3)
C0242656 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
IfYes,DateofRelapseorProgression:
Item
If Yes, Date of Relapse or Progression:
text
DiseaseProgressionRelapseSiteText
Item
Site(s) of relapse or progression
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18265 (NCI Thesaurus Property-2)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
Item Group
Notice Of New Primary
NewPrimaryCancerInd
Item
Has a new primary cancer, opposite breast cancer, or myelodysplastic syndrome (MDS) been diagnosed that has not been previously reported?
boolean
NewPrimaryCancerDate
Item
Date of Diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
New Primary Site
text
Item Group
Non-protocol Treatment
C1518384 (UMLS CUI)
Non-Protocol Therapy
Item
Has the patient received any non-protocol cancer therapy (prior to progression/relapse) not previously reported?
boolean
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25629 (NCI Thesaurus Property)
C19987 (NCI Thesaurus Property-2)
C25409 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1518384 (UMLS CUI)
Non-ProtocolTherapyFirstAdministeredDate
Item
Date of First Non-Protocol Therapy (If Yes,)
date
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Agent Name
Item
Agent
string
C25364 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C0729502 (UMLS CUI)
Item Group
Long Term Toxicity
LateAdverseEventInd
Item
Has the patient experienced any severe long term toxicity that has not been previously reported?
boolean
CTCAdverseEventTerm
Item
Toxicities and Grades
text
Item Group
Comments
C0947611 (UMLS CUI)
Comments
Item
Comments
string
C0947611 (UMLS CUI)
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