Description:

NSABP-B-47 Missing Data form for Medical Conditions and Lifestyle Questionnaire (Form QMD) A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women With Node- Positive or High-Risk Node-Negative HER2-Low Invasive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9556F723-E572-09D5-E040-BB89AD433F36

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9556F723-E572-09D5-E040-BB89AD433F36

Keywords:
Versions (2) ▾
  1. 12/18/14
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01275677 Quality of Life - NSABP-B-47 Missing Data form for Medical Conditions and Lifestyle Questionnaire (Form QMD) - 3161696v1.0

This paper worksheet may be completed to facilitate entry of information in NSABP Coordination Online. Partially completed online forms may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. Submit Form QMD online whenever the protocol-scheduled Medical Conditions and Lifestyle Questionnaire Follow-up (MCL-F) form is not filled out by the patient and the assessment cannot be obtained by phone or mail. No missing data form is required for partially completed MCL-F forms

Header
Reason Qol Not Assessed
Time point
Reason MCL-F was Not Assessed During Clinic Visit (Mark the main reason and add comments below)
Reason MCL-F was Not Assessed by Phone or Mail (Mark the main reason and add comments below)
Footer

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