Description:

NSABP-B-47 Hormonal/Endocrine Therapy Form (Form HT) 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=95594CE0-B466-936E-E040-BB89AD43333F

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=95594CE0-B466-936E-E040-BB89AD43333F

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

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01275677 Treatment - NSABP-B-47 Hormonal/Endocrine Therapy Form (Form HT) - 3161813v1.0

This paper worksheet may be completed to facilitate the entry of the information in NSABP Coordinator Online. Partially completed worksheets may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. This form applies ONLY to women with ER-positive and/or PgR-positive tumors. This form should be submitted through 6 years on study, even if all postoperative adjuvant hormonal treatment is reported to have ended. Do not report hormonal therapy that was taken to treat breast cancer recurrence or second primary cancer

Header
Unnamed Module 1
Reporting Period
Since being entered on study, has the patient received any postoperative adjuvant hormonal treatment? (If no, omit all remaining questions)
Was endocrine therapy use assessed at the specified time point (If yes, complete the following table)
Unnamed3
Was agent administered
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