ID

9356

Beschreibung

SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227) S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C46950-C286-3B4D-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C46950-C286-3B4D-E034-0003BA12F5E7

Stichworte

Versionen (2)
  1. 18.12.14 18.12.14 - Martin Dugas
  2. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Treatment - SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227) - 2057355v3.0

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227)
    1. No Instruction available.
Header
Beschreibung

Header

SWOG Patient ID
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

text

Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

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

InstitutionName

Datentyp

text

Physician (Groups other than SWOG)
Beschreibung

RegisteredInvestigator

Datentyp

text

Group Name
Beschreibung

ParticipatingGroupName

Datentyp

text

Study No.
Beschreibung

NCIProtocolNumber

Datentyp

text

Pt. ID
Beschreibung

Pt.ID

Datentyp

text

Status
Beschreibung

Status

Date of Last Contact or Death
Beschreibung

DeathDate/LastContactDate

Datentyp

date

Vital Status
Beschreibung

Patient'sVitalStatus

Datentyp

text

Treatment For Cycles 2-6
Beschreibung

Treatment For Cycles 2-6

Were there any dose modifications or additions/omissions to protocol treatment
Beschreibung

DoseModification(Change)

Datentyp

text

Cycle 2
Beschreibung

Cycle 2

Cycle Start Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle Stop Date
Beschreibung

CycleStopDate

Datentyp

text

Weight (First day of this cycle)
Beschreibung

PatientWeight

Datentyp

float

BSA (First day of this cycle)
Beschreibung

BodySurfaceArea

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Cycle 3
Beschreibung

Cycle 3

Cycle Start Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle Stop Date
Beschreibung

CycleStopDate

Datentyp

text

Weight (First day of this cycle)
Beschreibung

PatientWeight

Datentyp

float

BSA (First day of this cycle)
Beschreibung

BodySurfaceArea

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Comments
Beschreibung

Comments

Comments
Beschreibung

Comments

Datentyp

text

Cycle 4
Beschreibung

Cycle 4

Cycle Start Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle Stop Date
Beschreibung

CycleStopDate

Datentyp

text

Weight (First day of this cycle)
Beschreibung

PatientWeight

Datentyp

float

BSA (First day of this cycle)
Beschreibung

BodySurfaceArea

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Cycle 5
Beschreibung

Cycle 5

Cycle Start Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle Stop Date
Beschreibung

CycleStopDate

Datentyp

text

Weight (First day of this cycle)
Beschreibung

PatientWeight

Datentyp

float

BSA (First day of this cycle)
Beschreibung

BodySurfaceArea

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Cycle 6
Beschreibung

Cycle 6

Cycle Start Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle Stop Date
Beschreibung

CycleStopDate

Datentyp

text

Weight (First day of this cycle)
Beschreibung

PatientWeight

Datentyp

float

BSA (First day of this cycle)
Beschreibung

BodySurfaceArea

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Total dose for this cycle: gemcitabine (Arm 2 only)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Others, specify
Beschreibung

AgentName

Datentyp

text

Others, specify
Beschreibung

AgentName

Datentyp

text

Others, specify
Beschreibung

AgentName

Datentyp

text

Others, specify
Beschreibung

AgentName

Datentyp

text

Comments
Beschreibung

Comments

Comments
Beschreibung

Comments

Datentyp

text

Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)
Beschreibung

Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)

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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header
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 (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
NCIProtocolNumber
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Status
DeathDate/LastContactDate
Item
Date of Last Contact or Death
date
Item
Vital Status
text
CL.1
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Treatment For Cycles 2-6
Item
Were there any dose modifications or additions/omissions to protocol treatment
text
CL.2
Code List
Were there any dose modifications or additions/omissions to protocol treatment
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned, specify in comments)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned, specify in comments)
Item Group
Cycle 2
Chemotherapy Cycle Start Date
Item
Cycle Start Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
float
BodySurfaceArea
Item
BSA (First day of this cycle)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
Item Group
Cycle 3
Chemotherapy Cycle Start Date
Item
Cycle Start Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
float
BodySurfaceArea
Item
BSA (First day of this cycle)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
Item Group
Comments
Comments
Item
Comments
text
Item Group
Cycle 4
Chemotherapy Cycle Start Date
Item
Cycle Start Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
float
BodySurfaceArea
Item
BSA (First day of this cycle)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
Item Group
Cycle 5
Chemotherapy Cycle Start Date
Item
Cycle Start Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
float
BodySurfaceArea
Item
BSA (First day of this cycle)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
Item Group
Cycle 6
Chemotherapy Cycle Start Date
Item
Cycle Start Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CycleStopDate
Item
Cycle Stop Date
text
PatientWeight
Item
Weight (First day of this cycle)
float
BodySurfaceArea
Item
BSA (First day of this cycle)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose for this cycle: gemcitabine (Arm 2 only)
float
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
AgentName
Item
Others, specify
text
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0227 Treatment Summary Form (s0227)
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