ID

9356

Beschrijving

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

Trefwoorden

Versies (2)
  1. 18-12-14 18-12-14 - Martin Dugas
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Cervical Cancer NCT00057928 Treatment - SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227) - 2057355v3.0

Engels

No Instruction available.

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

Header

SWOG Patient ID
Beschrijving

SWOGPatientID

Datatype

text

SWOG Study No.
Beschrijving

SWOGStudyNo.

Datatype

text

Registration Step
Beschrijving

RegistrationStep

Datatype

text

Patient Initials (L, F M)
Beschrijving

Patient Initials

Datatype

text

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

InstitutionName

Datatype

text

Physician (Groups other than SWOG)
Beschrijving

RegisteredInvestigator

Datatype

text

Group Name
Beschrijving

ParticipatingGroupName

Datatype

text

Study No.
Beschrijving

NCIProtocolNumber

Datatype

text

Pt. ID
Beschrijving

Pt.ID

Datatype

text

Status
Beschrijving

Status

Date of Last Contact or Death
Beschrijving

DeathDate/LastContactDate

Datatype

date

Vital Status
Beschrijving

Patient'sVitalStatus

Datatype

text

Treatment For Cycles 2-6
Beschrijving

Treatment For Cycles 2-6

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

DoseModification(Change)

Datatype

text

Cycle 2
Beschrijving

Cycle 2

Cycle Start Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CycleStopDate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

BSA (First day of this cycle)
Beschrijving

BodySurfaceArea

Datatype

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)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

Cycle 3
Beschrijving

Cycle 3

Cycle Start Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CycleStopDate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

BSA (First day of this cycle)
Beschrijving

BodySurfaceArea

Datatype

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)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

Cycle 4
Beschrijving

Cycle 4

Cycle Start Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CycleStopDate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

BSA (First day of this cycle)
Beschrijving

BodySurfaceArea

Datatype

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)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

Cycle 5
Beschrijving

Cycle 5

Cycle Start Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CycleStopDate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

BSA (First day of this cycle)
Beschrijving

BodySurfaceArea

Datatype

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)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

Cycle 6
Beschrijving

Cycle 6

Cycle Start Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CycleStopDate

Datatype

text

Weight (First day of this cycle)
Beschrijving

PatientWeight

Datatype

float

BSA (First day of this cycle)
Beschrijving

BodySurfaceArea

Datatype

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)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

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

AgentTotalDose(percourse)

Datatype

float

Others, specify
Beschrijving

AgentName

Datatype

text

Others, specify
Beschrijving

AgentName

Datatype

text

Others, specify
Beschrijving

AgentName

Datatype

text

Others, specify
Beschrijving

AgentName

Datatype

text

Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

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

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

Terug naar het begin van de pagina

Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT SUMMARY FORM (S0227)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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)
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial