ID

9358

Beskrivning

SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (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=A9C3C405-9249-3D84-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C3C405-9249-3D84-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Cervical Cancer NCT00057928 Treatment - SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227) - 2057464v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227)
    1. No Instruction available.
Header
Beskrivning

Header

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Patient Initials (L, F M)
Beskrivning

Patient Initials

Datatyp

text

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

InstitutionName

Datatyp

text

Physician (Groups other than SWOG)
Beskrivning

RegisteredInvestigator

Datatyp

text

Group Name
Beskrivning

ParticipatingGroupName

Datatyp

text

Study No.
Beskrivning

Particip.GroupProtocolNumber

Datatyp

float

Pt. ID
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Status
Beskrivning

Status

Date of Last Contact or Death
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Vital Status
Beskrivning

Patient'sVitalStatus

Datatyp

text

First Cycle Of Treatment
Beskrivning

First Cycle Of Treatment

Cycle start date (same as treatment start date)
Beskrivning

Chemotherapy Cycle Start Date

Datatyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Cycle end date (Date immediately prior to the date next cycle begins, or date decision made to discontinue patient from protocol treatment if last cycle.)
Beskrivning

Chemotherapy Cycle End Date

Datatyp

text

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C0806020
Weight first day this cycle (kg)
Beskrivning

PatientWeight

Datatyp

float

BSA first day this cycle
Beskrivning

BodySurfaceArea

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Were there any dose modifications or additions/omissions to protocol treatment
Beskrivning

DoseModification(Change)

Datatyp

text

Total dose of gemcitabine for this cycle (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

float

Total dose of gemcitabine for this cycle (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

float

Total dose of gemcitabine for this cycle (Arm 2 only)
Beskrivning

AgentTotalDose(percourse)

Datatyp

float

Concomitant Medications / Medical Interventions
Beskrivning

Concomitant Medications / Medical Interventions

Start Date
Beskrivning

AgentBeginDate

Datatyp

date

Stop Date
Beskrivning

AgentEndDate

Datatyp

date

Others, specify
Beskrivning

AgentName

Datatyp

text

Others, specify
Beskrivning

AgentName

Datatyp

text

Comments
Beskrivning

Comments

Comments
Beskrivning

Comments

Datatyp

text

Ccrr Module For Southwest Oncology Group S0227 Treatment Form For First Cycle (s0227)
Beskrivning

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

Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0227 TREATMENT FORM FOR FIRST CYCLE (S0227)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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
Particip.GroupProtocolNumber
Item
Study No.
float
PatientStudyID,ParticipatingGroup
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
First Cycle Of Treatment
Chemotherapy Cycle Start Date
Item
Cycle start date (same as treatment start date)
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
Chemotherapy Cycle End Date
Item
Cycle end date (Date immediately prior to the date next cycle begins, or date decision made to discontinue patient from protocol treatment if last cycle.)
text
C1302181 (UMLS CUI-1)
C0806020 (UMLS CUI-2)
PatientWeight
Item
Weight first day this cycle (kg)
float
BodySurfaceArea
Item
BSA first day this cycle
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
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)
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
float
AgentTotalDose(percourse)
Item
Total dose of gemcitabine for this cycle (Arm 2 only)
float
Item Group
Concomitant Medications / Medical Interventions
AgentBeginDate
Item
Start Date
date
AgentEndDate
Item
Stop Date
date
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 Form For First Cycle (s0227)
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

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