Description:

SOUTHWEST ONCOLOGY GROUP S0221 BREAST CANCER PRESTUDY FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A6788C86-182E-5088-E034-0003BA0B1A09

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A6788C86-182E-5088-E034-0003BA0B1A09

Keywords:
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 NCT00070564 Pre-Study - SOUTHWEST ONCOLOGY GROUP S0221 BREAST CANCER PRESTUDY FORM - 2046547v3.0

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0221 BREAST CANCER PRESTUDY FORM
    1. No Instruction available.
Header
Patient Characteristics
Menopausal status (select one)
Performance Status
Disease Description
Stage
Tumor Laterality (select one)
ER Status
PgR Status
Was HER-2/neu status determined?
HER2/neu final diagnosis
Was an Oncotype DX assay performed
Laboratory Values
mg/dL
Ejection fraction
%
%
Prior Treatment Related To This Cancer
Most Extensive Primary Surgery (select one)
Was sentinel node sampling performed?
Sentinel Node Biopsy Results
Was axillary dissection performed?
Prior cytotoxic chemotherapy for this breast cancer?
Prior anthracycline chemotherapy
Prior taxane chemotherapy?
Prior Radiation Therapy
Ccrr Module For Southwest Oncology Group S0221 Breast Cancer Prestudy Form

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