Description:

Southwest Oncology Group Ovarian Function Assessment (S0230) Goserelin in Preventing Ovarian Failure in Women Receiving Chemotherapy for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BEA6A9CC-6D74-0D93-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BEA6A9CC-6D74-0D93-E034-0003BA12F5E7

Keywords:

Clinical Trial

Breast Neoplasms

Pre-Study Form

8/26/12 8/26/12 -
1/9/15 1/9/15 - Martin Dugas

Uploaded on:

January 9, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00068601 Pre-Study - Southwest Oncology Group Ovarian Function Assessment (S0230) - 2170708v3.0

Details

Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section.

1 forms

StudyEvent: Southwest Oncology Group Ovarian Function Assessment (S0230)
1. Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section.

Menstrual Cycle

First day of the most current or most recent menstrual cycle

Have the patient's menstrual periods been absent for the entire preceding 6 months?

Yes

If no, have the patient's menstrual periods been absent for the entire preceding 3 months?

Yes

Laboratory Test

Laboratory lower limit for postmenopausal FSH

Laboratory upper limit for postmenopausal estradiol

Laboratory upper limit for postmenopausal inhibin B

FSH level

FSH date

Estradiol level

Estradiol date

Inhibin B level

Inhibin B date (For women with Regular Menses)

Were these hormone levels measured on days 2, 3, or 4 of the menstrual cycle?

Yes

Specify reason

Comments

Ccrr Module For Southwest Oncology Group Ovarian Function Assessment (s0230)

SWOG Patient ID

Patient Initials (L, F, M)

Insitution/Affiliate

Physician

Group Name

Study NO.

Pt. ID

Date of Assessment

Assessment Time

1 Year (1 Year)

2 Year (2 Year)

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