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ID

9397

Descrizione

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

collegamento

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

Keywords

versioni (2)
  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Caricato su

9 janvier 2015

DOI

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Licenza

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

    Inglese

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

    1 moduli  
    Menstrual Cycle
    Descrizione

    Menstrual Cycle

    First day of the most current or most recent menstrual cycle
    Descrizione

    Firstdayoflastmenstrualperiod

    Tipo di dati

    text

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

    Havethepatient'smenstrualperiodsbeenabsentfortheentirepreceding6months?

    Tipo di dati

    boolean

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

    Ifno,havethepatient'smenstrualperiodsbeenabsentfortheentirepreceding3months?

    Tipo di dati

    boolean

    Laboratory Test
    Descrizione

    Laboratory Test

    Laboratory lower limit for postmenopausal FSH
    Descrizione

    LaboratoryProcedureFollicleStimulatingHormoneResultLowerLimitofNormalValue

    Tipo di dati

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C2286
    UMLS 2011AA Property-2
    C0733758
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C25555
    UMLS 2011AA ValueDomain-2
    C1518030
    Laboratory upper limit for postmenopausal estradiol
    Descrizione

    Laboratoryupperlimitforpostmenopausalestradiol

    Tipo di dati

    text

    Laboratory upper limit for postmenopausal inhibin B
    Descrizione

    LaboratoryupperlimitforpostmenopausalinhibinB

    Tipo di dati

    text

    FSH level
    Descrizione

    FSHvalue

    Tipo di dati

    text

    FSH date
    Descrizione

    LaboratoryProcedureFollicleStimulatingHormoneResultDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property-2
    C2286
    UMLS 2011AA Property-2
    C0733758
    Estradiol level
    Descrizione

    Estradiolpmol/L

    Tipo di dati

    text

    Estradiol date
    Descrizione

    Dateblooddrawnforthisestradiollevel

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Metathesaurus ObjectClass
    C0521425
    NCI Thesaurus Property
    C2295
    UMLS 2011AA Property
    C0014912
    NCI Thesaurus Property-2
    C37984
    UMLS 2011AA Property-2
    C0022877
    Inhibin B level
    Descrizione

    InhibinBlevel

    Tipo di dati

    text

    Inhibin B date (For women with Regular Menses)
    Descrizione

    InhibinBdate

    Tipo di dati

    text

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

    Werethesehormonelevelsmeasuredondays2,3,or4ofthemenstrualcycle?

    Tipo di dati

    boolean

    Specify reason
    Descrizione

    Specifyreason

    Tipo di dati

    text

    Comments
    Descrizione

    Research Comments

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Ccrr Module For Southwest Oncology Group Ovarian Function Assessment (s0230)
    Descrizione

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

    SWOG Patient ID
    Descrizione

    Trial subject ID SWOG

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Patient Initials (L, F, M)
    Descrizione

    Patient Initials

    Tipo di dati

    text

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

    Institution Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Physician
    Descrizione

    Investigator Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Group Name
    Descrizione

    Participating Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Group Name
    Descrizione

    Participating Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Study NO.
    Descrizione

    Study Number Participating Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Pt. ID
    Descrizione

    Trial subject ID Participating Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Date of Assessment
    Descrizione

    LesionAssessmentDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    Assessment Time
    Descrizione

    TimePeriod

    Tipo di dati

    text

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    Similar models

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

    1 moduli
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Menstrual Cycle
    Firstdayoflastmenstrualperiod
    Item
    First day of the most current or most recent menstrual cycle
    text
    Havethepatient'smenstrualperiodsbeenabsentfortheentirepreceding6months?
    Item
    Have the patient's menstrual periods been absent for the entire preceding 6 months?
    boolean
    Ifno,havethepatient'smenstrualperiodsbeenabsentfortheentirepreceding3months?
    Item
    If no, have the patient's menstrual periods been absent for the entire preceding 3 months?
    boolean
    Item Group
    Laboratory Test
    LaboratoryProcedureFollicleStimulatingHormoneResultLowerLimitofNormalValue
    Item
    Laboratory lower limit for postmenopausal FSH
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C2286 (NCI Thesaurus Property-2)
    C0733758 (UMLS 2011AA Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25555 (NCI Thesaurus ValueDomain-2)
    C1518030 (UMLS 2011AA ValueDomain-2)
    Laboratoryupperlimitforpostmenopausalestradiol
    Item
    Laboratory upper limit for postmenopausal estradiol
    text
    LaboratoryupperlimitforpostmenopausalinhibinB
    Item
    Laboratory upper limit for postmenopausal inhibin B
    text
    FSHvalue
    Item
    FSH level
    text
    LaboratoryProcedureFollicleStimulatingHormoneResultDate
    Item
    FSH date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C2286 (NCI Thesaurus Property-2)
    C0733758 (UMLS 2011AA Property-2)
    Estradiolpmol/L
    Item
    Estradiol level
    text
    Dateblooddrawnforthisestradiollevel
    Item
    Estradiol date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C0521425 (NCI Metathesaurus ObjectClass)
    C2295 (NCI Thesaurus Property)
    C0014912 (UMLS 2011AA Property)
    C37984 (NCI Thesaurus Property-2)
    C0022877 (UMLS 2011AA Property-2)
    InhibinBlevel
    Item
    Inhibin B level
    text
    InhibinBdate
    Item
    Inhibin B date (For women with Regular Menses)
    text
    Werethesehormonelevelsmeasuredondays2,3,or4ofthemenstrualcycle?
    Item
    Were these hormone levels measured on days 2, 3, or 4 of the menstrual cycle?
    boolean
    Specifyreason
    Item
    Specify reason
    text
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Item Group
    Ccrr Module For Southwest Oncology Group Ovarian Function Assessment (s0230)
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    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)
    Institution Name
    Item
    Insitution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Investigator Name
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Participating Group
    Item
    Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Participating Group
    Item
    Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Study NO.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Pt. ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    LesionAssessmentDate
    Item
    Date of Assessment
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    Item
    Assessment Time
    text
    CL.4
    Code List
    Assessment Time
    CL Item
    1 Year (1 Year)
    CL Item
    2 Year (2 Year)
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