ID

9401

Description

SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE 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=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BAD9-E0F6-50A4-E034-0003BA0B1A09

Keywords

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/5/15 7/5/15 -
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00070564 Off Treatment - SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE - 2050111v3.0

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Header
Description

Header

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

Patient Initials (L, F M)
Description

Patient Initials

Data type

text

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

MainMemberInstitution/AffiliateNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Physician (Groups other than SWOG)
Description

RegisteredInvestigator

Data type

text

Group Name (Groups other than SWOG)
Description

ParticipatingGroupName

Data type

text

Study No. (Groups other than SWOG)
Description

Particip.GroupProtocolNumber

Data type

float

Pt. ID (Groups other than SWOG)
Description

PatientStudyID,ParticipatingGroup

Data type

text

Unnamed2
Description

Unnamed2

Treatment Start Date
Description

TreatmentStartDate

Data type

date

Treatment End Date
Description

TreatmentEndDate

Data type

date

Regimen or Procedure or Site(s)
Description

RegimenorProcedureorSite(s)

Data type

text

Unnamed3
Description

Unnamed3

Off Treatment Reason (select one)
Description

OffTreatmentReason

Data type

text

Patient refused, due to toxicity, specify
Description

OffTreatmentReason,Toxicity

Data type

text

Patient refused, due to toxicity, specify
Description

OffTreatmentReason,Toxicity

Data type

text

Progression or relapse. Sites
Description

ProgressionSite

Data type

text

Other, specify (Off Treatment Date)
Description

OffTreatmentReason,Other

Data type

text

Other, specify (Off Treatment Date)
Description

OffTreatmentReason,Other

Data type

text

Date of completion, progression, death or decision to discontinue therapy
Description

OffTreatmentDate

Data type

date

Unnamed4
Description

Unnamed4

Will patient receive further treatment?
Description

FurtherTreatmentInd

Data type

text

Yes, specify
Description

TreatmentType,Specify

Data type

text

Unnamed5
Description

Unnamed5

Date of Last Contact (or death)
Description

DeathDate/LastContactDate

Data type

date

Vital Status
Description

Patient'sVitalStatus

Data type

text

Notes
Description

Notes

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group Off Treatment Notice
Description

Ccrr Module For Southwest Oncology Group Off Treatment Notice

Similar models

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP OFF TREATMENT NOTICE
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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)
MainMemberInstitution/AffiliateNumber
Item
Institution / Affiliate
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
ParticipatingGroupName
Item
Group Name (Groups other than SWOG)
text
Particip.GroupProtocolNumber
Item
Study No. (Groups other than SWOG)
float
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Groups other than SWOG)
text
Item Group
Unnamed2
TreatmentStartDate
Item
Treatment Start Date
date
TreatmentEndDate
Item
Treatment End Date
date
RegimenorProcedureorSite(s)
Item
Regimen or Procedure or Site(s)
text
Item Group
Unnamed3
Item
Off Treatment Reason (select one)
text
Code List
Off Treatment Reason (select one)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Medically required, due to toxicity, specify (Medically required, due to toxicity, specify)
CL Item
Patient refused, due to toxicity, specify (Patient refused, due to toxicity, specify)
CL Item
Patient refused, other than toxicity, specify (Patient refused, other than toxicity, specify)
CL Item
Progression or relapse. Sites (Progression or relapse. Sites)
CL Item
Death (Death)
CL Item
Other, Specify (Other, specify)
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
OffTreatmentReason,Toxicity
Item
Patient refused, due to toxicity, specify
text
ProgressionSite
Item
Progression or relapse. Sites
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentReason,Other
Item
Other, specify (Off Treatment Date)
text
OffTreatmentDate
Item
Date of completion, progression, death or decision to discontinue therapy
date
Item Group
Unnamed4
Item
Will patient receive further treatment?
text
Code List
Will patient receive further treatment?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TreatmentType,Specify
Item
Yes, specify
text
Item Group
Unnamed5
DeathDate/LastContactDate
Item
Date of Last Contact (or death)
date
Item
Vital Status
text
Code List
Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Item Group
Notes
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Off Treatment Notice

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