Description:

Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B24316ED-D5DA-16A3-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B24316ED-D5DA-16A3-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Brain and Central Nervous System Tumors NCT00053963 Off Treatment - Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] - 2077867v3.0

No Instruction available.

  1. StudyEvent: Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212]
    1. No Instruction available.
Header
Patient Status Information
Life Status at the Date of Last Contact
Disease Status at the end of the reporting period (Select one)
Has patient received anti-cancer therapy since the last OPTF report submission? (If the patient received anti-cancer therapy during this reporting period,)
select the type of treatment from this list (If the patient received anti-cancer therapy during this reporting period,)
Events Of Interest
Did the patient relapse or experience disease progression during the reporting period? (If yes,)
Did the patient experience a second malignant neoplasm during the reporting period? (If yes,)
Did the patient withdraw consent for follow-up at the end of the reporting period? (Note: Withdrawal of consent is to be coded only when the patient no longer wants to participate in the study and asks data no longer be submitted.)
Was the patient confirmed lost to follow-up at the end of the reporting period?
Was the patient enrolled on another COG therapeutic study at the end of the reporting period? (If disease status was evaluated during this interval,)
what was the patient's response?
Did patient receive radiation therapy during this reporting period? (If yes,)
Did patient receive PBSC transfusion? (If yes,)
Ccrr Module For Off Protocol Therapy Follow-up (optf) Report (master) [advl0212]