Description:

CALGB: 90104 Treatment and Follow-up Form Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6072-F2CE-7116-E034-0003BA12F5E7

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6072-F2CE-7116-E034-0003BA12F5E7
Keywords:
  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 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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Bladder Cancer NCT00014534 Treatment - CALGB: 90104 Treatment and Follow-up Form - 2169531v3.0

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  1. StudyEvent: CALGB: 90104 Treatment and Follow-up Form
    1. No Instruction available.
Ccrr Module For Calgb: 90104 Treatment And Follow-up Form
Amended data?
Patient's vital status
Primary cause of death
GCSF administered?
Treatment
Reason treatment ended
Were there any dose modifications or additions/omissions to protocol treatment?
1000/uL
1000/uL
mg/dL
Has the patient had a documented clinical assessment for this cancer?
Chest x-ray result
Abdominal/pelvic CT result
Has the patient been diagnosed with a local recurrence that has not been previously reported?
Site(s) of first local progression
Has the patient been diagnosed with a local-regional lymph node recurrence that has not been previously reported?
Site(s) of first local-regional lymph node progression
Has the patient been diagnosed with a distant metastatic progression that has not been previously reported?
Site(s) of first local (distant) progression
Has a new primary cancer or myelodysplatsic syndrome been diagnosed that has not been previously reported?
Has the patient experienced any severe, long-term toxicity that has not been previously reported?

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