INSTRUCTIONS: Use this form to capture the first occurrence of non-protocol anti-tumor therapy per registration step

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Generic drug form
Item
DCI Name
text
C25191 (NCI Thesaurus ValueDomain)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Item
Reporting Period
text
C25284 (NCI Thesaurus ValueDomain)
C2347804 (UMLS CUI-1)
C25214 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C25651 (NCI Thesaurus ObjectClass-2)
CL.1
Code List
Reporting Period
CL Item
Non-protocol Therapy (Non-Protocol Therapy)
Patient Initials
Item
Patient Initials (Last, First)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Protocol Number
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)
Institution Name
Item
Institution/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)
Trial subject ID Participating Group
Item
Participating Group Patient 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)
Data amended
Item
Please mark an 'X' if data have been amended. (Please circle amended items in red)
text
C25704 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Data amended date
Item
Date data amended (s - mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Investigator Signature
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Investigator Signature Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
Item Group
Non-protocol Therapy
C1518384 (UMLS CUI-1)
Non-Protocol Therapy Begin Date
Item
Date of First Non-Protocol Therapy
date
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C1518384 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
Non-protocol Chemotherapy
Item
Non-protocol Chemotherapy
boolean
C38148 (NCI Thesaurus ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0392920 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol Hormonal Therapy
Item
Non-protocol Hormonal Therapy
boolean
C38148 (NCI Thesaurus ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0279025 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol Immunotherapy
Item
Non-protocol Immunotherapy (Biological Response Modifiers)
boolean
C38148 (NCI Thesaurus ValueDomain)
C15262 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0021083 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol High Dose Chemotherapy/Stem Cell Transplant
Item
Non-protocol High Dose Chemotherapy/Stem Cell Transplant (Autologous or Allogeneic)
boolean
C15632 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C12981 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
C0392920 (UMLS CUI-1)
C0332835 (UMLS CUI-2)
C1518384 (UMLS CUI-3)
Non-protocol Surgery
Item
Non-protocol Surgery
boolean
C38148 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol surgery type
Item
Non-protocol surgery type
text
C25704 (NCI Thesaurus ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus Property)
C25590 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol Radiation Therapy
Item
Non-protocol Radiation Therapy
boolean
C38148 (NCI Thesaurus ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1522449 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Non-protocol RT type
Item
Non-protocol RT type
text
C25704 (NCI Thesaurus ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1522449 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Other Non-protocol Therapy
Item
Other Non-protocol Therapy
boolean
C17649 (NCI Thesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property-2)
C0205394 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
Name of other non-protocol therapy
Item
Name of other non-protocol therapy
text
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C42614 (NCI Thesaurus ValueDomain)
C1518384 (UMLS CUI-1)
C0205394 (UMLS CUI-2)
non-protocol therapy given for the disease of this protocol
Item
Was the non-protocol therapy given for the disease of this protocol
boolean
C2991 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C15368 (NCI Thesaurus Property)
C25590 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
C0012634 (UMLS CUI-1)
C1518384 (UMLS CUI-2)
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