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  1. StudyEvent: CALGB: 80101 Follow-up/Relapse Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
CALGB clinical trial administrative data
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
IntervalReportFromDate
Item
Reporting period start date
date
DeathDate/LastContactDate
Item
To: (Date of Last contact or death)
date
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
patient demographics
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital No
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
Item
Patient's vital status (mark one with an X)
text
Code List
Patient's vital status (mark one with an X)
CL Item
Alive (Alive)
CL Item
Dead (Dead)
CL Item
Lost (Lost)
Item
Primary cause of death (mark one with an X)
text
Code List
Primary cause of death (mark one with an X)
CL Item
Due To Protocol Treatment (Due to protocol treatment)
CL Item
Due To This Disease (Due to this disease)
CL Item
Due To Other Cause, Specify (Due to other cause, specify)
DeathReason,Specify
Item
Due to other cause, specify
text
Item Group
Notice Of Progression/relapse
Item
Has the patient developed a progression (or relapse) during this time period that has not been previously reported?
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C19987 (NCI Thesaurus Property)
C0242656 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Code List
Has the patient developed a progression (or relapse) during this time period that has not been previously reported?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Dateprogressiveorrecurrentdiseasediagnosed
Item
Date progressive or recurrent disease diagnosed
text
Item
Site(s) of progression/relapse (mark all that apply with an X)
text
Code List
Site(s) of progression/relapse (mark all that apply with an X)
CL Item
Anastomosis (Anastomosis)
C15609 (NCI Thesaurus)
C0677554 (UMLS 2011AA)
CL Item
Tumor Bed/regional Organs (Tumor bed/regional organs)
CL Item
Residual Stomach (Residual stomach)
CL Item
Lymph Nodes (Lymph nodes)
CL Item
Mesentery/peritoneum (Mesentery/peritoneum)
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Cns/brain (CNS/Brain)
CL Item
Other, Specify (Other, specify)
Other,specify(sitesofprogression)
Item
Other, specify (sites of progression)
text
ProgressionSite,LymphNodes
Item
Lymph nodes, specify site
text
Item Group
Stat Use Only
Item
Location of relapse
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18265 (NCI Thesaurus ObjectClass)
Code List
Location of relapse
CL Item
Local-regional (Local-regional)
C25388 (NCI Thesaurus)
C1947913 (UMLS 2011AA)
CL Item
Distant (Distant)
C25321 (NCI Thesaurus)
C0443203 (UMLS 2011AA)
Item Group
Notice Of New Primary
Item
Has a new primary cancer or AML/MDS been diagnosed that has not been previously reported?
text
Code List
Has a new primary cancer or AML/MDS been diagnosed that has not been previously reported?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
NewPrimaryCancerDate
Item
Date of diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
Site(s) of new primary
text
CompletedBy
Item
Completed by (First Name, Last Name)
text
DateCompleted
Item
Date completed
date
Item Group
Ccrr Module For Calgb: 80101 Follow-up/relapse Form

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