Post-Treatment Assessments, Tarceva in NSCLC patients who have EGFR-positive tumors NCT00373425

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Vital Assessment
C0031809 (UMLS CUI-1)
Assessment Date
Item
Date
date
C2985720 (UMLS CUI [1])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
ECOG
Item
ECOG performance status
integer
C1520224 (UMLS CUI [1])
Item Group
Physical Examination
C0031809 (UMLS CUI-1)
Examination Date
Item
Date Physical Examination performed:
date
C2826643 (UMLS CUI [1])
Item Group
Pregnancy Test
C0032976 (UMLS CUI-1)
Pregnancy Test
Item
Was pregnancy test performed?
boolean
C0032976 (UMLS CUI [1])
Date of Collection
Item
Date of Collection
date
C1516698 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Accession Number
Item
Accession Number
text
C2826726 (UMLS CUI [1])
Pregnancy Test
Item
Pregnancy Test: Not Applicable
boolean
C0032976 (UMLS CUI [1])
Item Group
Biochemistry/Proteomics
Date of collection
Item
Date of Collection
date
C0005834 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Accession Number
Item
Accession Number
integer
C2826726 (UMLS CUI [1])
Item Group
Reason Off Treatment
Item
Reason Off Treatment
integer
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Reason Off Treatment
Code List
Reason Off Treatment
CL Item
Completion of 2 years of study drug therapy (1)
CL Item
Relapse of NSCLC (Complete Relapse Report page and New Anticancer Treatment page, if applicable) (2)
CL Item
Adverse event, specify event(s) (3)
CL Item
Medical or ethical reasons, or noncompliance, following discussion between the lnvestigator and the OSI medical team (for reasons other than Adverse Event), specify reason(s) (4)
CL Item
Patient request (for reasons other than Adverse Event), specify reason(s) (5)
CL Item
Patient death (6)
Off Treatment Reason
Item
Specify event(s) or reason(s)
text
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Item Group
Death
C0011065 (UMLS CUI-1)
Death
Item
Did the patient die before the Post-treatment visit?
boolean
C0011065 (UMLS CUI [1])
Item
Primary Cause of Death
integer
C0007465 (UMLS CUI [1])
Primary Cause of Death
Code List
Primary Cause of Death
CL Item
NSCLC Relapse (1)
CL Item
Protocol-related toxicity, specify (2)
CL Item
Intercurrent illness, specify (3)
CL Item
Other, specify (4)
CL Item
Unknown (5)
Cause of death
Item
If applicable, please specify primary cause of death
text
C0007465 (UMLS CUI [1])
Item
Was an autopsy performed?
integer
C0004398 (UMLS CUI [1])
Autopsy
Code List
Was an autopsy performed?
CL Item
Yes (if Yes, append a copy of the autopsy report) (1)
CL Item
No (2)
Item Group
Investigator Signature
Investigator Signature
Item
Investigator's Signature
text
C25704 (NCI Thesaurus ValueDomain)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI [1])
Investigator Signature Date
Item
Date
date
C19464 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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