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  1. StudyEvent: Radiation Therapy Oncology Group Follow-up Form Phase III Recurrent Head and Neck Study Initial Evaluation Form
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Protocol ID RTOG
Item
RTOG Study
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Participant's Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
Participant's ID No.
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Data amended
Item
Amended data
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Age
Item
Age
integer
C16960 (NCI Thesaurus ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI [1])
Item
PERFORMANCE STATUS (ZUBROD)
text
C25361 (NCI Thesaurus ObjectClass)
C0597198 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.2
Code List
PERFORMANCE STATUS (ZUBROD)
CL Item
Completely Disabled (Completely disabled)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities (Ambulatory and capable of all selfcare but unable to carry out any work activities)
CL Item
Capable Of Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours (Capable of limited selfcare, confined to bed or chair more than 50% of waking hours)
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction (Fully active, able to carry on all pre-disease performance without restriction)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory (Restricted in physically strenuous activity but ambulatory)
Neutrophil count
Item
ANC
float
C25294 (NCI Thesaurus ObjectClass)
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0200633 (UMLS CUI [1])
Platelets
Item
Peripheral Platelet Count
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C12520 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0005821 (UMLS CUI [1])
Hemoglobin
Item
Hemoglobin
float
C16676 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0019046 (UMLS CUI [1])
Bilirubin
Item
Bilirubin
float
C20200 (NCI Thesaurus Property)
C305 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0005437 (UMLS CUI [1])
Bilirubin ULN
Item
Bilirubin ULN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C305 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0005437 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
AST
Item
AST (SGOT)
float
C13308 (NCI Thesaurus ObjectClass)
C25202 (NCI Thesaurus Property)
C37984 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0201899 (UMLS CUI [1])
AST ULN
Item
AST (SGOT) ULN
float
C25294 (NCI Thesaurus ObjectClass)
C25202 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0242192 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
ALT
Item
ALT (SGPT)
float
C13308 (NCI Thesaurus ObjectClass)
C37984 (NCI Thesaurus Property)
C25293 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0201836 (UMLS CUI [1])
ALT ULN
Item
ALT (SGPT) ULN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C25293 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0376147 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
Alkaline Phosphatase
Item
Alkaline Phosphatase
float
C13308 (NCI Thesaurus ObjectClass)
C37984 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C16276 (NCI Thesaurus Property-2)
C0201850 (UMLS CUI [1])
Alkaline Phosphatase ULN
Item
Alkaline Phosphatase ULN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C16276 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0201850 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
Creatinine Clearance
Item
Creatinine Clearance
float
C20200 (NCI Thesaurus Property)
C25747 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0373595 (UMLS CUI [1])
Calcium
Item
Calcium
float
C25294 (NCI Thesaurus ObjectClass)
C331 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C464 (NCI Thesaurus Property-3)
C25712 (NCI Thesaurus ValueDomain)
C0201925 (UMLS CUI [1])
LaboratoryProcedureCorrectedSerumCalciumMeasurementOutcomeValue
Item
CORRECTED SERUM CALCIUM (mg/dl)
float
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C74950 (NCI Thesaurus Property-2)
C0455288 (UMLS 2011AA Property-2)
Item
CT OR MRI OF TUMOR SITE
text
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C17999 (NCI Thesaurus Property-2)
C0441633 (UMLS 2011AA Property-2)
CL228352 (NCI Metathesaurus ObjectClass)
CL.3
Code List
CT OR MRI OF TUMOR SITE
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Item
CHEST CT
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.4
Code List
CHEST CT
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Item
ABDOMINAL CT
text
C17204 (NCI Thesaurus Property)
C0040405 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0000726 (NCI Metathesaurus ObjectClass)
CL.5
Code List
ABDOMINAL CT
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Item
BIOPSY OF TUMOR OR NEEDLE ASPIRATE/BIOPSY OF METASTATIC LYMPH NODE
text
C15189 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0005558 (UMLS CUI [1,1])
C0884358 (UMLS CUI [1,2])
CL.6
Code List
BIOPSY OF TUMOR OR NEEDLE ASPIRATE/BIOPSY OF METASTATIC LYMPH NODE
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CarotidArteryPhysicalExamInd-2
Item
PHYSICAL ASSESSMENT OF CAROTID
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12687 (NCI Thesaurus ObjectClass)
C0007272 (UMLS 2011AA ObjectClass)
CarotidArteryUltrasoundDopplerAssessmentInd-2
Item
DOPPLER ULTRASOUND
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12687 (NCI Thesaurus ObjectClass)
C0007272 (UMLS 2011AA ObjectClass)
C0162481 (NCI Metathesaurus Property)
CarotidArteryAngiogramInd-2
Item
CT OR MR ANGIOGRAM
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12687 (NCI Thesaurus ObjectClass)
C0007272 (UMLS 2011AA ObjectClass)
C16290 (NCI Thesaurus Property)
C0002978 (UMLS 2011AA Property)
CircumferentialTumorCarotidSheathInvolvementInd-2
Item
CIRCUMFERENTIAL TUMOR INVOLVEMENT OF CAROTID SHEATH
boolean
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
CL124270 (NCI Metathesaurus ObjectClass)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C0225220 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CarotidArteryStentInd-2
Item
WAS CAROTID ARTERY STENT PLACED?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12687 (NCI Thesaurus ObjectClass)
C0007272 (UMLS 2011AA ObjectClass)
C17168 (NCI Thesaurus Property)
C0038257 (UMLS 2011AA Property)
IntravenousAntibioticAtRegistrationInd-2
Item
IV ANTIBIOTICS AT TIME OF REGISTRATION
boolean
C13346 (NCI Thesaurus ObjectClass)
C0348016 (UMLS 2011AA ObjectClass)
C258 (NCI Thesaurus ObjectClass-2)
C0003232 (UMLS 2011AA ObjectClass-2)
C25646 (NCI Thesaurus Property)
C1514821 (UMLS 2011AA Property)
C25427 (NCI Thesaurus Property-2)
C1516077 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ChronicObstructiveAirwaysDiseaseHospitalizationInd-2
Item
HOSPITALIZED FOR COPD OR OTHER RESPIRATORY ILLNESS IN LAST 6 MONTHS
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
C3199 (NCI Thesaurus ObjectClass)
C0024117 (UMLS 2011AA ObjectClass)
Grade2PeripheralSensoryNeuropathyHistoryInd-2
Item
PREEXISTING GRADE > 2 PERIPHERAL SENSORY NEUROPATHY
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C3501 (NCI Thesaurus ObjectClass)
C0151313 (UMLS 2011AA ObjectClass)
C28078 (NCI Thesaurus ObjectClass-2)
C1522446 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
SymptomaticChronicHeartDiseasePresentInd-2
Item
SYMPTOMATIC OR UNCONTROLLED CARDIAC DISEASE
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25269 (NCI Thesaurus ObjectClass)
C0231220 (UMLS 2011AA ObjectClass)
CL299150 (NCI Metathesaurus ObjectClass)
Item
NEW YORK HEART ASSOCIATION CLASSIFICATION (If yes,)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C13306 (NCI Thesaurus ObjectClass)
C1522601 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus ObjectClass-2)
C0542341 (UMLS 2011AA ObjectClass-2)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
CL.16
Code List
NEW YORK HEART ASSOCIATION CLASSIFICATION (If yes,)
CL Item
No Symptoms With Ordinary Physical Activity (I)
CL Item
Symptoms With Ordinary Physical Activity; Slight Limitation Of Activity (II)
CL Item
Symptoms With Less Than Ordinary Physical Activity; Marked Limitation Of Activity (III)
CL Item
Symptoms With Any Physical Activity Or Even At Rest (IV)
Prior Surgery
Item
PRIOR SURGERY (FOR HEAD AND NECK CANCER)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0744961 (UMLS CUI-1)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
PriorSurgeryDate
Item
PRIOR SURGERY DATE (MOST RECENT)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
PriorChemotherapyAdministeredInd-3
Item
PRIOR CHEMOTHERAPY (FOR OTHER REASONS)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
PriorChemotherapyAdministeredEndDate
Item
PRIOR CHEMOTHERAPY END DATE
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
RadiationTherapyRecurrenceAdministeredPriorDose
Item
PRIOR DOSE TO THE RECURRENT / NEW PRIMARY SITE
float
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus ValueDomain)
C0332152 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
RadiationTherapySpinalCordAdministeredPriorDose
Item
PRIOR DOSE TO THE SPINAL CORD
float
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C12464 (NCI Thesaurus Property)
C0037925 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus ValueDomain)
C0332152 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
PriorRTEndDate
Item
PRIOR RADIATION THERAPY END DATE
date
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property-2)
C2746065 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
TYPE OF PATIENT DISEASE (CURRENT PRESENTATION)
text
C25471 (NCI Thesaurus ObjectClass)
C0521116 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.19
Code List
TYPE OF PATIENT DISEASE (CURRENT PRESENTATION)
CL Item
Locally Recurrent (Locally recurrent)
CL Item
Regionally Recurrent (Regionally recurrent)
CL Item
Locally And Regionally Recurrent (Locally and regionally recurrent)
CL Item
New Primary (New primary)
Item
T STAGE (of new primary only)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.20
Code List
T STAGE (of new primary only)
CL Item
T0, According To Ajcc Criteria (T0)
CL Item
T1, According To Ajcc Criteria (T1)
CL Item
T2, According To Ajcc Criteria (T2)
CL Item
T3, According To Ajcc Criteria (T3)
CL Item
T4, According To Ajcc Criteria (T4)
CL Item
Tis, According To Ajcc Criteria (Tis)
CL Item
Tx, According To Ajcc Criteria (TX)
Item
N STAGE (of new primary only)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.21
Code List
N STAGE (of new primary only)
CL Item
N0, According To Ajcc Guidelines (N0)
CL Item
N1, According To Ajcc Criteria (N1)
CL Item
N2a, According To Ajcc Guidelines (N2a)
CL Item
N2b, According To Ajcc Guidelines (N2b)
CL Item
N2c, According To Ajcc Guidelines (N2c)
CL Item
N3, According To Ajcc Guidelines (N3)
CL Item
Nx, According To Ajcc Guidelines (NX)
Item
PRIMARY SITE (CURRENT PRESENTATION)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.22
Code List
PRIMARY SITE (CURRENT PRESENTATION)
CL Item
Oral Cavity Nos (ORAL CAVITY, NOS)
CL Item
Oral Tongue (Oral tongue)
CL Item
Floor Of Mouth (Floor of mouth)
C0026638 (NCI Metathesaurus)
CL Item
Buccal Mucosa (Buccal mucosa)
C12505 (NCI Thesaurus)
C1578559 (UMLS 2011AA)
CL Item
Lower Gingiva (Lower gingiva)
CL Item
Upper Gingiva (Upper gingiva)
CL Item
Retromolar Trigone (Retromolar trigone)
CL Item
Hard Palate (Hard palate)
C12230 (NCI Thesaurus)
C0226901 (UMLS 2011AA)
CL Item
Nasopharynx Nos (NASOPHARYNX, NOS)
CL Item
Posterior Superior Wall (Posterior superior wall)
CL Item
Lateral Wall (Lateral wall)
CL Item
Oropharynx Nos (OROPHARYNX, NOS)
CL Item
Faucial Arch (Faucial arch)
CL Item
Tonsillar Fossa Tonsil (Tonsillar fossa, tonsil)
CL Item
Base Of Tongue (Base of tongue)
C0226958 (NCI Metathesaurus)
CL Item
Pharyngeal Oropharynx (Pharyngeal Oropharynx)
CL Item
Soft Palate (Soft Palate)
C12231 (NCI Thesaurus)
C0030219 (UMLS 2011AA)
CL Item
Hypopharynx Nos (HYPOPHARYNX, NOS)
CL Item
Pyriform Fossa (Pyriform fossa)
CL Item
Postcricoid Area (Postcricoid area)
CL Item
Posterior Wall (Posterior wall)
CL Item
Supraglottic Larynx (SUPRAGLOTTIC LARYNX, NOS)
CL Item
Ventricular Band (Ventricular band)
CL Item
Arytenoid (Arytenoid)
CL Item
Suprahyoid Epiglottis (Suprahyoid epiglottis)
CL Item
Infrahyoid Epiglottis (Infrahyoid epiglottis)
CL Item
Aryepiglottic Fold (Aryepiglottic fold)
CL Item
Glottic Larynx (GLOTTIC LARYNX, NOS)
CL Item
Vocal Cords (Vocal cords)
CL Item
Subglottic (SUBGLOTTIC LARYNX, NOS)
CL Item
Subglottic (Subglottic)
CL Item
Other (OTHER)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Primary Disease Site
Item
OTHER, SPECIFY
text
C25685 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
Item
HISTOLOGIC DIAGNOSIS (CURRENT PRESENTATION)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0205462 (UMLS 2011AA ValueDomain-2)
CL.23
Code List
HISTOLOGIC DIAGNOSIS (CURRENT PRESENTATION)
CL Item
Squamous Cell Carcinoma, Including Variants (Squamous cell carcinoma, including variants)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
HeadandNeckTumorRecurrencePresentCount
Item
HOW MANY RECURRENCES / NEW PRIMARIES HAS THE PATIENT HAD SINCE TREATMENT OF THE ORIGINAL HEAD AND NECK CANCER?
float
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C3352 (NCI Thesaurus Property-2)
C0034897 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
LymphomaFirstRecurrenceDate
Item
DATE OF FIRST RECURRENCE (OR NEW PRIMARY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
C3208 (NCI Thesaurus ObjectClass)
C0024299 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property-2)
BaselineMalignantNeoplasmLongestDiameterMeasurement
Item
LARGEST MEASURABLE LESION
float
C25213 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25558 (NCI Thesaurus Property-2)
C1522425 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
DistantMetastasisPresentInd-2
Item
DISTANT METASTASES PRESENT?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25321 (NCI Thesaurus ObjectClass)
C0443203 (UMLS 2011AA ObjectClass)
C19151 (NCI Thesaurus ObjectClass-2)
C0027627 (UMLS 2011AA ObjectClass-2)
Item
DOES THE PATIENT HAVE A HISTORY OF PRIOR CANCER OTHER THAN THE UPPER AERO-DIGESTIVE TRACT?
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C12418 (NCI Thesaurus Property-2)
C0460004 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.26
Code List
DOES THE PATIENT HAVE A HISTORY OF PRIOR CANCER OTHER THAN THE UPPER AERO-DIGESTIVE TRACT?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PriorCancerDiagnosisSite
Item
SITE OF PRIOR CANCER
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CancerAblationDate
Item
PRIOR CANCER DATE ERADICATED
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C20985 (NCI Thesaurus Property)
C0547070 (UMLS 2011AA Property)
Item
WEIGHT LOSS IN PREVIOUS SIX MONTHS
text
C25664 (NCI Thesaurus ValueDomain)
C1262477 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C3828652 (UMLS CUI-2)
C3445 (NCI Thesaurus Property)
C25613 (NCI Thesaurus ValueDomain-2)
CL.27
Code List
WEIGHT LOSS IN PREVIOUS SIX MONTHS
CL Item
<5% Of Body Weight (< 5% of body weight)
CL Item
5 To <10% Of Body Weight (5 to < 10% of body weight)
CL Item
10 To <20% Of Body Weight (10 to < 20% of body weight)
CL Item
> Or = 20% Of Body Weight (> or = 20% of body weight)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
DOES THE PATIENT HAVE A PAST HISTORY OF SWALLOWING PROBLEMS?
text
C25518 (NCI Thesaurus ObjectClass)
C0542341 (UMLS 2011AA ObjectClass)
C38028 (NCI Thesaurus ObjectClass-2)
C0011167 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C37940 (NCI Thesaurus Property-2)
C0011155 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.28
Code List
DOES THE PATIENT HAVE A PAST HISTORY OF SWALLOWING PROBLEMS?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
HOW LONG WERE SWALLOWING PROBLEMS APPARENT? (If yes,)
text
C25518 (NCI Thesaurus ObjectClass)
C0542341 (UMLS 2011AA ObjectClass)
C38028 (NCI Thesaurus ObjectClass-2)
C0011167 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C37940 (NCI Thesaurus Property-2)
C0011155 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.29
Code List
HOW LONG WERE SWALLOWING PROBLEMS APPARENT? (If yes,)
CL Item
Less Than 1 Month (Less than 1 month)
CL Item
1 To <7 Months (1 to <7 months)
CL Item
7 To <13 Months (7 to <13 months)
CL Item
13 To <19 Months (13 to <19 months)
CL Item
19 To <24 Months (19 to <24 months)
CL Item
2 Years Or Longer (2 years or longer)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
DOES THE PATIENT CURRENTLY HAVE SWALLOWING PROBLEMS?
text
C25518 (NCI Thesaurus ObjectClass)
C0542341 (UMLS 2011AA ObjectClass)
C38028 (NCI Thesaurus ObjectClass-2)
C0011167 (UMLS 2011AA ObjectClass-2)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C37940 (NCI Thesaurus Property-2)
C0011155 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.30
Code List
DOES THE PATIENT CURRENTLY HAVE SWALLOWING PROBLEMS?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
HOW LONG HAVE SWALLOWING PROBLEMS BEEN PRESENT? (If yes,)
text
C25518 (NCI Thesaurus ObjectClass)
C0542341 (UMLS 2011AA ObjectClass)
C38028 (NCI Thesaurus ObjectClass-2)
C0011167 (UMLS 2011AA ObjectClass-2)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C37940 (NCI Thesaurus Property-2)
C0011155 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.31
Code List
HOW LONG HAVE SWALLOWING PROBLEMS BEEN PRESENT? (If yes,)
CL Item
Less Than 1 Month (Less than 1 month)
CL Item
1 To <7 Months (1 to <7 months)
CL Item
7 To <13 Months (7 to <13 months)
CL Item
13 To <19 Months (13 to <19 months)
CL Item
19 To <24 Months (19 to <24 months)
CL Item
2 Years Or Longer (2 years or longer)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
DOES THE PATIENT HAVE A PAST HISTORY OF TUBE FEEDINGS?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C73430 (NCI Thesaurus ObjectClass)
C0041281 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
CL.32
Code List
DOES THE PATIENT HAVE A PAST HISTORY OF TUBE FEEDINGS?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
HOW LONG WERE TUBE FEEDINGS GIVEN? (If yes,)
text
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C73430 (NCI Thesaurus ObjectClass)
C0041281 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.33
Code List
HOW LONG WERE TUBE FEEDINGS GIVEN? (If yes,)
CL Item
Less Than 1 Month (Less than 1 month)
CL Item
1 To <7 Months (1 to <7 months)
CL Item
7 To <13 Months (7 to <13 months)
CL Item
13 To <19 Months (13 to <19 months)
CL Item
19 To <24 Months (19 to <24 months)
CL Item
2 Years Or Longer (2 years or longer)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
DOES THE PATIENT CURRENTLY REQUIRE TUBE FEEDING?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C73430 (NCI Thesaurus ObjectClass)
C0041281 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
CL.34
Code List
DOES THE PATIENT CURRENTLY REQUIRE TUBE FEEDING?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
IS PATIENT DEPENDENT ON TUBE FEEDING FOR >50% OF NUTRITIONAL SUPPORT? (If yes,)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C73430 (NCI Thesaurus ObjectClass)
C0041281 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
CL.35
Code List
IS PATIENT DEPENDENT ON TUBE FEEDING FOR >50% OF NUTRITIONAL SUPPORT? (If yes,)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item Group
Comments
Research Comments
Item
COMMENTS
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Person Completing Form
Item
Person completing form
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Form Completion Date
Item
Form completion date, original
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
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