ID

40623

Beschrijving

ICHOM Breast Cancer data collection Version 1.0.1 Revised: March 30, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. For Breast Cancer, the following treatment approaches (or interventions) are covered by our Standard Set. Conditions*: All patients (men and women) with newly pathologically diagnosed invasive breast cancer (stage I-IV) and ductal carcinoma in situ (DCIS). *Excluded Conditions: Rare tumors (e.g. phyllodes tumor), lobular carcinoma in situ (LCIS) and patients with recurrent disease at baseline will be excluded. Treatment approaches: (Reconstructive) Surgery | Radiotherapy | Chemotherapy | Hormonal Therapy | Targeted Therapy | This document contains the Follow-up - Clinical-reported form. Annual follow-up is reassessed from date of surgery or start of chemo-/radiotherapy (also in case of recurrence), so that it will run parallel with annual outpatient visit. Distinction for long-term follow-up: Local disease: Up to 10 years follow-up. Metastatic disease: Annually for life Collecting Patient-Reported Outcome Measures: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, EORTC QLQ-BR23, EORTC QLQ-LMC21). As a permission is needed for use of these questionnaires, only the total score of each will be included in this version of the standard set. More information can be found at http://groups.eortc.be/qol/eortc-qlq-c30 BREAST-Q Patient Reported Outcomes Instrument (BREAST-Q). As a license is needed for use of this questionnaire, only the total score will be included in this version of the standard set. For more information, please visit: https:// eprovide.mapi-trust.org/instruments/ breast-q#contact_and_conditions_of_ use Functional Assessment of Cancer Therapy Endocrine Subscale (FACT-ES). As a permission is needed for use of this questionnaire, only the total score of each will be included in this version of the standard set. For more information see http://www.facit.org/facitorg/ questionnaires. Reference: Ong WL, Schouwenburg MG, van Bommel AC, et al. A Standard Set of Value-Based Patient-Centered Outcomes for Breast Cancer: The International Consortium for Health Outcomes Measurement (ICHOM) Initiative. JAMA Oncol. 2017;3(5):677–685. doi:10.1001/jamaoncol.2016.4851 The Standard set of ICHOM was supported by the Dutch Dnstitute for Clinical Auditing, Onderlinge Waarborgmaatschappij Centrale Zorgverzekeraars group, Ramsay Health Care and Karolinska Institute. For this version of the standard set, semantic annotation with UMLS CUIs has been added.

Link

http://www.ichom.org/

Trefwoorden

Versies (5)
  1. 07-07-19 07-07-19 -
  2. 07-07-19 07-07-19 -
  3. 22-07-19 22-07-19 -
  4. 26-07-19 26-07-19 - Sarah Riepenhausen
  5. 30-04-20 30-04-20 - Sarah Riepenhausen
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30 april 2020

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Creative Commons BY-NC 4.0
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ICHOM Breast Cancer

Engels

Follow-up - Clinical-reported

1 Formulieren  
Administrative Data
Beschrijving

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Beschrijving

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Datatype

integer

Alias
UMLS CUI [1]
C1269815
Patient's last name:
Beschrijving

The patients' name will not be shared with ICHOM.  INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical

Datatype

text

Alias
UMLS CUI [1]
C1299487
Time Relative to Baseline
Beschrijving

This Item does not exist in the original standard set, instead it is asked to do the following: Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. For example, VARIABLEID_AT (After treatment); VARIABLEID_AS (After surgery); VARIABLEID_UPDATE (Update at least annually), etc.

Datatype

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Tumor factors
Beschrijving

Tumor factors

Alias
UMLS CUI-1
C0475752
Indicate if the patient carries a genetic mutation predisposing breast cancer:
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Baseline and after 1 year REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0314657
UMLS CUI [1,2]
C0678222
Treatment variables
Beschrijving

Treatment variables

Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 0 = No treatment
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C1298908
UMLS CUI [2]
C0087111
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 1 = Surgery
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0543467
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 2 = Surgery to axilla
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2,1]
C0543467
UMLS CUI [2,2]
C0004454
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 3 = Delayed reconstruction
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2,1]
C0085076
UMLS CUI [2,2]
C0524865
UMLS CUI [2,3]
C0205421
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 4 = Radiotherapy
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C1522449
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 5 = Chemotherapy
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0392920
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 6 = Hormonal therapy
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0279025
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 7 = Targeted therapy
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C2985566
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 8 = Best supportive care
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0344211
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 999 = Unknown
Beschrijving

INCLUSION CRITERIA: All patients TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answers

Datatype

boolean

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0439673
Indicate whether the patient received surgery during the last year:
Beschrijving

INCLUSION CRITERIA: If answered "surgery" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0543467
UMLS CUI [1,2]
C4086728
Provide the date of surgery:
Beschrijving

INCLUSION CRITERIA: If answered "surgery" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0543467
DD/MM/YYYY
Indicate whether the patient received surgery to the axilla during the last year:
Beschrijving

INCLUSION CRITERIA: If answered "surgery to axilla" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0543467
UMLS CUI [1,2]
C0004454
UMLS CUI [1,3]
C4086728
Please provide the date of surgery to the axilla (DD/MM/YYYY):
Beschrijving

INCLUSION CRITERIA: If answered "surgery to axilla" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0004454
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0543467
DD/MM/YYYY
Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year:
Beschrijving

INCLUSION CRITERIA: If answered " sentinel lymph node biopsy" or "axillary sampling on surgery axilla [SURGERYAX] [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0337383
UMLS CUI [1,2]
C0729594
UMLS CUI [1,3]
C4086728
Please provide the date of axillary clearance (DD/MM/YYYY):
Beschrijving

INCLUSION CRITERIA: If answered "yes" on axillary clearance [SURGERYAX2] IMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0337383
UMLS CUI [1,2]
C0729594
UMLS CUI [1,3]
C0011008
DD/MM/YYYY
Indicate whether the patient received a delayed reconstruction during the last year:
Beschrijving

INCLUSION CRITERIA: If answered "delayed reconstruction" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0205421
UMLS CUI [1,2]
C0085076
UMLS CUI [1,3]
C4086728
Please provide the date of delayed reconstruction (DD/MM/YYYY):
Beschrijving

INCLUSION CRITERIA: If "yes" on reconstruction TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0205421
UMLS CUI [1,2]
C0085076
UMLS CUI [1,3]
C0011008
DD/MM/YYYY
Indicate whether the patient received radiotherapy during the last year:
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C4086728
Indicate location/type of radiotherapy: 0 = Breast
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0006141
Indicate location/type of radiotherapy: 1 = Chest wall
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0205076
Indicate location/type of radiotherapy: 2 = Axillary nodal irradiation
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0729594
Indicate location/type of radiotherapy: 3 = Supraclavicular irradiation
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0589496
Indicate location/type of radiotherapy: 4 = Internal mammary node irradiation
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0229755
Indicate location/type of radiotherapy: 5 = Tumor bed boost
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C3640144
UMLS CUI [1,3]
C1511253
Indicate location/type of radiotherapy: 6 = Brain metastases
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0220650
Indicate location/type of radiotherapy: 7 = Bone metastases
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0153690
Indicate location/type of radiotherapy: 8 = Any metastatic site
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0280457
Indicate location/type of radiotherapy: 9 = Other
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0205394
Indicate location/type of radiotherapy: 999 = Unknown
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C1522449
UMLS CUI [1,2]
C0439673
Please provide the start date of radiotherapy:
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0436382
UMLS CUI [1,2]
C3173309
DD/MM/YYYY
Please provide the stop date of radiotherapy:
Beschrijving

INCLUSION CRITERIA: If answered "radiotherapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0436385
UMLS CUI [1,2]
C0806020
DD/MM/YYYY
Indicate whether the patient received chemotherapy neoadjuvant or adjuvant:
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1]
C0392920
Indicate what type of chemotherapy (select all that apply) 0 = Anthracycline containing
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0282564
Indicate what type of chemotherapy (select all that apply) 1 = Taxane containing
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0215136
Indicate what type of chemotherapy (select all that apply) 2 = Platinum containing
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0032207
Indicate what type of chemotherapy (select all that apply) 3 = Other
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0205394
Indicate what type of chemotherapy (select all that apply) 999 = Unknown
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer

Datatype

boolean

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0439673
Please provide the start date of chemotherapy:
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C3173309
DD/MM/YYYY
Please provide the stop date of chemotherapy, if applicable:
Beschrijving

INCLUSION CRITERIA: If answered "chemotherapy" on treatment TIMING: Update at least annually REPORTING SOURCE: Clinical

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0806020
DD/MM/YYYY
Indicate whether the patient received hormonal therapy neoadjuvant or adjuvant:
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single Answer

Datatype

integer

Alias
UMLS CUI [1]
C0279025
Indicate what type of hormonal therapy (select all that apply) 0 = Aromatase inhibitor
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0593802
Indicate what type of hormonal therapy (select all that apply) 1 = Selective estrogen-receptor modulator (e.g. Tamoxifen)
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0732611
UMLS CUI [3]
C0039286
Indicate what type of hormonal therapy (select all that apply) 2 = Oophorectomy
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0029936
Indicate what type of hormonal therapy (select all that apply) 3 = LHRH agonist
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C1518041
Indicate what type of hormonal therapy (select all that apply) 4 = Other
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0205394
Indicate what type of hormonal therapy (select all that apply) 999 = Unknown
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Multiple answer Separate multiple entries with "";""

Datatype

boolean

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0332307
UMLS CUI [2]
C0439673
Please provide the start date of hormonal therapy:
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0808070
DD/MM/YYYY
Please provide the stop date of hormonal therapy, if applicable:
Beschrijving

INCLUSION CRITERIA: If answered "hormonal therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C0806020
DD/MM/YYYY
Indicate what type of targeted therapy:
Beschrijving

INCLUSION CRITERIA: If answered "targeted therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1]
C2985566
Please provide the start date of targeted therapy:
Beschrijving

INCLUSION CRITERIA: If answered "targeted therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C2985566
UMLS CUI [1,2]
C3173309
DD/MM/YYYY
Please provide the stop date of targeted therapy, if applicable:
Beschrijving

INCLUSION CRITERIA: If answered "targeted therapy" on treatment [TREATMENT] TIMING: Update at least annually REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C2985566
UMLS CUI [1,2]
C1531784
DD/MM/YYYY
Survival and Disease control
Beschrijving

Survival and Disease control

Indicate whether there is evidence of local, regional or distant recurrence.
Beschrijving

INCLUSION CRITERIA: Only if the intent of treatment is curative   TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Single Answer

Datatype

integer

Alias
UMLS CUI [1]
C0034897
Provide method of confirmation:
Beschrijving

INCLUSION CRITERIA: Only if answered "yes" on recurrence [RECUR] TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Single Answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0034897
UMLS CUI [1,2]
C0332307
UMLS CUI [1,3]
C0750484
Provide the date of the recurrence:
Beschrijving

INCLUSION CRITERIA: Only if answered "yes" on recurrence [RECUR] TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0807712
DD/MM/YYYY
Indicate whether the patient has died
Beschrijving

INCLUSION CRITERIA: All patients TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Single Answer

Datatype

integer

Alias
UMLS CUI [1]
C0011065
Provide the date of the death
Beschrijving

INCLUSION CRITERIA: If answered "yes" on patient died [DEATH] TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Date by DD/MM/YYYY; Please enter "999" if date is unknown

Datatype

date

Maateenheden
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C1148348
DD/MM/YYYY
Indicate if death is attributable to breast cancer
Beschrijving

INCLUSION CRITERIA: If answered "yes" on patient died [DEATH] TIMING: 1 year post treatment, tracked annually up to 10 years REPORTING SOURCE: Clinical TYPE: Single answer

Datatype

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0596130
UMLS CUI [1,3]
C0678222
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Similar models

Follow-up - Clinical-reported

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Patient's last name
Item
Patient's last name:
text
C1299487 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Tumor factors
C0475752 (UMLS CUI-1)
Item
Indicate if the patient carries a genetic mutation predisposing breast cancer:
integer
C0314657 (UMLS CUI [1,1])
C0678222 (UMLS CUI [1,2])
Genetic mutation
Code List
Indicate if the patient carries a genetic mutation predisposing breast cancer:
CL Item
No mutation (0)
C1298908 (UMLS CUI-1)
C0026882 (UMLS CUI-2)
(Comment:en)
CL Item
BRCA 1 (1)
C1511022 (UMLS CUI-1)
(Comment:en)
CL Item
BRCA 2 (2)
C1511024 (UMLS CUI-1)
(Comment:en)
CL Item
Other mutation (3)
C0205394 (UMLS CUI-1)
C0026882 (UMLS CUI-2)
(Comment:en)
CL Item
Not tested (4)
C3640292 (UMLS CUI-1)
(Comment:en)
Item Group
Treatment variables
Treatment: No
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 0 = No treatment
boolean
C1298908 (UMLS CUI [1])
C0087111 (UMLS CUI [2])
Treatment: Surgery
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 1 = Surgery
boolean
C0087111 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Treatment: Surgery to axilla
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 2 = Surgery to axilla
boolean
C0087111 (UMLS CUI [1])
C0543467 (UMLS CUI [2,1])
C0004454 (UMLS CUI [2,2])
Treatment: Delayed reconstruction
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 3 = Delayed reconstruction
boolean
C0087111 (UMLS CUI [1])
C0085076 (UMLS CUI [2,1])
C0524865 (UMLS CUI [2,2])
C0205421 (UMLS CUI [2,3])
Treatment: Radiotherapy
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 4 = Radiotherapy
boolean
C1522449 (UMLS CUI [1])
Treatment: Chemotherapy
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 5 = Chemotherapy
boolean
C0087111 (UMLS CUI [1])
C0392920 (UMLS CUI [2])
Treatment: Hormonal therapy
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 6 = Hormonal therapy
boolean
C0087111 (UMLS CUI [1])
C0279025 (UMLS CUI [2])
Treatment: Targeted therapy
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 7 = Targeted therapy
boolean
C0087111 (UMLS CUI [1])
C2985566 (UMLS CUI [2])
Treatment: Best supportive care
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 8 = Best supportive care
boolean
C0087111 (UMLS CUI [1])
C0344211 (UMLS CUI [2])
Treatment: Unknown
Item
Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 999 = Unknown
boolean
C0087111 (UMLS CUI [1])
C0439673 (UMLS CUI [2])
Item
Indicate whether the patient received surgery during the last year:
integer
C0543467 (UMLS CUI [1,1])
C4086728 (UMLS CUI [1,2])
Surgery
Code List
Indicate whether the patient received surgery during the last year:
CL Item
Breast conserving surgery (BCS) (0)
C0917927 (UMLS CUI-1)
(Comment:en)
CL Item
BCS with mammoplasty  (1)
C0917927 (UMLS CUI-1)
C0085076 (UMLS CUI-2)
(Comment:en)
CL Item
Mastectomy without immediate reconstruction (2)
C0024881 (UMLS CUI-1)
C0332288 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
(Comment:en)
CL Item
Mastectomy with immediate reconstruction (direct/staged implant) (3)
C0024881 (UMLS CUI-1)
C0332283 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
C0021102 (UMLS CUI-4)
(Comment:en)
CL Item
Mastectomy with immediate reconstruction (autologous) (4)
C0024881 (UMLS CUI-1)
C0332283 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
C0439859 (UMLS CUI-4)
(Comment:en)
CL Item
Mastectomy with immediate reconstruction (direct/staged implant and autologous) (5)
C0024881 (UMLS CUI-1)
C0332283 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
C0021102 (UMLS CUI-4)
C0439859 (UMLS CUI-5)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Surgery date
Item
Provide the date of surgery:
date
C0011008 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
Item
Indicate whether the patient received surgery to the axilla during the last year:
integer
C0543467 (UMLS CUI [1,1])
C0004454 (UMLS CUI [1,2])
C4086728 (UMLS CUI [1,3])
Surgery axilla
Code List
Indicate whether the patient received surgery to the axilla during the last year:
CL Item
Sentinel lymph node biopsy (0)
C0796693 (UMLS CUI-1)
(Comment:en)
CL Item
Axillary sampling (1)
C0004454 (UMLS CUI-1)
C0441621 (UMLS CUI-2)
(Comment:en)
CL Item
Axillary clearance (2)
C0337383 (UMLS CUI-1)
C0729594 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Surgery axilla date
Item
Please provide the date of surgery to the axilla (DD/MM/YYYY):
date
C0004454 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0543467 (UMLS CUI [1,3])
Item
Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year:
integer
C0337383 (UMLS CUI [1,1])
C0729594 (UMLS CUI [1,2])
C4086728 (UMLS CUI [1,3])
Death
Code List
Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year:
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Axillary clearance date
Item
Please provide the date of axillary clearance (DD/MM/YYYY):
date
C0337383 (UMLS CUI [1,1])
C0729594 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Indicate whether the patient received a delayed reconstruction during the last year:
integer
C0205421 (UMLS CUI [1,1])
C0085076 (UMLS CUI [1,2])
C4086728 (UMLS CUI [1,3])
Reconstruction
Code List
Indicate whether the patient received a delayed reconstruction during the last year:
CL Item
Delayed reconstruction (direct/staged implant) (0)
C0021102 (UMLS CUI-1)
C0205421 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
(Comment:en)
CL Item
Delayed reconstruction ( autologous) (1)
C0439859 (UMLS CUI-1)
C0205421 (UMLS CUI-2)
C0085076 (UMLS CUI-3)
(Comment:en)
CL Item
Delayed reconstruction (implant/autologous) (2)
C0021102 (UMLS CUI-1)
C0439859 (UMLS CUI-2)
C0205421 (UMLS CUI-3)
C0085076 (UMLS CUI-4)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Reconstruction date
Item
Please provide the date of delayed reconstruction (DD/MM/YYYY):
date
C0205421 (UMLS CUI [1,1])
C0085076 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Indicate whether the patient received radiotherapy during the last year:
integer
C1522449 (UMLS CUI [1,1])
C4086728 (UMLS CUI [1,2])
Radiotherapy
Code List
Indicate whether the patient received radiotherapy during the last year:
CL Item
Neoadjuvant (0)
C1298676 (UMLS CUI-1)
(Comment:en)
CL Item
Adjuvant (1)
C1298675 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Radiotherapy type: breast
Item
Indicate location/type of radiotherapy: 0 = Breast
boolean
C1522449 (UMLS CUI [1,1])
C0006141 (UMLS CUI [1,2])
Radiotherapy type: Chest wall
Item
Indicate location/type of radiotherapy: 1 = Chest wall
boolean
C1522449 (UMLS CUI [1,1])
C0205076 (UMLS CUI [1,2])
Radiotherapy type: Axillary nodal irradiation
Item
Indicate location/type of radiotherapy: 2 = Axillary nodal irradiation
boolean
C1522449 (UMLS CUI [1,1])
C0729594 (UMLS CUI [1,2])
Radiotherapy type: Supraclavicular irradiation
Item
Indicate location/type of radiotherapy: 3 = Supraclavicular irradiation
boolean
C1522449 (UMLS CUI [1,1])
C0589496 (UMLS CUI [1,2])
Radiotherapy type: Internal mammary node irradiation
Item
Indicate location/type of radiotherapy: 4 = Internal mammary node irradiation
boolean
C1522449 (UMLS CUI [1,1])
C0229755 (UMLS CUI [1,2])
Radiotherapy type: Tumor bed boost
Item
Indicate location/type of radiotherapy: 5 = Tumor bed boost
boolean
C1522449 (UMLS CUI [1,1])
C3640144 (UMLS CUI [1,2])
C1511253 (UMLS CUI [1,3])
Radiotherapy type: Brain metastases
Item
Indicate location/type of radiotherapy: 6 = Brain metastases
boolean
C1522449 (UMLS CUI [1,1])
C0220650 (UMLS CUI [1,2])
Radiotherapy type: Bone metastases
Item
Indicate location/type of radiotherapy: 7 = Bone metastases
boolean
C1522449 (UMLS CUI [1,1])
C0153690 (UMLS CUI [1,2])
Radiotherapy type: Any metastatic site
Item
Indicate location/type of radiotherapy: 8 = Any metastatic site
boolean
C1522449 (UMLS CUI [1,1])
C0280457 (UMLS CUI [1,2])
Radiotherapy type: Other
Item
Indicate location/type of radiotherapy: 9 = Other
boolean
C1522449 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Radiotherapy type: Unknown
Item
Indicate location/type of radiotherapy: 999 = Unknown
boolean
C1522449 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
Start of radiotherapy
Item
Please provide the start date of radiotherapy:
date
C0436382 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
End of radiotherapy
Item
Please provide the stop date of radiotherapy:
date
C0436385 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate whether the patient received chemotherapy neoadjuvant or adjuvant:
integer
C0392920 (UMLS CUI [1])
Radiotherapy
Code List
Indicate whether the patient received chemotherapy neoadjuvant or adjuvant:
CL Item
Neoadjuvant (0)
C1298676 (UMLS CUI-1)
(Comment:en)
CL Item
Adjuvant (1)
C1298675 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Type of chemotherapy: Anthracycline containing
Item
Indicate what type of chemotherapy (select all that apply) 0 = Anthracycline containing
boolean
C0392920 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0282564 (UMLS CUI [2])
Type of chemotherapy: Taxane containing
Item
Indicate what type of chemotherapy (select all that apply) 1 = Taxane containing
boolean
C0392920 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0215136 (UMLS CUI [2])
Type of chemotherapy: Platinum containing
Item
Indicate what type of chemotherapy (select all that apply) 2 = Platinum containing
boolean
C0392920 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0032207 (UMLS CUI [2])
Type of chemotherapy: Other
Item
Indicate what type of chemotherapy (select all that apply) 3 = Other
boolean
C0392920 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0205394 (UMLS CUI [2])
Type of chemotherapy: Unknown
Item
Indicate what type of chemotherapy (select all that apply) 999 = Unknown
boolean
C0392920 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0439673 (UMLS CUI [2])
Start of chemotherapy
Item
Please provide the start date of chemotherapy:
date
C0392920 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
End of chemotherapy
Item
Please provide the stop date of chemotherapy, if applicable:
date
C0392920 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate whether the patient received hormonal therapy neoadjuvant or adjuvant:
integer
C0279025 (UMLS CUI [1])
Radiotherapy
Code List
Indicate whether the patient received hormonal therapy neoadjuvant or adjuvant:
CL Item
Neoadjuvant (0)
C1298676 (UMLS CUI-1)
(Comment:en)
CL Item
Adjuvant (1)
C1298675 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Hormonal therapy type: Aromatase inhibitor
Item
Indicate what type of hormonal therapy (select all that apply) 0 = Aromatase inhibitor
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0593802 (UMLS CUI [2])
Hormonal therapy type: Selective estrogen-receptor modulator
Item
Indicate what type of hormonal therapy (select all that apply) 1 = Selective estrogen-receptor modulator (e.g. Tamoxifen)
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0732611 (UMLS CUI [2])
C0039286 (UMLS CUI [3])
Hormonal therapy type: Oophorectomy
Item
Indicate what type of hormonal therapy (select all that apply) 2 = Oophorectomy
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0029936 (UMLS CUI [2])
Hormonal therapy type: LHRH agonist
Item
Indicate what type of hormonal therapy (select all that apply) 3 = LHRH agonist
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C1518041 (UMLS CUI [2])
Hormonal therapy type: Other
Item
Indicate what type of hormonal therapy (select all that apply) 4 = Other
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0205394 (UMLS CUI [2])
Hormonal therapy type: Unknown
Item
Indicate what type of hormonal therapy (select all that apply) 999 = Unknown
boolean
C0279025 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0439673 (UMLS CUI [2])
Start of hormonal therapy
Item
Please provide the start date of hormonal therapy:
date
C0279025 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stop of hormonal therapy
Item
Please provide the stop date of hormonal therapy, if applicable:
date
C0279025 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate what type of targeted therapy:
integer
C2985566 (UMLS CUI [1])
Targeted therapy
Code List
Indicate what type of targeted therapy:
CL Item
Her-2 targeting therapy (0)
C1512413 (UMLS CUI-1)
C2985566 (UMLS CUI-2)
(Comment:en)
CL Item
Other (1)
C0205394 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of targeted therapy
Item
Please provide the start date of targeted therapy:
date
C2985566 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
Stop of targeted therapy
Item
Please provide the stop date of targeted therapy, if applicable:
date
C2985566 (UMLS CUI [1,1])
C1531784 (UMLS CUI [1,2])
Item Group
Survival and Disease control
Item
Indicate whether there is evidence of local, regional or distant recurrence.
integer
C0034897 (UMLS CUI [1])
Recurrence
Code List
Indicate whether there is evidence of local, regional or distant recurrence.
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes, local recurrence (1)
C0027643 (UMLS CUI-1)
(Comment:en)
CL Item
Yes, regional recurrence (2)
C0521158 (UMLS CUI-1)
C0205147 (UMLS CUI-2)
(Comment:en)
CL Item
Yes, distant recurrence (3)
C0521158 (UMLS CUI-1)
C0443203 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Provide method of confirmation:
integer
C0034897 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
Recurrence method
Code List
Provide method of confirmation:
CL Item
Radiological diagnosis (0)
C0043299 (UMLS CUI-1)
(Comment:en)
CL Item
Histological diagnosis (1)
C0679557 (UMLS CUI-1)
(Comment:en)
CL Item
Radiological and histological diagnosis (2)
C0043299 (UMLS CUI-1)
C0679557 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (3)
C0439673 (UMLS CUI-1)
(Comment:en)
Recurrence date
Item
Provide the date of the recurrence:
date
C0807712 (UMLS CUI [1])
Item
Indicate whether the patient has died
integer
C0011065 (UMLS CUI [1])
Death
Code List
Indicate whether the patient has died
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Date of death
Item
Provide the date of the death
date
C1148348 (UMLS CUI [1])
Item
Indicate if death is attributable to breast cancer
integer
C0007465 (UMLS CUI [1,1])
C0596130 (UMLS CUI [1,2])
C0678222 (UMLS CUI [1,3])
Complication attribute
Code List
Indicate if death is attributable to breast cancer
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
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