Form:NOD Pancreatic Cancer Data Abstraction v5.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 1832)
   1832Participant initials: (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1219)
* 1219Date of contact (MM/DD/YYYY): (Go To: 2176)
* 2176Visit code (Go To: 5149)
 
Permissible Values (value):6 months (6)
 
 12 months (12)
 
 24 months (24)
 
 36 months (36)
* 5149Pancreatic malignancy histology, WHO (Go To: 4822)
 
Permissible Values (value):Ductal adenocarcinoma 8500/3 (10)
 
 Intraductal papillary mucinous neoplasm (IPMN) with an associated invasive carcinoma 8453/3 (22)
 
 Mucinous cystic neoplasm (MCN) with an associated invasive carcinoma 8470/3 (28)
 
 Neoplasm of the neuroendocrine pancreas (or islet cell tumor) (40) (Go To: 1097)
 
 Periampullary carcinoma (50) (Go To: 5150)
 
 Other, specify: (97) (Go To: 5151)
* 5151Pancreatic malignancy histology, WHO (Other, specify) (Go To: 1097)
* 5150Periampullary tumor primary site (Go To: 1097)
 
Permissible Values (value):Ampullary (5)
 
 Duodenal (6)
 
 Extrahepatic bile duct (7)
 
 Other, specify: (97) (Go To: 5152)
 
 Unknown (99)
* 5152Periampullary tumor primary site, (Other, specify) (Go To: 1097)
* 4822Pancreatic cancer diagnosis method (Check all that apply) (Go To: 1837)
 
Permissible Values (value):Imaging showing pancreatic mass and/or metastases (CT/MRI/Abdominal US/EUS) (2) (Go To: 955)
 
 Elevated CA 19-9 (3) (Go To: 4823)
 
 Biopsy of pancreatic primary (EUS-guided/Percutaneous/At surgery) (4) (Go To: 2596)
 
 Biopsy of metastatic lesion (5) (Go To: 2596)
 
 Other, specify: (97) (Go To: 4824)
* 5445Date symptoms noted in EMR (Go To: 1837)
* 955Date of imaging test (MM/DD/YYYY): (Go To: 1837)
* 4823CA 19-9, IU/mL (Go To: 5145)
* 5145CA 19-9 date (MM/DD/YYYY) (Go To: 1837)
* 2596Date of biopsy (MM/DD/YYYY) (Go To: 1837)
* 4824Pancreatic cancer diagnosis method, Other, specify (Go To: 1837)
* 1837Date of cancer diagnosis (MM/DD/YYYY): (Go To: 5141)
* 5141Pancreatic T-stage, clinical (Go To: 5142)
 
Permissible Values (value):TX (7)
 
 T0 (9)
 
 Tis (10)
 
 T1 (11)
 
 T1a (14)
 
 T1b (15)
 
 T1c (16)
 
 T2 (20)
 
 T3 (30)
 
 T4 (40)
 
 Unknown (99)
* 5142Pancreatic N-stage, clinical (Go To: 5143)
 
Permissible Values (value):NX (1)
 
 N0 (2)
 
 N1 (10)
 
 N2 (20)
 
 Unknown (99)
* 5143Pancreatic M-stage, clinical (Go To: 5138)
 
Permissible Values (value):MX (1)
 
 M1 (10)
 
 Unknown (99)
* 5138Pancreatic stage group, clinical (Go To: 2750)
 
Permissible Values (value):Stage 0 (0)
 
 Stage IA (11)
 
 Stage IB (14)
 
 Stage IIA (21)
 
 Stage IIB (25)
 
 Stage III (30)
 
 Stage IV (40)
 
 Unknown (99)
* 2750AJCC Manual edition: (Go To: 5051)
 
Permissible Values (value):Edition 8 went into effect 2018 (8)
 
 Unknown (99)
* 5051Diagnosis status (pancreatic) (Go To: 5148)
 
Permissible Values (value):Definite (1)
 
 Probable (2)
 
 Possible (3)
 
 Unknown (99)
* 5148Was the cancer resected? (Go To: 2148)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 774)
 
 Unknown (99)
* 774Date of surgery (MM/DD/YYYY): (Go To: 844)
* 844Date pathology report completed (MM/DD/YYYY): (Go To: 839)
   839ID number of local pathology report: (Go To: 3307)
* 3307Pancreatic T-stage, pathologic: (Go To: 5024)
 
Permissible Values (value):TX (7)
 
 T0 (9)
 
 Tis (10)
 
 T1 (11)
 
 T1a (14)
 
 T1b (15)
 
 T1c (16)
 
 T2 (20)
 
 T3 (30)
 
 T4 (40)
 
 Unknown (99)
* 5024Pancreatic T-stage, pathologic suffix (Go To: 3308)
 
Permissible Values (value):None (0)
 
 (m) (1)
* 3308Pancreatic N-stage, pathologic: (Go To: 4874)
 
Permissible Values (value):NX (1)
 
 N0 (2)
 
 N1 (10)
 
 N2 (20)
 
 Unknown (99)
* 4874Pancreatic M-stage, pathologic (Go To: 4875)
 
Permissible Values (value):M0 (1)
 
 M1 (10)
 
 Unknown (99)
* 4875Stage group, pancreatic (Go To: 2148)
 
Permissible Values (value):Stage 0 (0)
 
 Stage IA (11)
 
 Stage IB (14)
 
 Stage IIA (21)
 
 Stage IIB (25)
 
 Stage III (30)
 
 Stage IV (40)
 
 Unknown (99)
* 2148Primary cancer treatment(s) received: (Go To: 4223)
 
Permissible Values (value):Chemotherapy (1)
 
 Radiation therapy (2)
 
 Surgery (3)
 
 Palliative care (8)
 
 Immunotherapy (11)
 
 Other, specify: (97) (Go To: 2150)
 
 Unknown (99)
* 2150Primary cancer treatment(s) received: (Other, specify) (Go To: 4223)
* 4223Weight (value): (Go To: 4224)
* 4224Weight (unit): (Go To: 4243)
 
Permissible Values (value):kg (kilograms) (1)
 
 lbs (pounds) (2)
 
 Unknown (99)
* 4243Date weight recorded (MM/DD/YYYY): (Go To: 4820)
* 4820Has the participant been diagnosed with study-related disease? (Go To: 1334)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 4821)
 
 Unknown (99)
* 4821Pancreatic diagnosis (check all that apply) (Go To: 1334)
 
Permissible Values (value):Pancreatitis (2)
 
 Pancreatic cysts (3)
 
 Other, specify: (97) (Go To: 5154)
 
 Unknown (99)
* 5154Study-related disease diagnosis, Other, specify) (Go To: 1334)
* 1334New primary cancer [other than basal/squamous cell skin cancer] confirmed by a doctor since last routine study contact? (Have you been diagnosed with a new primary cancer [other than basal/squamous cell skin cancer] since your last routine study contact?) (Go To: 3980)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 1343)
 
 Unknown (99)
* 1343Cancer type/location (Go To: 3980)
 
Permissible Values (value):Bladder (1)
 
 Bone (2)
 
 Brain (3)
 
 Breast (4)
 
 Cervix (5)
 
 Colon (6)
 
 Endometrium (22)
 
 Esophagus (7)
 
 Gall bladder (40)
 
 Head & neck (mouth, nose, and throat) (8)
 
 Kidney (9)
 
 Leukemia (11)
 
 Liver (10)
 
 Lung (12)
 
 Lymphoma, including Hodgkins (13)
 
 Mesothelioma (42)
 
 Multiple myeloma (44)
 
 Ovary (14)
 
 Prostate (16)
 
 Rectum (17)
 
 Skin (melanoma, no basal or squamous) (18)
 
 Stomach (19)
 
 Testis (24)
 
 Thyroid (20)
 
 Uterus (21)
 
 Vagina (26)
 
 Other (95)
 
 Unknown (99)
* 3980Total bilirubin concentration, mg/dL. (Go To: 3979)
* 3979Total bilirubin date: (MM/DD/YYYY) (Go To: 1045)
* 1045Performance status (Which of the following options would you say describes your current performance status?) (Go To: 2980)
 
Permissible Values (value):Fully active, able to carry on all pre-disease performance without restriction (0)
 
 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work (1)
 
 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours (2)
 
 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (3)
 
 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair (4)
 
 Unknown (99)
* 2980Currently taking any medications or supplements (including herbal or nutrient supplements)? (Go To: 4839)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 3144)
 
 Unknown (99)
* 3144Number of loops: (Go To: 2159)
 
Permissible Values (value):1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
 
 11 (11)
 
 12 (12)
 
 13 (13)
 
 14 (14)
 
 15 (15)
 
 16 (16)
 
 17 (17)
 
 18 (18)
 
 19 (19)
 
 20 (20)
* 2159Specimen line number or identifier (system-generated): (Go To: 1873)
* 1873Medication Name: (Go To: 4862)
* 4862Medication dose (Go To: 4938)
* 4938Medication units (Go To: 4937)
* 4937Medication category (Go To: 5278)
 
Permissible Values (value):Anti-DM (1)
 
 Steroid (2)
 
 Insulin (5)
 
 Other (95)
   5278Drug descriptor ID (auto-entered) (Go To: 5437)
* 5437Medication frequency (Go To: 3163)
 
Permissible Values (value):1 per day (1)
 
 2 per day (2)
 
 3 per day (3)
 
 4 per day (4)
 
 PRN (20)
 
 Other, specify: (97) (Go To: 5438)
 
 Unknown (99)
* 5438Medication frequency, other, specify (Go To: 3163)
   3163Loop-specific comments 2: (Go To: 4839)
* 4839Hemoglobin A1c (HbA1c) performed? (Go To: 1097)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 3214)
 
 Unknown (99)
* 3214Number of subform loops to record 2: (Go To: 3201)
 
Permissible Values (value):1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
 
 11 (11)
 
 12 (12)
 
 13 (13)
 
 14 (14)
 
 15 (15)
 
 16 (16)
 
 17 (17)
 
 18 (18)
 
 19 (19)
 
 20 (20)
* 3201Line number or identifier 2 (system-generated): (Go To: 4840)
* 4840Hemoglobin A1c (HbA1c), % (Go To: 4841)
* 4841Hemoglobin A1c (HbA1c) date (MM/DD/YYYY) (Go To: 3158)
   3158Loop-specific comments: (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)