| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 866) |
| * 866 | Date of follow-up visit: (Go To: 422) |
| * 422 | EDRN Site ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 929) |
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 773) |
| * 773 | Visit code (Go To: 505) |
| | | Permissible Values (value): | F03 (5) |
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| * 505 | Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 905) |
| | | Permissible Values (value): | No (0) |
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| 506 | Average number cigarettes currently smoked per day? (How many cigarettes do you currently smoke per day?) (Go To: 905) |
| * 905 | New 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: 870) |
| | | Permissible Values (value): | No (0) |
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| 742 | Cancer type/location (Go To: 510) |
| | | Permissible Values (value): | Bladder (1) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| 510 | Date of diagnosis (MM/YYYY) (Go To: 870) |
| 870 | Number of blood-related daughters born into participant's family since last routine study contact: (How many blood-related daughters have been born into your family since your last routine study contact?) [Not including adopted, foster, or step-daughters] (Go To: 869) |
| 869 | Number of blood-related sons born into participant's family since last routine study contact: (How many blood-related sons have been born into your family since your last routine study contact?) [Not including adopted, foster, or step-sons] (Go To: 1086) |
| * 1086 | Have any of your first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer] since your last routine study contact? [Not including half-siblings, step-siblings, or step-children.] (Go To: 912) |
| | | Permissible Values (value): | No (0) |
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| * 1087 | How many of the participant´s living and deceased first degree blood relatives have been diagnosed with cancer [other than basal/squamous cell skin cancer] since last routine study contact? (How many of your living and deceased first degree blood relatives (biological parents, siblings, children) have been diagnosed with cancer [other than basal/squamous cell skin cancer] since your last routine study contact? [Not including half-siblings, step-siblings, step-parents, or step-children].) (Go To: 518) |
| * 518 | Relative type (mother, brother, etc) (Go To: 741) |
| | | Permissible Values (value): | Brother (1) |
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| * 741 | Cancer type/Location (Go To: 520) |
| | | Permissible Values (value): | Bladder (1) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| * 520 | Age when diagnosed (Go To: 912) |
| 912 | Since your last routine study contact have you been treated with any of the following intravesical therapies or agents? [Check all that apply.] (Go To: 893) |
| | | Permissible Values (value): | BCG (Bacillus of Calmette & Guerin) (1) |
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| | | | Gene therapy, specify: (6) (Go To: 932) |
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| | | | Other, specify: (97) (Go To: 931) |
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| * 932 | Gene therapy, specify: (Go To: 893) |
| * 931 | Intravesical therapy (Other, specify) (Go To: 893) |
| 893 | Since your last routine study contact, have you had any of the following devices inserted into your urinary tract? (Check all that apply.) (Go To: 892) |
| | | Permissible Values (value): | Urinary stent(s) (1) |
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| 892 | Since your last routine study contact, have you had any of the following genitourinary symptoms? (Check all that apply.) (Go To: 1071) |
| | | Permissible Values (value): | Urinary frequency (frequent, strong urges to urinate) (1) |
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| | | | Urinary urgency (need to urinate more frequently than usual) (2) |
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| | | | Urinary incontinence (leaking urine) (3) |
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| | | | Urinary retention (difficulty completely emptying the bladder) (4) |
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| | | | Dysuria (pain when urinating) (5) |
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| 1071 | Since your last routine study contact, have you been told by a doctor that you have any of the following genitourinary conditions? (Check all that apply.) (Go To: End of Form) |
| | | Permissible Values (value): | [Males only] BPH (Benign prostatic hypertrophy) (1) |
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| | | | Hematuria (blood in the urine) (2) |
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| | | | [Males only] Prostatitis (an inflamed prostate) (3) |
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| | | | Urinary tract infection (4) |
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| | | | Pyelonephritis (kidney infection) (5) |
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| | | | Urethritis (inflammation of the urethra) (6) |
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| | | | Other type of genitourinary tract infection (7) |
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| 521 | Since your last routine study contact, have your menstrual periods stopped due to natural menopause, hysterectomy, the removal of both ovaries, or radiation or chemotherapy treatment? (Go To: End of Form) |
| | | Permissible Values (value): | No (0) |
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