Protocol - Cancer Treatments

Description:

These questions start by asking if the respondent has had cancer. For respondents who have had cancer, detailed follow-up questions ask about the type of cancer treatment, including surgery, chemotherapy, radiation, and hormone therapy.

Protocol:

1. Have you ever had cancer?

[ ] Yes

[ ] No

If so, please complete the following chart:

** Please include any diagnosis of Breast DCIS here, and specify Breast Cancer or DCIS.

Cancer Site/Type:	Example: Breast Cancer	Your Cancer:
Laterality (Left/Right/Not Applicable)	Left
Date of Diagnosis	12/2000
Age of Diagnosis	47
Did you have Surgery for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Name of Procedure	Radical mastectomy (left)
Surgery Date	1/5/2001
Treatment Hospital	Jefferson, Philadelphia, PA
Did you receive Chemotherapy for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Type of Chemo* (Please choose from chemo drug list below)	Adriamycin® & Cytoxan®
Date Chemo completed	2/2001
Treatment Hospital	Jefferson, Philadelphia, PA
Did you receive Radiation for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
Date Radiation completed	3/2001
Treatment Hospital	HUP
Did you receive Hormonal Therapy for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Name of Hormone Therapy (ex. Tamoxifen, Aromasin®, Femara®)	Tamoxifen
Treatment Hospital	HUP
Date Hormonal Therapy started	4/2001
Did you receive any other type(s) of therapy?	[_] Yes [X] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Please specify.
Date Other Therapy started
Treatment Hospital
Have you had a Recurrence with this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Date of Recurrence?	9/2002
Where did this cancer recur? (ex. lung, breast, liver)	Lung
Treatment Hospital	HUP

If you have been diagnosed with more than one cancer, please complete the following chart:

Cancer Site/Type:	Example: Second Cancer: Breast Cancer	Your Second Cancer:
Laterality (Left/Right/Not Applicable)	Right
Date of Diagnosis	5/2003
Age of Diagnosis	50
Did you have Surgery for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Name of Procedure	Radical mastectomy (right)
Surgery Date	6/1/2003
Treatment Hospital	Jefferson, Philadelphia, PA
Did you receive Chemotherapy for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Type of Chemo* (Please choose from list below)	Adriamycin® & Cytoxan®
Date Chemo started	7/2003
Treatment Hospital	Jefferson, Philadelphia, PA
Did you receive Radiation for this Cancer?	[_] Yes [X] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
Date Radiation started
Treatment Hospital
Did you receive Hormonal Therapy for this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Name of Hormone Therapy (ex. Tamoxifen, Aromasin®, Femara®)	Tamoxifen
Treatment Hospital	HUP
Date Hormonal Therapy started	8/2003
Did you receive any other type(s) of therapy?	[_] Yes [X] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Please specify.
Date Other Therapy started
Treatment Hospital
Have you had a Recurrence with this Cancer?	[X] Yes [_] No [_] Not Sure	[_] Yes [_] No [_] Not Sure
If yes: Date of Recurrence?	10/2004
Where did this cancer recur? (ex. lung, breast, liver)	Chest Wall
Treatment Hospital	HUP

*Chemo Drug List Examples

Adriamycin®
Paclitaxel Taxotere®
Cytoxan®
Xeloda®
Other

Leucovorin®
Fluorouracil®
Methotrexate Taxol®
Herceptin®
Avastin®

Adriamycin is ® a registered trademark, Pharmacia Inc.

Cytoxan® and Taxol® are registered trademarks, Bristol-Myers Squibb Company.

Aromasin® is a registered trademark, Pfizer, Inc.

Femara® is a registered trademark, Novartis Pharmaceuticals Corporation.

Taxotere® is a registered trademark, Sanofi-Aventis U.S. LLC.

Xeloda® is a registered trademark, Roche Pharmaceuticals.

Leucovorin® is a registered trademark, Mayne Pharma (USA) Inc.

Fluorouracil® is a registered trademark, Gensia Sicor Pharmaceuticals, Inc.

Herceptin® and Avastin® are registered trademarks, Genentech, Inc.

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Download PDF

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Women, aged 18 years and above*

*While this protocol was used in a study of women, the Cancer Working Group deems it appropriate to use with adult males.

Specific Instructions:

Complete the entire protocol only if the respondent answers "Yes" to question 1.

Selection Rationale

This protocol was selected because it provides the respondent with a form to self-report on the cancer sites and the details of the types of treatment received.

Language

English

Standards

Standard	Name	ID	Source
Common Data Elements (CDE)	Person Cancer Treatment History Text	2960986	CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)	Cancer treatment proto	62610-1	LOINC

Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

University of Pennsylvania, Abramson Cancer Center, Cancer Risk Evaluation Program, Health History Questionnaire 9/2006, questions from pages 2&ndash3.

General References

None

Protocol ID:

71101

Variables:

Export Variables

Variable Name	Variable ID	Variable Description	Version	dbGaP Mapping
PX071101_Cancer_Chemotherapy	PX071101020501	Did you receive Chemotherapy for this Cancer?	4	N/A
PX071101_Cancer_Chemotherapy2	PX071101030501	Did you receive Chemotherapy for this Cancer?	4	N/A
PX071101_Cancer_Chemotherapy_Completed_Date	PX071101020503	Date Chemo completed?	4	N/A
PX071101_Cancer_Chemotherapy_Drug_Name	PX071101020502	Type of Chemo?	4	N/A
PX071101_Cancer_Chemotherapy_Drug_Name2	PX071101030502	Type of Chemo?	4	N/A
PX071101_Cancer_Chemotherapy_Hospital	PX071101020504	Treatment Hospital?	4	N/A
PX071101_Cancer_Chemotherapy_Hospital2	PX071101030504	Treatment Hospital?	4	N/A
PX071101_Cancer_Chemotherapy_Started_Date2	PX071101030503	Date Chemo started?	4	N/A
PX071101_Cancer_Diagnosis_Age	PX071101020300	Age of Diagnosis?	4	Variable Mapping
PX071101_Cancer_Diagnosis_Age2	PX071101030300	Age of Diagnosis?	4	Variable Mapping
PX071101_Cancer_Diagnosis_Date	PX071101020200	Date of Diagnosis?	4	Variable Mapping
PX071101_Cancer_Diagnosis_Date2	PX071101030200	Date of Diagnosis?	4	Variable Mapping
PX071101_Cancer_Hormonal_Therapy	PX071101020701	Did you receive Hormonal Therapy for this Cancer?	4	N/A
PX071101_Cancer_Hormonal_Therapy2	PX071101030701	Did you receive Hormonal Therapy for this Cancer?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Drug_Name	PX071101020702	Name of Hormone Therapy?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Drug_Name2	PX071101030702	Name of Hormone Therapy?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Hospital	PX071101020704	Treatment Hospital?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Hospital2	PX071101030704	Treatment Hospital?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Started_Date	PX071101020703	Date Hormonal Therapy started?	4	N/A
PX071101_Cancer_Hormonal_Therapy_Started_Date2	PX071101030703	Date Hormonal Therapy started?	4	N/A
PX071101_Cancer_Laterality	PX071101020100	Laterality?	4	N/A
PX071101_Cancer_Laterality2	PX071101030100	Laterality?	4	N/A
PX071101_Cancer_Other_Therapy	PX071101020801	Did you receive any other type(s) of therapy?	4	N/A
PX071101_Cancer_Other_Therapy2	PX071101030801	Did you receive any other type(s) of therapy?	4	N/A
PX071101_Cancer_Other_Therapy_Hospital	PX071101020804	Treatment Hospital?	4	N/A
PX071101_Cancer_Other_Therapy_Hospital2	PX071101030804	Treatment Hospital?	4	N/A
PX071101_Cancer_Other_Therapy_Name	PX071101020802	Name of Other Therapy?	4	N/A
PX071101_Cancer_Other_Therapy_Name2	PX071101030802	Name of Other Therapy?	4	N/A
PX071101_Cancer_Other_Therapy_Started_Date	PX071101020803	Date Other Therapy started?	4	N/A
PX071101_Cancer_Other_Therapy_Started_Date2	PX071101030803	Date Other Therapy started?	4	N/A
PX071101_Cancer_Radiation	PX071101020601	Did you receive Radiation for this Cancer?	4	N/A
PX071101_Cancer_Radiation2	PX071101030601	Did you receive Radiation for this Cancer?	4	N/A
PX071101_Cancer_Radiation_Completed_Date	PX071101020602	Date Radiation completed?	4	N/A
PX071101_Cancer_Radiation_Hospital	PX071101020603	Treatment Hospital	4	N/A
PX071101_Cancer_Radiation_Hospital2	PX071101030603	Treatment Hospital	4	N/A
PX071101_Cancer_Radiation_Started_Date2	PX071101030602	Date Radiation started?	4	N/A
PX071101_Cancer_Recurrence	PX071101020901	Have you had a Recurrence with this Cancer?	4	N/A
PX071101_Cancer_Recurrence2	PX071101030901	Have you had a Recurrence with this Cancer?	4	N/A
PX071101_Cancer_Recurrence_Date	PX071101020902	Date of Recurrence?	4	N/A
PX071101_Cancer_Recurrence_Date2	PX071101030902	Date of Recurrence?	4	N/A
PX071101_Cancer_Recurrence_Hospital	PX071101020904	Treatment Hospital?	4	N/A
PX071101_Cancer_Recurrence_Hospital2	PX071101030904	Treatment Hospital?	4	N/A
PX071101_Cancer_Recurrence_Site	PX071101020903	Where did this cancer recur? (ex. lung, breast, liver)	4	N/A
PX071101_Cancer_Recurrence_Site2	PX071101030903	Where did this cancer recur? (ex. lung, breast, liver)	4	N/A
PX071101_Cancer_Site	PX071101020000	Cancer Site/Type?	4	N/A
PX071101_Cancer_Site2	PX071101030000	Cancer Site/Type?	4	N/A
PX071101_Cancer_Surgery	PX071101020401	Did you have Surgery for this Cancer?	4	N/A
PX071101_Cancer_Surgery2	PX071101030401	Did you have Surgery for this Cancer?	4	N/A
PX071101_Cancer_Surgery_Date	PX071101020403	Surgery Date?	4	N/A
PX071101_Cancer_Surgery_Date2	PX071101030403	Surgery Date?	4	N/A
PX071101_Cancer_Surgery_Hospital	PX071101020404	Treatment Hospital?	4	N/A
PX071101_Cancer_Surgery_Hospital2	PX071101030404	Treatment Hospital?	4	N/A
PX071101_Cancer_Surgery_Name	PX071101020402	Name of Procedure?	4	N/A
PX071101_Cancer_Surgery_Name2	PX071101030402	Name of Procedure?	4	N/A
PX071101_Had_Cancer	PX071101010000	Have you ever had cancer?	4	N/A

Research Domain Information

Measure Name:

Cancer Treatments

Release Date:

December 30, 2009

Definition

A measure to assess history of cancer treatments

Purpose

The purpose of this measure is to assess if a respondent has had cancer and the type(s) of treatment received.

Keywords

cancer, treatment, Chemotherapy, radiation, surgery, hormone therapy, chemo, Cancer Risk Evaluation Program (CREP)

Mapping for PX071101_Cancer_Diagnosis_Age

dbGAP Study	dbGAP Variable	dbGAP Variable Description
A Family-Based Study of Genes and Environment in Young-Onset Breast Cancer	phv00196060	Age at diagnosis of participating case
A Multiethnic GWAS of Prostate Cancer	phv00124444	Age at diagnosis for cancer cases
A Multiethnic GWAS of Prostate Cancer	phv00142469	Age at diagnosis for cancer cases
A Multiethnic GWAS of Prostate Cancer	phv00142488	Age at diagnosis for cancer cases
CARDIA Cohort	phv00114557	AGE AT DX, TUMOR. Q 1.09A
CARDIA Cohort	phv00113097	AGE, DX OF TUMOR. Q 1.09A
Genentech Lung Cancer Sequencing	phv00112393	Disease onset age
GWAS on Cataract and HDL in the PMRP	phv00073585	Age at first cancer indication
High Density SNP Association Analysis of Lung Cancer	phv00201873	Disease onset age
Jackson Heart Study (JHS) Cohort	phv00128100	8b: Age told you had cancer?
Multi-Ethnic Study of Atherosclerosis (MESA) Cohort	phv00085767	AGE OF FIRST CANCER DX
Multiethnic Cohort (MEC) Breast Cancer Genetics	phv00173165	Age at diagnosis for cancer cases
NEI Age-Related Eye Disease Study (AREDS)	phv00053877	AGE FIRST TOLD HAD CANCER (ALL PARTICIPANTS)
NHLBI Cleveland Family Study (CFS) Candidate Gene Association Resource (CARe)	phv00123543	95 Age Diagnosed - Cancer
Prostate Cancer Genome Sequencing Project	phv00167302	Disease onset age
Tyrosine Kinase Mutations in Endometrial Cancer	phv00221197	Disease onset age
Whole Genome Association Study of Bipolar Disorder	phv00051921	B1 Cancer, age, (African American participants). DIGS4
Whole Genome Association Study of Bipolar Disorder	phv00017009	B1. Cancer, age. (Participants with European ancestry). DIGS4
Whole Genome Sequencing of Triple Negative Breast Cancer	phv00124473	Disease onset age

Mapping for PX071101_Cancer_Diagnosis_Age2

dbGAP Study	dbGAP Variable	dbGAP Variable Description
A Family-Based Study of Genes and Environment in Young-Onset Breast Cancer	phv00196060	Age at diagnosis of participating case
A Multiethnic GWAS of Prostate Cancer	phv00124444	Age at diagnosis for cancer cases
A Multiethnic GWAS of Prostate Cancer	phv00142469	Age at diagnosis for cancer cases
A Multiethnic GWAS of Prostate Cancer	phv00142488	Age at diagnosis for cancer cases
CARDIA Cohort	phv00114557	AGE AT DX, TUMOR. Q 1.09A
CARDIA Cohort	phv00113097	AGE, DX OF TUMOR. Q 1.09A
Genentech Lung Cancer Sequencing	phv00112393	Disease onset age
GWAS on Cataract and HDL in the PMRP	phv00073585	Age at first cancer indication
High Density SNP Association Analysis of Lung Cancer	phv00201873	Disease onset age
Jackson Heart Study (JHS) Cohort	phv00128100	8b: Age told you had cancer?
Multi-Ethnic Study of Atherosclerosis (MESA) Cohort	phv00085767	AGE OF FIRST CANCER DX
Multiethnic Cohort (MEC) Breast Cancer Genetics	phv00173165	Age at diagnosis for cancer cases
NEI Age-Related Eye Disease Study (AREDS)	phv00053877	AGE FIRST TOLD HAD CANCER (ALL PARTICIPANTS)
NHLBI Cleveland Family Study (CFS) Candidate Gene Association Resource (CARe)	phv00123543	95 Age Diagnosed - Cancer
Prostate Cancer Genome Sequencing Project	phv00167302	Disease onset age
Tyrosine Kinase Mutations in Endometrial Cancer	phv00221197	Disease onset age
Whole Genome Association Study of Bipolar Disorder	phv00051921	B1 Cancer, age, (African American participants). DIGS4
Whole Genome Association Study of Bipolar Disorder	phv00017009	B1. Cancer, age. (Participants with European ancestry). DIGS4
Whole Genome Sequencing of Triple Negative Breast Cancer	phv00124473	Disease onset age

Mapping for PX071101_Cancer_Diagnosis_Date

dbGAP Study	dbGAP Variable	dbGAP Variable Description
Framingham Cohort	phv00080780	Diagnosis date of tumor or cancer
Jackson Heart Study (JHS) Cohort	phv00125262	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125003	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125088	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125173	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125259	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125006	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125091	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125176	7n. And the date it was diagnosed

Mapping for PX071101_Cancer_Diagnosis_Date2

dbGAP Study	dbGAP Variable	dbGAP Variable Description
Framingham Cohort	phv00080780	Diagnosis date of tumor or cancer
Jackson Heart Study (JHS) Cohort	phv00125003	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125088	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125173	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125259	7k. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125006	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125091	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125176	7n. And the date it was diagnosed
Jackson Heart Study (JHS) Cohort	phv00125262	7n. And the date it was diagnosed

Protocol - Cancer Treatments

Related Protocols:

Essential Protocols:

Description:

Protocol:

Protocol Name from Source:

Availability:

Personnel and Training Required

Equipment Needs

Requirements

Mode of Administration

Life Stage:

Participants:

Specific Instructions:

Selection Rationale

Language

Standards

Derived Variables

Process and Review

Source

General References

Protocol ID:

Variables:

Measure Name:

Release Date:

Definition

Purpose

Keywords