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CanSaRCC
Canadian Sarcoma Clinical and
Research Collaboration
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Data Fields Request
Project Title:
*Please make sure the project title matches the title you provided in the "Submit Project Request" form
Demographics:
Hospital ID (MRN)
Consent (Y/N)
Date consent obtained
Consent obtained by
Is the consent form on file?
Deceased (Y/N)
Date of death
Cause of Death
Patient Diagnosis:
Pathological Diagnosis
Date of Diagnosis
Tumour size (cm)
Tumour incidentally found
Primary Tumour Site
Age at Diagnosis
Tumour size categorical
Primary disease treated and recurred
Symptom Onset
Presentation Status
Tumour Orientation
Patient enrolled in QOL
Date of Presentation
Metastatic disease
Predisposing Factors
Other Cancer Diagnosis
Date of Birth
Previous Radiation
Family History:
Relationship to patient
Type of Sarcoma
Date of Diagnosis
Age at Diagnosis
Other type of cancer
Previous Radiation:
Start Date
End Date
Radiation Type
Radiation Site
Radiation Dose
Number of Fractions
Previous Chemo:
Line of Therapy
Start Date
End Date
Number of Cycles Received
Reason for Treatment Discontinuation
Drug Name
Previous Surgery:
Surgery Date
Institution
Surgeon Name
Type of Surgery
Type of Resection
Biopsy Pathology:
Biopsy Date
Specimen Number
Biopsy Institution
Type of Biopsy
Pathological Diagnosis
Grade at bx
Mitoses numerator
Mitoses denominator
Mutational Status:
Mutations
Describe Mutation
Surgery:
Surgery Date
Name of Surgeon
Location of Surgery
Type of Surgery
Status of Surgery
If Emergency, indication
Intent of Surgery
Deep vs. superficial
Type of Resection
Type of Plastic Reconstruction
Type of Urologic Reconstruction
Vascular Reconstruction
Type of Surgery
Complications
Stoma (Y/N)
Was Surgical Mesh Used?
Was Ablation used?
Tumour Site
Surgical Pathology:
Date of Surgical Path Report
Number on Path Report
Margin status
Percent Necrosis
Dimensions of tumor
Tumor Orientation
Tumor size categorical
Mitotic rate numerator
Mitotic rate denominator
Radiation:
Start Date (first cycle)
End Date (last cycle)
Line of therapy
On treatment
Indication for Chemo
Patient BSA at treatment start
Number of cycles received
Drugs were given
Date of first evaluation on treatment
Date of evaluation at end of treatment
Best response to chemotherapy
Reson for treatment discontinuation
Patient part of clinical trial (Y/N)
Chemotherapy:
Start Date
Patient BSA at treatment start
Date of evaluation at end of treatment
End Date
Number of cycles received
Best response to chemotherapy
Line of Therapy
What drug/combination of drugs were given?
Reason for treatment discontinuation
Indication for Chemo
Date of first evaluation on treatment
Is patient part of a clinical trial?
Follow-Up:
Date of Follow up (DD-MM-YYYY)
Status of Patient
Visit Status
Disease Event (Recurrence/Progression)
Imaging:
Date of Imaging Study
Reason for imaging
Modality of imaging
Site
Other Details
Research Sample:
Type of Sample
Date of Collection (DD-MM-YYY)
What is the OCGN Number assigned?
What is the biospecimen number of the sample?
Location of the sample
Notes:
Please specify any data parameters or inclusion/exclusion criteria. Ex. Date of Diagnosis: please include patients diagnosed between 2012-2016. Ex. Pathological Diagnosis: please include all patients with a Liposarcoma diagnosis.