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CanSaRCC
Canadian Sarcoma Research and
Clinical 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
Inclusion Criteria:
Please specify: 1. Diagnosis (i.e. LMS).2. Years of Interest (i.e. 2008 -2018) .3. Stage (i.e. Met, Not Met, Both). 4. Notes
Demographics:
Hospital ID 1 (MSH)
Hospital ID 2 (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
Age at Diagnosis
Tumour incidentally found
Primary Tumour Site
Presentation Status
Primary disease treated and recurred
Initial Presentation/Symptom Onset
Metastatic disease at diagnosis
Patient enrolled in QOL
Date of Presentation to Sarcoma Centre
Tumour size (cm)
Other Cancer Diagnosis (Date of Diagnosis, Cancer Type)
Date of Diagnosis
Tumour size categorical
Event1
Date of Birth
Tumour Orientation
Event2
Sex
Predisposing Factors
Event3
Family History:
Relationship to patient
Type of Sarcoma
Date of Diagnosis
Age at Diagnosis
Other Type of Cancer
Previous Radiation:
Start Date
End Date
Cancer Type
Institution
Radiation Type
Radiation Site
Radiation Dose (Gy)
Number of Fractions
Previous Chemo:
Line of therapy
Start Date
End Date
Cancer Type
Institution
Number of Cycles Received
Reason for Treatment Discontinuation
Drug Name
Previous Surgery:
Cancer Type
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
Mitosis numerator
Mitosis 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 a Surgical Mesh Used?
Was Biological Mesh Used?
Was Ablation used?
What type of ablation was used?
Tumour Site
Surgical Pathology:
Surgical Pathology Report Date
Specimen Number
Pathological Diagnosis
Grade
Margin status
Percent Necrosis
Tumour Dimensions (cm)
Tumour Size Categorical
Mitotic rate numerator
Mitotic rate denominator
Radiation:
Start Date
Radiation Indication
Was radiation treatment interrupted?
Pre-radiation tumour size dimensions
End Date
Radiation Response
What was the reason for treatment interruption?
Tumour Orientation
Radiation Type
Radiation Dose (Gy)
Did the patient experience toxicity(ies) to treatment?
Post-radiation tumour size dimensions
Radiation Site
Number of Fraction
What Grade?
Tumour Orientation
Chemotherapy:
Start Date
Number of cycles received
Reason for treatment discontinuation
End Date
What drug/combination of drugs were given?
Is patient part of a clinical trial?
Line of Therapy
Dose
Trial Number
On treatment
Date of first evaluation on treatment
Date on study
Indication for Chemo
Date of evaluation at end of treatment
Date off study
Patient BSA at treatment start
Best response to chemotherapy
Type of study
Follow-Up:
Date of Follow up
Status of Patient
Visit Status
Imaging:
Date of Imaging Study
Reason for imaging
Modality of imaging
Site
Finding of Imaging
Multifocal
Dimensions of Tumour
Tumour Orientation
Categorical dimensions of tumour
Other Details
Research Sample:
Type of Sample
Research Surgical Path Number
Status of Sample
Tumor Tissue - Multi Region (Y/N)
RNA Ratio
Date of Collection
Surgical Path Number
Notes
Gross Pathology Image
Genomics
OCGN Number
Location of Sample
Tumor Tissue - Diagnosis
DNA Concentration
Animal Model
Biospeciman Number