ICHOM Patient Centered Outcomes Measure Set for Breast Cancer
1.0.0 - trial-use International flag

ICHOM Patient Centered Outcomes Measure Set for Breast Cancer, published by HL7 International - Clinical Interoperability Council Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/fhir-ichom-breast-cancer-ig/ and changes regularly. See the Directory of published versions

Questionnaire: ClinicalResponseSixMonths (Experimental)

Official URL: http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseSixMonths Version: 1.0.0
Standards status: Informative Computable Name: ClinicalResponseSixMonths

Clinical response questionnaire at 6 months post-treatment follow-up

LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. ClinicalResponseSixMonthsClinical response questionnaire at 6 months post-treatment follow-upQuestionnairehttp://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseSixMonths#1.0.0
... General-Information-ClinicalGeneral information1..1group
.... NA-ClinicalWhat is the patient's medical record number?1..1string
.... LastName-ClinicalWhat is the patient's last name?1..1string
... Tumor-FactorsTumor factors1..1group
.... received_surgeryHas the patient received surgery?1..1boolean
.... TNMPT_BREASTIndicate the pathological tumor stage (per AJCC 8th Ed.)1..1choiceEnable When: received_surgery = true
Value Set: TNM Primary Tumor ValueSet
.... TNMPN_BREASTIndicate the pathological nodal stage (per AJCC 8th Ed.)1..1choiceEnable When: received_surgery = true
Value Set: TNM Regional Nodes ValueSet
.... TNMPM_BREASTIndicate the pathological distant metastasis (per AJCC 8th Ed.)1..1choiceEnable When: received_surgery = true
Value Set: TNM Distant Metastases ValueSet
.... SIZEINVIndicate size of invasive component of tumor (in mm)1..1integerEnable When: received_surgery = true
.... NumLymphNodesResectIndicate the number of lymph nodes resected1..1integerEnable When: received_surgery = true
.... LYMPHINV_BREASTIndicate the number of lymph nodes involved according to the TNM stage AJCC 8th Ed.1..1integerEnable When: received_surgery = true
... Treatment-VariablesTreatment Variables1..1group
.... TREATMENT_BREASTIndicate whether the patient received one of the following treatment during the last year (select all that apply)1..*choiceValue Set: Type of treatments ValueSet
.... SURGERY_BREASTIndicate whether the patient received surgery during the last year1..1choiceEnable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003)
Value Set: Types of breast surgery ValueSet
.... SurgeryDateKnownIs the date of surgery known?1..1booleanEnable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003)
.... SurgeryDatePlease provide the date of surgery1..1dateEnable When: SurgeryDateKnown = true
.... SURGERYAXIndicate whether the patient received surgery to the axilla1..1choiceEnable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008)
Value Set: Axilla surgery ValueSet
.... SURGERYAXDATE-KnownIs the date of surgery to the axilla known?1..1booleanEnable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008)
.... SURGERYAXDATEPlease provide the date of surgery to the axilla1..1dateEnable When: SURGERYAXDATE-Known = true
.... SURGERYAX2Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year1..1choiceEnable When:
  • SURGERYAX = Sentinel lymph node biopsy (SNOMED CT#396487001)
  • SURGERYAX = Excision of axillary lymph node (SNOMED CT#234262008)

Value Set: Yes, No and Unknown Valueset
.... SURGERYAX2DATE-KnownIs the date of axillary clearance known?1..1booleanEnable When: SURGERYAX2 = Yes (expandedYes-NoIndicator#Y)
.... SURGERYAX2DATEPlease provide the date of axillary clearance1..1dateEnable When: SURGERYAX2DATE-Known = true
.... RECONSTRUCTION_DELAYIndicate whether the patient received a delayed reconstruction1..1choiceEnable When: SURGERY_BREAST = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction)
Value Set: Yes, No and Unknown Valueset
.... SURGERY_RECONSTRUCTIONIndicate what type of reconstruction the patient received1..1choiceEnable When:
  • SURGERY_BREAST = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction)
  • SURGERY_BREAST = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction)

Value Set: Type of reconstruction surgery ValueSet
.... ImplantReconstructionIndicate the location of the implant1..1choiceEnable When:
Value Set: Location of the implant ValueSet
.... RECONSTRUCTDATE-KnownIs the date of the delayed reconstruction known?1..1booleanEnable When: RECONSTRUCTION_DELAY = Yes (expandedYes-NoIndicator#Y)
.... RECONSTRUCTDATEPlease provide the date of delayed reconstruction1..1dateEnable When: RECONSTRUCTDATE-Known = true
.... RADIOTX_BREASTWhat was the intent of radiotherapy1..*choiceEnable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
Value Set: Intent of therapy ValueSet
.... RADIOTXTYPE_BREASTIndicate location/type of radiotherapy1..1choiceEnable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
Value Set: The location of radiotherapy ValueSet
.... RadioTxStartDate-KnownIs the start date of radiotherapy known?1..1booleanEnable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
.... RadioTxStartDatePlease provide the start date of radiotherapy1..1dateEnable When: RadioTxStartDate-Known = true
.... RadioTxStopDate-KnownIs the stop date of radiotherapy known?1..1booleanEnable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
.... RadioTxStopDatePlease provide the stop date of radiotherapy1..1dateEnable When: RadioTxStopDate-Known = true
.... CHEMOTXINTENTIndicate the intent of chemotherapy1..1choiceEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)

Value Set: Intent of therapy ValueSet
.... CHEMOTXTYPE_BREASTIndicate the type of chemotherapy (select all that apply)1..*choiceEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)

Value Set: Type of chemotherapy ValueSet
.... ChemoTxStartDate-KnownIs the start date of chemotherapy known?1..1booleanEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
.... ChemoTxStartDatePlease provide the start date of chemotherapy1..1dateEnable When: ChemoTxStartDate-Known = true
.... ChemoTxStopdate-KnownIs the stop date of chemotherapy known?1..1booleanEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
.... ChemoTxStopdatePlease provide the stop date of chemotherapy1..1dateEnable When: ChemoTxStopdate-Known = true
.... HORMONTX_BREASTIndicate the intent of hormonal therapy1..1choiceEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
Value Set: Intent of therapy ValueSet
.... HORMONTXTYPEIndicate the type of hormonal therapy (select all that apply)1..*choiceEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
Value Set: Type of hormonal therapy ValueSet
.... HORMONTXSTARTDATE-KnownIs the start date of hormonal therapy known?1..1booleanEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
.... HORMONTXSTARTDATEPlease provide the start date of hormonal therapy1..1dateEnable When: HORMONTXSTARTDATE-Known = true
.... HORMONTXSTOPDATE-KnownIs the stop date of hormonal therapy known?1..1booleanEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
.... HORMONTXSTOPDATEPlease provide the stop date of hormonal therapy, if applicable1..1dateEnable When: HORMONTXSTOPDATE-Known = true
.... TARGETTX_BREASTIndicate the type of targeted therapy1..1choiceEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
Value Set: Type of targeted therapy ValueSet
.... TargetTxStartDate-KnownIs the start date of targeted therapy known?1..1booleanEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
.... TargetTxStartDatePlease provide the start date of targeted therapy1..1dateEnable When: TargetTxStartDate-Known = true
.... TargetTxStopDate-KnownIs the stop date of targeted therapy known?1..1booleanEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
.... TargetTxStopDatePlease provide the stop date of targeted therapy1..1dateEnable When: TargetTxStopDate-Known = true
.... SURGERYPATIENTIndicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply)1..*choiceValue Set: Type of re-operation
.... SURGERYDATEPATIENT-KnownIs the date of the reoperation known?1..1booleanEnable When:
.... SURGERYDATEPATIENTPlease provide the date of the reoperation1..1dateEnable When: SURGERYDATEPATIENT-Known = true
... DisutilityofCareDisutility of care1..1group
.... REOP_BREASTIndicate if the patient has undergone a reoperation due to involved margins after primary surgery1..1choiceEnable When: SURGERY_BREAST != unknown (NullFlavor#UNK)
Value Set: Re-operation due to involved margins ValueSet
.... REOP_RECONSTRUCTIONWhat type of reconstruction did the patient receive during reoperation?1..1choiceEnable When: REOP_BREAST = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction)
Value Set: Type of reconstruction surgery ValueSet
.... REOPDATE_BREAST-KnownIs the date of the reoperation due to positive margins known?1..1booleanEnable When: REOP_BREAST != unknown (NullFlavor#UNK)
.... REOPDATE_BREASTProvide the date of the reoperation due to positive margins1..1dateEnable When: REOPDATE_BREAST-Known = true
.... ComplicationImpactWhat was the impact of the complication experienced by the patient1..*choiceEnable When:
Value Set: Impact of complication ValueSet
.... ComplicationAttrTreatmentIndicate whether the complication is attributable to treatment1..1choiceEnable When:
Value Set: Yes, No and Unknown Valueset
.... COMPL_BREASTIndicate the type of complication1..1choiceEnable When: ComplicationAttrTreatment = Yes (expandedYes-NoIndicator#Y)
Value Set: Type of complication ValueSet

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