LinkId Text Cardinality Type Description & Constraints TreatmentVariables Questionnaire https://connect.ichom.org/fhir/Questionnaire/TreatmentVariables#0.0.1 TREATMENT_BREAST Indicate whether the patient received one of the following treatment during the last year: (select all that apply) 1..* choice Value Set: Treatment variables SURGERY_BREAST Indicate whether the patient received surgery during the last year: 0..1 choice Enable When: TREATMENT_BREAST = Surgery (Treatment variables#1) Value Set: BreastSurgeryTypes SurgeryDate Provide the date of surgery: 0..1 date Enable When: TREATMENT_BREAST = Surgery (Treatment variables#1) SURGERYAX Indicate whether the patient received surgery to the axilla during the last year: 0..1 choice Enable When: TREATMENT_BREAST = Surgery to axilla (Treatment variables#2) Value Set: Surgery Axilla Types SURGERYAXDATE Please provide the date of surgery to the axilla: 0..1 date Enable When: TREATMENT_BREAST = Surgery to axilla (Treatment variables#2) SURGERYAX2 Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year: 0..1 choice Enable When: SURGERYAX = Sentinel lymph node biopsy (Surgery Axilla Code System#0) SURGERYAX = Axillary sampling (Surgery Axilla Code System#1) Value Set: Boolean extended Code System SURGERYAX2DATE Please provide the date of axillary clearance: 0..1 date Enable When: SURGERYAX2 = Yes (Boolean extended Code System#1) RECONSTRUCT Indicate whether the patient received a delayed reconstruction during the last year: 0..1 choice Enable When: TREATMENT_BREAST = Delayed reconstruction (Treatment variables#3) Value Set: Delayed reconstruction Code System RECONSTRUCTDATE Please provide the date of delayed reconstruction: 0..1 date Enable When: TREATMENT_BREAST = Delayed reconstruction (Treatment variables#3) RADIOTX_BREAST If the patient received radiotherapy during the last year, please indicate the intent of radiotherapy: 0..1 choice Enable When: TREATMENT_BREAST = Radiotherapy (Treatment variables#4) Value Set: Intent of Therapy ValueSet RADIOTXTYPE_BREAST Indicate location/type of radiotherapy: 0..1 choice Enable When: TREATMENT_BREAST = Radiotherapy (Treatment variables#4) Value Set: Location of radiotherapy ValueSet RadioTxStartDate Please provide the start date of radiotherapy: 0..1 date Enable When: TREATMENT_BREAST = Radiotherapy (Treatment variables#4) RadioTxStopDate Please provide the stop date of radiotherapy: 0..1 date Enable When: TREATMENT_BREAST = Radiotherapy (Treatment variables#4) CHEMOTXINTENT If the patient received chemotherapy during the last year, please indicate the intent of chemotherapy: 0..1 choice Enable When: TREATMENT_BREAST = Chemotherapy (Treatment variables#5) Value Set: Intent of Therapy ValueSet CHEMOTXTYPE_BREAST Indicate what type of chemotherapy (select all that apply): 0..1 choice Enable When: TREATMENT_BREAST = Chemotherapy (Treatment variables#5) Value Set: Type of chemotherapy ValueSet ChemoTxStartDate Please provide the start date of chemotherapy: 0..1 date Enable When: TREATMENT_BREAST = Chemotherapy (Treatment variables#5) ChemoTxStopdate Please provide the stop date of chemotherapy: 0..1 date Enable When: TREATMENT_BREAST = Chemotherapy (Treatment variables#5) HORMONTX_BREAST If the patient received hormontherapy during the last year, please indicate the intent of hormontherapy: 0..1 choice Enable When: TREATMENT_BREAST = Hormonal therapy (Treatment variables#6) Value Set: Intent of Therapy ValueSet HORMONTXTYPE Indicate what type of hormonal therapy (select all that apply): 0..1 choice Enable When: TREATMENT_BREAST = Hormonal therapy (Treatment variables#6) Value Set: Hormonal therapy type ValueSet HORMONTXSTARTDATE Please provide the start date of hormonal therapy: 0..1 date Enable When: TREATMENT_BREAST = Hormonal therapy (Treatment variables#6) HORMONTXSTOPDATE Please provide the stop date of hormonal therapy, if applicable: 0..1 date Enable When: TREATMENT_BREAST = Hormonal therapy (Treatment variables#6) TARGETTX_BREAST Indicate what type of targeted therapy: 0..1 choice Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables#7) Value Set: Targeted Therapy ValueSet TargetTxStartDate Please provide the start date of targeted therapy, if applicable 0..1 date Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables#7) TargetTxStopDate Please provide the stop date of targeted therapy, if applicable 0..1 date Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables#7) SURGERYPATIENT Indicate if the patient has had one of the following re-operations since their surgery for breast cancer? (select all that apply) 0..1 choice Value Set: Reoperations ValueSet SURGERYDATEPATIENT When was the reoperation? 0..1 date Enable When: SURGERYPATIENT = Breast reconstruction surgery (Reoperations Code System#1) SURGERYPATIENT = Mastectomy (Reoperations Code System#2) SURGERYPATIENT = Axillary dissection (Reoperations Code System#3) SYSTPATIENT Is the patient currently receiving systemic (ie drug) treatment for breast cancer? 0..1 choice Value Set: Systemic Therapy ValueSet SYSTDATEPATIENT When did the systemic treatment stop? 0..1 date Enable When: SYSTPATIENT = Breast reconstruction surgery (Reoperations Code System#1) REOP_BREAST Indicate if the patient has undergone a reoperation due to involved margins after primary surgery: 0..1 choice Enable When: SURGERY_BREAST != Unknown (Breast surgery types#999) Value Set: Involved margins ValueSet REOPDATE_BREAST Please provide the date of the reoperation due to positive margins: 0..1 date Enable When: REOP_BREAST != Unknown (Involved margins Code System#999) REOP_BREAST != No reoperation due to involved margins (Involved margins Code System#0) ComplicationImpact Please state the impact of the complication experienced by the patient: 1..1 choice Enable When: TREATMENT_BREAST != No reoperation due to involved margins (Involved margins Code System#0) TREATMENT_BREAST != Unknown (Involved margins Code System#999) Value Set: Complication impact ValueSet ComplicationAttrTreatment Indicate whether the complication is attributable to treatment: 0..1 choice Enable When: TREATMENT_BREAST != No complication (Complication impact Code System#0) TREATMENT_BREAST != Unknown (Complication impact Code System#999) Value Set: Boolean extended Code System COMPL_BREAST Please indicate the type of complication: 0..1 choice Enable When: ComplicationAttrTreatment = Yes (Boolean extended Code System#1) Value Set: Complication type ValueSet Documentation for this format
Indicate whether the patient received one of the following treatment during the last year: (select all that apply)
Indicate whether the patient received surgery during the last year:
Indicate whether the patient received surgery to the axilla during the last year:
Please provide the date of surgery to the axilla:
Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year:
Please provide the date of axillary clearance:
Indicate whether the patient received a delayed reconstruction during the last year:
Please provide the date of delayed reconstruction:
If the patient received radiotherapy during the last year, please indicate the intent of radiotherapy:
Please provide the start date of radiotherapy:
Please provide the stop date of radiotherapy:
If the patient received chemotherapy during the last year, please indicate the intent of chemotherapy:
Indicate what type of chemotherapy (select all that apply):
Please provide the start date of chemotherapy:
Please provide the stop date of chemotherapy:
If the patient received hormontherapy during the last year, please indicate the intent of hormontherapy:
Indicate what type of hormonal therapy (select all that apply):
Please provide the start date of hormonal therapy:
Please provide the stop date of hormonal therapy, if applicable:
Please provide the start date of targeted therapy, if applicable
Please provide the stop date of targeted therapy, if applicable
Indicate if the patient has had one of the following re-operations since their surgery for breast cancer? (select all that apply)
Is the patient currently receiving systemic (ie drug) treatment for breast cancer?
Indicate if the patient has undergone a reoperation due to involved margins after primary surgery:
Please provide the date of the reoperation due to positive margins:
Please state the impact of the complication experienced by the patient:
Indicate whether the complication is attributable to treatment:
Please indicate the type of complication: