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

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: ClinicalResponseAnnualUpdate (Experimental)

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

Clinical response questionnaire at annual post-treatment follow-up

LinkId | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
AnnualClinicalResponse | Clinical response questionnaire at annual post-treatment follow-up |  | Questionnaire | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseAnnualUpdate#1.0.0
General-Information-Clinical | General information | 1..1 | group |
NA-Clinical | What is the patient's medical record number? | 1..1 | string |
LastName-Clinical | What is the patient's last name? | 1..1 | string |
Tumor-Factors | Tumor factors | 1..1 | group |
MUTBC | Indicate if the patient carries a genetic mutation predisposing breast cancer | 1..* | choice | Value Set: Germline Mutation ValueSet
Treatment-Variables | Treatment Variables | 1..1 | group |
TREATMENT_BREAST | Indicate whether the patient received one of the following treatment during the last year (select all that apply) | 1..* | choice | Value Set: Type of treatments ValueSet
SURGERY_BREAST | Indicate whether the patient received surgery during the last year | 1..1 | choice | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003) Value Set: Types of breast surgery ValueSet
SurgeryDateKnown | Is the date of surgery known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003)
SurgeryDate | Please provide the date of surgery | 1..1 | date | Enable When: SurgeryDateKnown = true
SURGERYAX | Indicate whether the patient received surgery to the axilla | 1..1 | choice | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008) Value Set: Axilla surgery ValueSet
SURGERYAXDATE-Known | Is the date of surgery to the axilla known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008)
SURGERYAXDATE | Please provide the date of surgery to the axilla | 1..1 | date | Enable When: SURGERYAXDATE-Known = true
SURGERYAX2 | Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year | 1..1 | choice | Enable 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-Known | Is the date of axillary clearance known? | 1..1 | boolean | Enable When: SURGERYAX2 = Yes (expandedYes-NoIndicator#Y)
SURGERYAX2DATE | Please provide the date of axillary clearance | 1..1 | date | Enable When: SURGERYAX2DATE-Known = true
RECONSTRUCTION_DELAY | Indicate whether the patient received a delayed reconstruction | 1..1 | choice | Enable When: SURGERY_BREAST = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Yes, No and Unknown Valueset
SURGERY_RECONSTRUCTION | Indicate what type of reconstruction the patient received | 1..1 | choice | Enable 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
ImplantReconstruction | Indicate the location of the implant | 1..1 | choice | Enable When: SURGERY_RECONSTRUCTION != Autologous (Type of reconstruction surgery CodeSystem#autologous) SURGERY_RECONSTRUCTION != unknown (NullFlavor#UNK) Value Set: Location of the implant ValueSet
RECONSTRUCTDATE-Known | Is the date of the delayed reconstruction known? | 1..1 | boolean | Enable When: RECONSTRUCTION_DELAY = Yes (expandedYes-NoIndicator#Y)
RECONSTRUCTDATE | Please provide the date of delayed reconstruction | 1..1 | date | Enable When: RECONSTRUCTDATE-Known = true
RADIOTX_BREAST | What was the intent of radiotherapy | 1..* | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: Intent of therapy ValueSet
RADIOTXTYPE_BREAST | Indicate location/type of radiotherapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: The location of radiotherapy ValueSet
RadioTxStartDate-Known | Is the start date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
RadioTxStartDate | Please provide the start date of radiotherapy | 1..1 | date | Enable When: RadioTxStartDate-Known = true
RadioTxStopDate-Known | Is the stop date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001)
RadioTxStopDate | Please provide the stop date of radiotherapy | 1..1 | date | Enable When: RadioTxStopDate-Known = true
CHEMOTXINTENT | Indicate the intent of chemotherapy | 1..1 | choice | Enable 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_BREAST | Indicate the type of chemotherapy (select all that apply) | 1..* | choice | Enable 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-Known | Is the start date of chemotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy) TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
ChemoTxStartDate | Please provide the start date of chemotherapy | 1..1 | date | Enable When: ChemoTxStartDate-Known = true
ChemoTxStopdate-Known | Is the stop date of chemotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy) TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
ChemoTxStopdate | Please provide the stop date of chemotherapy | 1..1 | date | Enable When: ChemoTxStopdate-Known = true
HORMONTX_BREAST | Indicate the intent of hormonal therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Intent of therapy ValueSet
HORMONTXTYPE | Indicate the type of hormonal therapy (select all that apply) | 1..* | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Type of hormonal therapy ValueSet
HORMONTXSTARTDATE-Known | Is the start date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
HORMONTXSTARTDATE | Please provide the start date of hormonal therapy | 1..1 | date | Enable When: HORMONTXSTARTDATE-Known = true
HORMONTXSTOPDATE-Known | Is the stop date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
HORMONTXSTOPDATE | Please provide the stop date of hormonal therapy, if applicable | 1..1 | date | Enable When: HORMONTXSTOPDATE-Known = true
TARGETTX_BREAST | Indicate the type of targeted therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) Value Set: Type of targeted therapy ValueSet
TargetTxStartDate-Known | Is the start date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
TargetTxStartDate | Please provide the start date of targeted therapy | 1..1 | date | Enable When: TargetTxStartDate-Known = true
TargetTxStopDate-Known | Is the stop date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
TargetTxStopDate | Please provide the stop date of targeted therapy | 1..1 | date | Enable When: TargetTxStopDate-Known = true
SURGERYPATIENT | Indicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply) | 1..* | choice | Value Set: Type of re-operation
SURGERYDATEPATIENT-Known | Is the date of the reoperation known? | 1..1 | boolean | Enable When: SURGERYPATIENT != unknown (NullFlavor#UNK) SURGERYPATIENT != Clinical finding absent (SNOMED CT#373572006)
SURGERYDATEPATIENT | Please provide the date of the reoperation | 1..1 | date | Enable When: SURGERYDATEPATIENT-Known = true
Survival-and-Disease-control | Survival and disease control | 1..1 | group |
Survival-Q0 | Was the intent of the treatment curative? | 1..1 | boolean |
MalignancyRecur | Is there evidence of local, regional or distant recurrence of neoplasm? | 1..1 | choice | Enable When: Survival-Q0 = true Value Set: Recurrence of neoplasm ValueSet
RecurMethod | What was the method of confirming recurrence of neoplasm? | 1..1 | choice | Enable When: MalignancyRecur = Yes, local recurrence (Recurrence of neoplasm CodeSystem#local-recurrence) MalignancyRecur = Yes, regional recurrence (Recurrence of neoplasm CodeSystem#regional-recurrence) MalignancyRecur = Yes, distant recurrence (Recurrence of neoplasm CodeSystem#distant-recurrence) Value Set: Recurrence method ValueSet
RecurDateCancer-Known | Is the date of cancer recurrence known? | 1..1 | boolean | Enable When: MalignancyRecur = Yes, local recurrence (Recurrence of neoplasm CodeSystem#local-recurrence) MalignancyRecur = Yes, regional recurrence (Recurrence of neoplasm CodeSystem#regional-recurrence) MalignancyRecur = Yes, distant recurrence (Recurrence of neoplasm CodeSystem#distant-recurrence)
RecurDateCancer | What is the date of cancer recurrence? | 1..1 | date | Enable When: RecurDateCancer-Known = true
VitalStatus | Indicate if the person has deceased, regardless of cause | 1..1 | choice | Value Set: Yes, No and Unknown Valueset
DeceasedDate-Known | Is the date of death of the patient known? | 1..1 | boolean | Enable When: VitalStatus = Yes (expandedYes-NoIndicator#Y)
DeceasedDate | Please provide the date of death of the patient | 1..1 | date | Enable When: DeceasedDate-Known = true
DEATHBC | Is the death attributable to breast cancer? | 1..1 | choice | Enable When: VitalStatus = Yes (expandedYes-NoIndicator#Y) Value Set: Yes, No and Unknown Valueset
Documentation for this format