IDEA4RC FHIR Implementation Guide
0.1.0 - CI Build 150

IDEA4RC FHIR Implementation Guide, published by IDEA4RC Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/idea4rc/ and changes regularly. See the Directory of published versions

Logical Model: SystemicTreatmentI4rc - Detailed Descriptions

Draft as of 2024-11-12

Definitions for the SystemicTreatment logical model.

Guidance on how to interpret the contents of this table can be found here

0. SystemicTreatment
Definition

Systemic Treatment

ShortSystemic Treatment
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. SystemicTreatment.episodeEventReference
Definition

EpisodeEvent element containing the data regarding the patient's cancer

ShortEpisode Event reference
Control1..1
Typehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent
Obligations
    ObligationsActor
    SHALL:handle
    SHALL:handle
    4. SystemicTreatment.typeOfSystemicTreatment
    Definition

    Select the type of Systemic treatment administered. It is possible to directly select the single treatment as appropriate.

    Shorttype of Systemic treatment
    Comments

    Chemotherapy; Immunotherapy; Target therapy; Unknown

    Chemotherapy - 4273629 Immunotherapy - 40310107 Target therapy - 40488979 Unknown - 4129922

    Control1..1
    TypeCodeableConcept
    Obligations
      ObligationsActor
      SHALL:handle
      SHALL:handle
      6. SystemicTreatment.intent
      Definition

      Clarifies the reasons why Other therapy is administered ? Curative chemotherapy is chemotherapy administered with the goal of achieving a complete remission and preventing the recurrence of cancer. ? Palliative chemotherapy refers to any chemotherapy administration that is not curative but administered simply to decrease tumor load and increase life expectancy. It has been defined also as ??treatment in circumstances where the impact of intervention is insufficient to result in major survival advantage, but does affect improvement in terms of tumor?related symptoms??

      ShortIntent
      Comments

      Palliative; Curative; Unknwon Palliative - 4179711 Curative - Unknown - 4129922

      Control1..1
      TypeCodeableConcept
      Obligations
        ObligationsActor
        SHALL:handle
        8. SystemicTreatment.setting
        Definition

        clarifies the context / how the therapy was administered alone or in conjunction with other treatments ? Neoadjuvant: treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. ? Adjuvant: additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy. ? Concomitant/concurrent: A treatment that is given at the same time as another (es. Chemotherapy + radiotherapy).

        ShortSetting
        Comments

        Neo-adjuvant; Concomitant; Adjuvant; Other tretament alone; Unknown; Neo-adjuvant - 44808409 Concomitant - Adjuvant - 44804498 Other tretament alone - Unknown - 4129922

        Control1..1
        TypeCodeableConcept
        Obligations
          ObligationsActor
          SHALL:handle
          10. SystemicTreatment.computedTomographyInfo
          Definition

          Information for computed tomography

          ShortComputed tomography info
          Comments

          Pre-operative; Post-operative; Intra-operative (hypertermic intraperiotoneal chemotherapy HIPEC ); therapeutic (without surgery) Preoperative - 4119031 Postoperative period - 4118656 Hyperthermic intraperitoneal chemotherapy - 3184898 Therapeutic - 4133895

          Control0..1
          TypeCodeableConcept
          Obligations
            ObligationsActor
            SHALL:handle
            12. SystemicTreatment.startDateSystemicTreatment
            Definition

            Specifies when Other treatment begins

            ShortStart date Systemic treatment
            Control1..1
            Typedate
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Obligations
              ObligationsActor
              SHALL:handle
              SHALL:handle
              14. SystemicTreatment.endDateSystemicTreatment
              Definition

              Specifies when Other treatment ends

              ShortEnd date Systemic treatment
              Control1..1
              Typedate
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Obligations
                ObligationsActor
                SHALL:handle
                SHALL:handle
                16. SystemicTreatment.numberOfCyclesAdministrations
                Definition

                clarifies how many times the treatment was administered. A cycle of treatment is a period of treatment followed by a period of rest (no treatment). For example, treatment given for one week followed by three weeks of rest is one cycle of treatment. A cycle can be repeated multiple times.

                ShortNumber of cycles/ administrations
                Control0..1
                Typedecimal
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Obligations
                  ObligationsActor
                  SHALL:handle
                  SHALL:handle
                  18. SystemicTreatment.regimen
                  Definition

                  Regimen

                  ShortRegimen
                  Control0..1
                  TypeBackboneElement
                  Obligations
                    ObligationsActor
                    SHALL:handle
                    SHALL:handle
                    20. SystemicTreatment.regimen.drugs1
                    Definition

                    Drugs 1

                    ShortDrugs 1
                    Comments

                    ATC list Athena vocabulary ATC

                    Control1..1
                    TypeCodeableConcept
                    Obligations
                      ObligationsActor
                      SHALL:handle
                      SHALL:handle
                      22. SystemicTreatment.regimen.drugs2
                      Definition

                      Drugs 2

                      ShortDrugs 2
                      Comments

                      ATC list Athena vocabulary ATC

                      Control1..1
                      TypeCodeableConcept
                      Obligations
                        ObligationsActor
                        SHALL:handle
                        SHALL:handle
                        24. SystemicTreatment.regimen.drugs3
                        Definition

                        Drugs 3

                        ShortDrugs 3
                        Comments

                        ATC list Athena vocabulary ATC

                        Control1..1
                        TypeCodeableConcept
                        Obligations
                          ObligationsActor
                          SHALL:handle
                          SHALL:handle
                          26. SystemicTreatment.regimen.startDateRegimenChanged
                          Definition

                          specifies when the new Other treatment begins, if a combination please specify the start of the first drug

                          ShortStart date regimen changed
                          Control1..1
                          Typedate
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Obligations
                            ObligationsActor
                            SHALL:handle
                            28. SystemicTreatment.regimen.endDateRegimenChanged
                            Definition

                            specifies when the new Other treatment ends,if a combination please specify the end of the last drug

                            ShortEnd date regimen changed
                            Control1..1
                            Typedate
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Obligations
                              ObligationsActor
                              SHALL:handle
                              30. SystemicTreatment.reasonForEndOfTreatment
                              Definition

                              Clarifies the reasons why the treatment ended or was interrupted

                              ShortReason for end of treatment
                              Comments

                              Completion; Toxicity; Comorbidity; Patient intolerance; Patients decision; Death; Unknown. Completion - 4058777 Toxicity - 438028 Comorbidity - 4162706 Patient intolerance - 4105297 Patients decision - Death - 4306655 Unknown - 4129922

                              Control1..1
                              TypeCodeableConcept
                              Obligations
                                ObligationsActor
                                SHALL:handle
                                SHALL:handle
                                32. SystemicTreatment.treatmentResponse
                                Definition

                                Measures how well a cancer patient responds to treatment. RECIST criteria should not be applied. The definition of Complete response; Partial response; Stable disease; Progression, should be based on the clinical judgement based on imaging. Only when setting=neoadiuvant or palliative

                                ShortTreatment response (based on imaging alone; no recist or other criteria)
                                Comments

                                Complete response; Partial response; Stable disease; Progression; Unknown. Complete response - 4163135 Partial response - 4161302 Stable disease - 4241442 Progression - 4168352 Unknown - 4129922

                                Control1..1
                                TypeCodeableConcept
                                Obligations
                                  ObligationsActor
                                  SHALL:handle
                                  SHALL:handle

                                  Guidance on how to interpret the contents of this table can be found here

                                  0. SystemicTreatment
                                  Definition

                                  Systemic Treatment

                                  ShortSystemic Treatment
                                  Control0..*
                                  Is Modifierfalse
                                  Logical ModelInstances of this logical model are not marked to be the target of a Reference
                                  2. SystemicTreatment.episodeEventReference
                                  Definition

                                  EpisodeEvent element containing the data regarding the patient's cancer

                                  ShortEpisode Event reference
                                  Control1..1
                                  Typehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent
                                  Obligations
                                    ObligationsActor
                                    SHALL:handle
                                    SHALL:handle
                                    4. SystemicTreatment.typeOfSystemicTreatment
                                    Definition

                                    Select the type of Systemic treatment administered. It is possible to directly select the single treatment as appropriate.

                                    Shorttype of Systemic treatment
                                    Comments

                                    Chemotherapy; Immunotherapy; Target therapy; Unknown

                                    Chemotherapy - 4273629 Immunotherapy - 40310107 Target therapy - 40488979 Unknown - 4129922

                                    Control1..1
                                    TypeCodeableConcept
                                    Obligations
                                      ObligationsActor
                                      SHALL:handle
                                      SHALL:handle
                                      6. SystemicTreatment.intent
                                      Definition

                                      Clarifies the reasons why Other therapy is administered ? Curative chemotherapy is chemotherapy administered with the goal of achieving a complete remission and preventing the recurrence of cancer. ? Palliative chemotherapy refers to any chemotherapy administration that is not curative but administered simply to decrease tumor load and increase life expectancy. It has been defined also as ??treatment in circumstances where the impact of intervention is insufficient to result in major survival advantage, but does affect improvement in terms of tumor?related symptoms??

                                      ShortIntent
                                      Comments

                                      Palliative; Curative; Unknwon Palliative - 4179711 Curative - Unknown - 4129922

                                      Control1..1
                                      TypeCodeableConcept
                                      Obligations
                                        ObligationsActor
                                        SHALL:handle
                                        8. SystemicTreatment.setting
                                        Definition

                                        clarifies the context / how the therapy was administered alone or in conjunction with other treatments ? Neoadjuvant: treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. ? Adjuvant: additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy. ? Concomitant/concurrent: A treatment that is given at the same time as another (es. Chemotherapy + radiotherapy).

                                        ShortSetting
                                        Comments

                                        Neo-adjuvant; Concomitant; Adjuvant; Other tretament alone; Unknown; Neo-adjuvant - 44808409 Concomitant - Adjuvant - 44804498 Other tretament alone - Unknown - 4129922

                                        Control1..1
                                        TypeCodeableConcept
                                        Obligations
                                          ObligationsActor
                                          SHALL:handle
                                          10. SystemicTreatment.computedTomographyInfo
                                          Definition

                                          Information for computed tomography

                                          ShortComputed tomography info
                                          Comments

                                          Pre-operative; Post-operative; Intra-operative (hypertermic intraperiotoneal chemotherapy HIPEC ); therapeutic (without surgery) Preoperative - 4119031 Postoperative period - 4118656 Hyperthermic intraperitoneal chemotherapy - 3184898 Therapeutic - 4133895

                                          Control0..1
                                          TypeCodeableConcept
                                          Obligations
                                            ObligationsActor
                                            SHALL:handle
                                            12. SystemicTreatment.startDateSystemicTreatment
                                            Definition

                                            Specifies when Other treatment begins

                                            ShortStart date Systemic treatment
                                            Control1..1
                                            Typedate
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Obligations
                                              ObligationsActor
                                              SHALL:handle
                                              SHALL:handle
                                              14. SystemicTreatment.endDateSystemicTreatment
                                              Definition

                                              Specifies when Other treatment ends

                                              ShortEnd date Systemic treatment
                                              Control1..1
                                              Typedate
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Obligations
                                                ObligationsActor
                                                SHALL:handle
                                                SHALL:handle
                                                16. SystemicTreatment.numberOfCyclesAdministrations
                                                Definition

                                                clarifies how many times the treatment was administered. A cycle of treatment is a period of treatment followed by a period of rest (no treatment). For example, treatment given for one week followed by three weeks of rest is one cycle of treatment. A cycle can be repeated multiple times.

                                                ShortNumber of cycles/ administrations
                                                Control0..1
                                                Typedecimal
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Obligations
                                                  ObligationsActor
                                                  SHALL:handle
                                                  SHALL:handle
                                                  18. SystemicTreatment.regimen
                                                  Definition

                                                  Regimen

                                                  ShortRegimen
                                                  Control0..1
                                                  TypeBackboneElement
                                                  Obligations
                                                    ObligationsActor
                                                    SHALL:handle
                                                    SHALL:handle
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    20. SystemicTreatment.regimen.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    22. SystemicTreatment.regimen.drugs1
                                                    Definition

                                                    Drugs 1

                                                    ShortDrugs 1
                                                    Comments

                                                    ATC list Athena vocabulary ATC

                                                    Control1..1
                                                    TypeCodeableConcept
                                                    Obligations
                                                      ObligationsActor
                                                      SHALL:handle
                                                      SHALL:handle
                                                      24. SystemicTreatment.regimen.drugs2
                                                      Definition

                                                      Drugs 2

                                                      ShortDrugs 2
                                                      Comments

                                                      ATC list Athena vocabulary ATC

                                                      Control1..1
                                                      TypeCodeableConcept
                                                      Obligations
                                                        ObligationsActor
                                                        SHALL:handle
                                                        SHALL:handle
                                                        26. SystemicTreatment.regimen.drugs3
                                                        Definition

                                                        Drugs 3

                                                        ShortDrugs 3
                                                        Comments

                                                        ATC list Athena vocabulary ATC

                                                        Control1..1
                                                        TypeCodeableConcept
                                                        Obligations
                                                          ObligationsActor
                                                          SHALL:handle
                                                          SHALL:handle
                                                          28. SystemicTreatment.regimen.startDateRegimenChanged
                                                          Definition

                                                          specifies when the new Other treatment begins, if a combination please specify the start of the first drug

                                                          ShortStart date regimen changed
                                                          Control1..1
                                                          Typedate
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Obligations
                                                            ObligationsActor
                                                            SHALL:handle
                                                            30. SystemicTreatment.regimen.endDateRegimenChanged
                                                            Definition

                                                            specifies when the new Other treatment ends,if a combination please specify the end of the last drug

                                                            ShortEnd date regimen changed
                                                            Control1..1
                                                            Typedate
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Obligations
                                                              ObligationsActor
                                                              SHALL:handle
                                                              32. SystemicTreatment.reasonForEndOfTreatment
                                                              Definition

                                                              Clarifies the reasons why the treatment ended or was interrupted

                                                              ShortReason for end of treatment
                                                              Comments

                                                              Completion; Toxicity; Comorbidity; Patient intolerance; Patients decision; Death; Unknown. Completion - 4058777 Toxicity - 438028 Comorbidity - 4162706 Patient intolerance - 4105297 Patients decision - Death - 4306655 Unknown - 4129922

                                                              Control1..1
                                                              TypeCodeableConcept
                                                              Obligations
                                                                ObligationsActor
                                                                SHALL:handle
                                                                SHALL:handle
                                                                34. SystemicTreatment.treatmentResponse
                                                                Definition

                                                                Measures how well a cancer patient responds to treatment. RECIST criteria should not be applied. The definition of Complete response; Partial response; Stable disease; Progression, should be based on the clinical judgement based on imaging. Only when setting=neoadiuvant or palliative

                                                                ShortTreatment response (based on imaging alone; no recist or other criteria)
                                                                Comments

                                                                Complete response; Partial response; Stable disease; Progression; Unknown. Complete response - 4163135 Partial response - 4161302 Stable disease - 4241442 Progression - 4168352 Unknown - 4129922

                                                                Control1..1
                                                                TypeCodeableConcept
                                                                Obligations
                                                                  ObligationsActor
                                                                  SHALL:handle
                                                                  SHALL:handle

                                                                  Guidance on how to interpret the contents of this table can be found here

                                                                  0. SystemicTreatment
                                                                  Definition

                                                                  Systemic Treatment

                                                                  ShortSystemic Treatment
                                                                  Control0..*
                                                                  Is Modifierfalse
                                                                  Logical ModelInstances of this logical model are not marked to be the target of a Reference
                                                                  2. SystemicTreatment.episodeEventReference
                                                                  Definition

                                                                  EpisodeEvent element containing the data regarding the patient's cancer

                                                                  ShortEpisode Event reference
                                                                  Control1..1
                                                                  Typehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent
                                                                  Obligations
                                                                    ObligationsActor
                                                                    SHALL:handle
                                                                    SHALL:handle
                                                                    4. SystemicTreatment.typeOfSystemicTreatment
                                                                    Definition

                                                                    Select the type of Systemic treatment administered. It is possible to directly select the single treatment as appropriate.

                                                                    Shorttype of Systemic treatment
                                                                    Comments

                                                                    Chemotherapy; Immunotherapy; Target therapy; Unknown

                                                                    Chemotherapy - 4273629 Immunotherapy - 40310107 Target therapy - 40488979 Unknown - 4129922

                                                                    Control1..1
                                                                    TypeCodeableConcept
                                                                    Obligations
                                                                      ObligationsActor
                                                                      SHALL:handle
                                                                      SHALL:handle
                                                                      6. SystemicTreatment.intent
                                                                      Definition

                                                                      Clarifies the reasons why Other therapy is administered ? Curative chemotherapy is chemotherapy administered with the goal of achieving a complete remission and preventing the recurrence of cancer. ? Palliative chemotherapy refers to any chemotherapy administration that is not curative but administered simply to decrease tumor load and increase life expectancy. It has been defined also as ??treatment in circumstances where the impact of intervention is insufficient to result in major survival advantage, but does affect improvement in terms of tumor?related symptoms??

                                                                      ShortIntent
                                                                      Comments

                                                                      Palliative; Curative; Unknwon Palliative - 4179711 Curative - Unknown - 4129922

                                                                      Control1..1
                                                                      TypeCodeableConcept
                                                                      Obligations
                                                                        ObligationsActor
                                                                        SHALL:handle
                                                                        8. SystemicTreatment.setting
                                                                        Definition

                                                                        clarifies the context / how the therapy was administered alone or in conjunction with other treatments ? Neoadjuvant: treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. ? Adjuvant: additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy. ? Concomitant/concurrent: A treatment that is given at the same time as another (es. Chemotherapy + radiotherapy).

                                                                        ShortSetting
                                                                        Comments

                                                                        Neo-adjuvant; Concomitant; Adjuvant; Other tretament alone; Unknown; Neo-adjuvant - 44808409 Concomitant - Adjuvant - 44804498 Other tretament alone - Unknown - 4129922

                                                                        Control1..1
                                                                        TypeCodeableConcept
                                                                        Obligations
                                                                          ObligationsActor
                                                                          SHALL:handle
                                                                          10. SystemicTreatment.computedTomographyInfo
                                                                          Definition

                                                                          Information for computed tomography

                                                                          ShortComputed tomography info
                                                                          Comments

                                                                          Pre-operative; Post-operative; Intra-operative (hypertermic intraperiotoneal chemotherapy HIPEC ); therapeutic (without surgery) Preoperative - 4119031 Postoperative period - 4118656 Hyperthermic intraperitoneal chemotherapy - 3184898 Therapeutic - 4133895

                                                                          Control0..1
                                                                          TypeCodeableConcept
                                                                          Obligations
                                                                            ObligationsActor
                                                                            SHALL:handle
                                                                            12. SystemicTreatment.startDateSystemicTreatment
                                                                            Definition

                                                                            Specifies when Other treatment begins

                                                                            ShortStart date Systemic treatment
                                                                            Control1..1
                                                                            Typedate
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Obligations
                                                                              ObligationsActor
                                                                              SHALL:handle
                                                                              SHALL:handle
                                                                              14. SystemicTreatment.endDateSystemicTreatment
                                                                              Definition

                                                                              Specifies when Other treatment ends

                                                                              ShortEnd date Systemic treatment
                                                                              Control1..1
                                                                              Typedate
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Obligations
                                                                                ObligationsActor
                                                                                SHALL:handle
                                                                                SHALL:handle
                                                                                16. SystemicTreatment.numberOfCyclesAdministrations
                                                                                Definition

                                                                                clarifies how many times the treatment was administered. A cycle of treatment is a period of treatment followed by a period of rest (no treatment). For example, treatment given for one week followed by three weeks of rest is one cycle of treatment. A cycle can be repeated multiple times.

                                                                                ShortNumber of cycles/ administrations
                                                                                Control0..1
                                                                                Typedecimal
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                Obligations
                                                                                  ObligationsActor
                                                                                  SHALL:handle
                                                                                  SHALL:handle
                                                                                  18. SystemicTreatment.regimen
                                                                                  Definition

                                                                                  Regimen

                                                                                  ShortRegimen
                                                                                  Control0..1
                                                                                  TypeBackboneElement
                                                                                  Obligations
                                                                                    ObligationsActor
                                                                                    SHALL:handle
                                                                                    SHALL:handle
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    20. SystemicTreatment.regimen.id
                                                                                    Definition

                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                    ShortUnique id for inter-element referencing
                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Is Modifierfalse
                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                    Summaryfalse
                                                                                    22. SystemicTreatment.regimen.extension
                                                                                    Definition

                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                    ShortAdditional content defined by implementations
                                                                                    Comments

                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                    Control0..*
                                                                                    TypeExtension
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesextensions, user content
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    SlicingThis element introduces a set of slices on SystemicTreatment.regimen.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 24. SystemicTreatment.regimen.modifierExtension
                                                                                      Definition

                                                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                                      Comments

                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                      Alternate Namesextensions, user content, modifiers
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      26. SystemicTreatment.regimen.drugs1
                                                                                      Definition

                                                                                      Drugs 1

                                                                                      ShortDrugs 1
                                                                                      Comments

                                                                                      ATC list Athena vocabulary ATC

                                                                                      Control1..1
                                                                                      TypeCodeableConcept
                                                                                      Obligations
                                                                                        ObligationsActor
                                                                                        SHALL:handle
                                                                                        SHALL:handle
                                                                                        28. SystemicTreatment.regimen.drugs2
                                                                                        Definition

                                                                                        Drugs 2

                                                                                        ShortDrugs 2
                                                                                        Comments

                                                                                        ATC list Athena vocabulary ATC

                                                                                        Control1..1
                                                                                        TypeCodeableConcept
                                                                                        Obligations
                                                                                          ObligationsActor
                                                                                          SHALL:handle
                                                                                          SHALL:handle
                                                                                          30. SystemicTreatment.regimen.drugs3
                                                                                          Definition

                                                                                          Drugs 3

                                                                                          ShortDrugs 3
                                                                                          Comments

                                                                                          ATC list Athena vocabulary ATC

                                                                                          Control1..1
                                                                                          TypeCodeableConcept
                                                                                          Obligations
                                                                                            ObligationsActor
                                                                                            SHALL:handle
                                                                                            SHALL:handle
                                                                                            32. SystemicTreatment.regimen.startDateRegimenChanged
                                                                                            Definition

                                                                                            specifies when the new Other treatment begins, if a combination please specify the start of the first drug

                                                                                            ShortStart date regimen changed
                                                                                            Control1..1
                                                                                            Typedate
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Obligations
                                                                                              ObligationsActor
                                                                                              SHALL:handle
                                                                                              34. SystemicTreatment.regimen.endDateRegimenChanged
                                                                                              Definition

                                                                                              specifies when the new Other treatment ends,if a combination please specify the end of the last drug

                                                                                              ShortEnd date regimen changed
                                                                                              Control1..1
                                                                                              Typedate
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Obligations
                                                                                                ObligationsActor
                                                                                                SHALL:handle
                                                                                                36. SystemicTreatment.reasonForEndOfTreatment
                                                                                                Definition

                                                                                                Clarifies the reasons why the treatment ended or was interrupted

                                                                                                ShortReason for end of treatment
                                                                                                Comments

                                                                                                Completion; Toxicity; Comorbidity; Patient intolerance; Patients decision; Death; Unknown. Completion - 4058777 Toxicity - 438028 Comorbidity - 4162706 Patient intolerance - 4105297 Patients decision - Death - 4306655 Unknown - 4129922

                                                                                                Control1..1
                                                                                                TypeCodeableConcept
                                                                                                Obligations
                                                                                                  ObligationsActor
                                                                                                  SHALL:handle
                                                                                                  SHALL:handle
                                                                                                  38. SystemicTreatment.treatmentResponse
                                                                                                  Definition

                                                                                                  Measures how well a cancer patient responds to treatment. RECIST criteria should not be applied. The definition of Complete response; Partial response; Stable disease; Progression, should be based on the clinical judgement based on imaging. Only when setting=neoadiuvant or palliative

                                                                                                  ShortTreatment response (based on imaging alone; no recist or other criteria)
                                                                                                  Comments

                                                                                                  Complete response; Partial response; Stable disease; Progression; Unknown. Complete response - 4163135 Partial response - 4161302 Stable disease - 4241442 Progression - 4168352 Unknown - 4129922

                                                                                                  Control1..1
                                                                                                  TypeCodeableConcept
                                                                                                  Obligations
                                                                                                    ObligationsActor
                                                                                                    SHALL:handle
                                                                                                    SHALL:handle