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 - XML Profile

Draft as of 2025-07-25

XML representation of the SystemicTreatment logical model.

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<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="SystemicTreatment"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition SystemicTreatment</b></p><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment" title="Systemic Treatment
Maturity Level: 0 Draft">SystemicTreatment</a><a name="SystemicTreatment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://build.fhir.org/types.html#Base">Base</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Systemic Treatment</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.diagnosisReference" title="Diagnosis reference in case the treatment was done for baseline">diagnosisReference</a><a name="SystemicTreatment.diagnosisReference"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-Diagnosis.html">Diagnosis</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Diagnosis reference (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.episodeEvent" title="EpisodeEvent element containing the data regarding the patient's cancer">episodeEvent</a><a name="SystemicTreatment.episodeEvent"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-EpisodeEvent.html">EpisodeEvent</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Episode Event reference (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.systemicTreatmentHospital" title="In which hospital was the SystemicTreatment performed">systemicTreatmentHospital</a><a name="SystemicTreatment.systemicTreatmentHospital"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">SystemicTreatment Hospital (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.typeOfSystemicTreatment" title="Select the type of systemic treatment administered. It is possible to directly select the single treatment as appropriate.">typeOfSystemicTreatment</a><a name="SystemicTreatment.typeOfSystemicTreatment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">type of systemic treatment (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.intent" title="Clarifies the reasons why systemic 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…”">intent</a><a name="SystemicTreatment.intent"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Intent (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.setting" title="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 and radiotherapy).">setting</a><a name="SystemicTreatment.setting"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Setting (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.chemotherapyInfo" title="Information for chemotherapy">chemotherapyInfo</a><a name="SystemicTreatment.chemotherapyInfo"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Chemotherapy info (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.startDateSystemicTreatment" title="Specifies when systemic treatment begins">startDateSystemicTreatment</a><a name="SystemicTreatment.startDateSystemicTreatment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Start date systemic treatment (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.endDateSystemicTreatment" title="Specifies when systemic treatment ends">endDateSystemicTreatment</a><a name="SystemicTreatment.endDateSystemicTreatment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">End date systemic treatment (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.numberOfCycles" title="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.">numberOfCycles</a><a name="SystemicTreatment.numberOfCycles"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#Quantity">Quantity</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Number of cycles/ administrations (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.regimen" title="The regimen applied to the patient. If this is not present, or the specific regimen is not listed here, use the DrugsForTreatments entity.">regimen</a><a name="SystemicTreatment.regimen"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Regimen (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.startDateRegimenChanged" title="Specifies when the new systemic treatment begins, if a combination please specify the start of the first drug">startDateRegimenChanged</a><a name="SystemicTreatment.startDateRegimenChanged"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Start date regimen changed (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.endDateRegimenChanged" title="Specifies when the new  systemic treatment ends,if a combination please specify the end of the last drug">endDateRegimenChanged</a><a name="SystemicTreatment.endDateRegimenChanged"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">End date regimen changed (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.reasonForEndOfTreatment" title="Clarifies the reasons why the treatment ended or was interrupted">reasonForEndOfTreatment</a><a name="SystemicTreatment.reasonForEndOfTreatment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reason for end of treatment (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-SystemicTreatment-definitions.html#SystemicTreatment.treatmentResponse" title="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">treatmentResponse</a><a name="SystemicTreatment.treatmentResponse"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Treatment response (based on imaging alone; no recist or other criteria) (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
  </text>
  <url
       value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment"/>
  <version value="0.1.0"/>
  <name value="SystemicTreatmentI4RC"/>
  <title value="Systemic Treatment"/>
  <status value="draft"/>
  <date value="2025-07-25T13:48:09+00:00"/>
  <publisher value="IDEA4RC Project"/>
  <contact>
    <name value="IDEA4RC Project"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.idea4rc.eu/"/>
    </telecom>
  </contact>
  <contact>
    <name value="IDEA4RC Project"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.idea4rc.eu/"/>
    </telecom>
  </contact>
  <description value="Systemic Treatment
Maturity Level: 0 Draft"/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="150"/>
      <display value="Europe"/>
    </coding>
  </jurisdiction>
  <fhirVersion value="4.0.1"/>
  <kind value="logical"/>
  <abstract value="false"/>
  <type
        value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment"/>
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Base"/>
  <derivation value="specialization"/>
  <snapshot>
    <extension
               url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
      <valueString value="4.0.1"/>
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    <element id="SystemicTreatment">
      <path value="SystemicTreatment"/>
      <short value="Systemic Treatment"/>
      <definition value="Systemic Treatment
Maturity Level: 0 Draft"/>
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      <max value="*"/>
      <base>
        <path value="Base"/>
        <min value="0"/>
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      <isModifier value="false"/>
    </element>
    <element id="SystemicTreatment.diagnosisReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
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        <extension url="code">
          <valueCode value="SHALL:handle"/>
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        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
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                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.diagnosisReference"/>
      <short value="Diagnosis reference (M)"/>
      <definition
                  value="Diagnosis reference in case the treatment was done for baseline"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.diagnosisReference"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Diagnosis"/>
      </type>
    </element>
    <element id="SystemicTreatment.episodeEvent">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
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                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
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      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.episodeEvent"/>
      <short value="Episode Event reference (M)"/>
      <definition
                  value="EpisodeEvent element containing the data regarding the patient's cancer"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.episodeEvent"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code
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    <element id="SystemicTreatment.systemicTreatmentHospital">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
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      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
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        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.systemicTreatmentHospital"/>
      <short value="SystemicTreatment Hospital (M)"/>
      <definition
                  value="In which hospital was the SystemicTreatment performed"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.systemicTreatmentHospital"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element id="SystemicTreatment.typeOfSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
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      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
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                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.typeOfSystemicTreatment"/>
      <short value="type of systemic treatment (M)"/>
      <definition
                  value="Select the type of systemic treatment administered. It is possible to directly select the single treatment as appropriate."/>
      <comment
               value="Chemotherapy - 4273629
Immunotherapy - 40310107
Targeted therapy -  912065"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.typeOfSystemicTreatment"/>
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      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.intent">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
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                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.intent"/>
      <short value="Intent (O)"/>
      <definition
                  value="Clarifies the reasons why systemic 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…”"/>
      <comment
               value="Palliative - 4179711
Curative procedure intent - 4162591"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.intent"/>
        <min value="0"/>
        <max value="*"/>
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      <type>
        <code value="CodeableConcept"/>
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    </element>
    <element id="SystemicTreatment.setting">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.setting"/>
      <short value="Setting (O)"/>
      <definition
                  value="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 and radiotherapy)."/>
      <comment
               value="Neo-adjuvant - 44808409
Concomitant - 2000100028
 Adjuvant - 44804498
Systemic treatment alone - 2000100029"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.setting"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.chemotherapyInfo">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
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                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.chemotherapyInfo"/>
      <short value="Chemotherapy info (O)"/>
      <definition value="Information for chemotherapy"/>
      <comment
               value="Preoperative - 4119031
Postoperative period - 4118656
Hyperthermic intraperitoneal chemotherapy - 3184898
Therapeutic - 4133895"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.chemotherapyInfo"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.startDateSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.startDateSystemicTreatment"/>
      <short value="Start date systemic treatment (M)"/>
      <definition value="Specifies when systemic treatment begins"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.startDateSystemicTreatment"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.endDateSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.endDateSystemicTreatment"/>
      <short value="End date systemic treatment (M)"/>
      <definition value="Specifies when systemic treatment ends"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.endDateSystemicTreatment"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.numberOfCycles">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.numberOfCycles"/>
      <short value="Number of cycles/ administrations (O)"/>
      <definition
                  value="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."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.numberOfCycles"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
    </element>
    <element id="SystemicTreatment.regimen">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.regimen"/>
      <short value="Regimen (O)"/>
      <definition
                  value="The regimen applied to the patient. If this is not present, or the specific regimen is not listed here, use the DrugsForTreatments entity."/>
      <comment
               value="Doxorubicin and Ifosfamide - 35806965
Ifosfamide and Paclitaxel - 35805248
doxorubicin and vincristine - 2000100054
Epirubicin monotherapy - 35804228
Etoposide monotherapy - 35803691
Gemcitabine monotherapy - 35804135
Ifosfamide and Gemcitabine - 35806435
gemcitabine and vincristine - 2000100055
high dose cisplatin - 2000100056
Ifosfamide monotherapy - 35804542
ifosfamide and etoposide - 2000100057
Irinotecan liposomal monotherapy - 35805368
Lenvatinib monotherapy - 35805795
Methotrexate monotherapy - 35804095
Nivolumab monotherapy - 35803677
ADT (other androgen deprivation therapy) - 35806821
Oxaliplatin monotherapy - 35805078
Paclitaxel monotherapy - 35804166
Gemcitabine and Paclitaxel - 35804158
Ifosfamide and Paclitaxel - 35805248
Paclitaxel and Trastuzumab (TH) - 35804201
Paclitaxel and Vinorelbine - 35101452
  Pembrolizumab monotherapy - 35803678
Sorafenib monotherapy - 35803487
Trastuzumab emtansine monotherapy (TDM1) - 35805230
Trastuzumab monotherapy - 35804222
Vinorelbine monotherapy - 35804241
weekly carboplatin - 2000100058
weekly cisplatin - 2000100059

Epirubicin and Ifosfamide - 35806948
Vincristine and Doxorubicin and Ifosfamide - 2000100060
Vincristine,  Actinomycin D, Ifosfamide (
VAI) - 35805452
Docetaxel and Gemcitabine - 35803577
Dacarbazine and Doxorubicin - 35806964
Methotrexate and Doxorubicin and Cisplatin - 2000100061
Methotrexate and Doxorubicin and Ifosfamide - 2000100062
Doxorubicin and Cisplatin and Ifosfamide - 2000100063
Cisplatin and Doxorubicin - 35804819
Methotrexate and Vinorelbine - 2000100064
Ifosfamide and Etoposide (IE) - 35805454
Vincristine and Doxorubicin and Cyclophosphamide - 2000100065
Cyclophosphamide and Etoposide - 35806476
Doxorubicin and Ifosfamide and Dacarbazine - 2000100066
Dacarbazine and Gemcitabine - 35806969
Cyclophosphamide and Topotecan - 35805453
Irinotecan and Vincristine - 2000100067
Irinotecan and Temozolomide - 35805455
Busulfan and Melphalan - 35804000
TNF and Melphalan - 2000100068
Cyclophosphamide and Vinorelbine - 2000100069
Vincristine, Ifosfamide, Doxorubicin, Etoposide (VIDE) - 35805451
Pazopanib monotherapy - 35805690
Regorafenib monotherapy - 35804569
high dose Ifosfamide - 2000100070"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.regimen"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.startDateRegimenChanged">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.startDateRegimenChanged"/>
      <short value="Start date regimen changed (M)"/>
      <definition
                  value="Specifies when the new systemic treatment begins, if a combination please specify the start of the first drug"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.startDateRegimenChanged"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.endDateRegimenChanged">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.endDateRegimenChanged"/>
      <short value="End date regimen changed (M)"/>
      <definition
                  value="Specifies when the new  systemic treatment ends,if a combination please specify the end of the last drug"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.endDateRegimenChanged"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.reasonForEndOfTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.reasonForEndOfTreatment"/>
      <short value="Reason for end of treatment (M)"/>
      <definition
                  value="Clarifies the reasons why the treatment ended or was interrupted"/>
      <comment
               value="Completed successfully - 44788181
Chemotherapy changed acute chemotherapy toxicity - 4162594 
Treatment ended due to comorbidity - 2000100030
Intolerance to drug - 4240582
Procedure discontinued by patient - 37017062
Death - 4306655"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.reasonForEndOfTreatment"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.treatmentResponse">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/SystemicTreatment|0.1.0"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.treatmentResponse"/>
      <short
             value="Treatment response (based on imaging alone; no recist or other criteria) (M)"/>
      <definition
                  value="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"/>
      <comment
               value="Complete Remission - 32946
Partial Remission - 32947
Stable Disease - 32948
Progression - 32949
Not applicable - 4294169 (Not usable in OMOP)"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="SystemicTreatment.treatmentResponse"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
  </snapshot>
  <differential>
    <element id="SystemicTreatment">
      <path value="SystemicTreatment"/>
      <short value="Systemic Treatment"/>
      <definition value="Systemic Treatment
Maturity Level: 0 Draft"/>
    </element>
    <element id="SystemicTreatment.diagnosisReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.diagnosisReference"/>
      <short value="Diagnosis reference (M)"/>
      <definition
                  value="Diagnosis reference in case the treatment was done for baseline"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Diagnosis"/>
      </type>
    </element>
    <element id="SystemicTreatment.episodeEvent">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.episodeEvent"/>
      <short value="Episode Event reference (M)"/>
      <definition
                  value="EpisodeEvent element containing the data regarding the patient's cancer"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent"/>
      </type>
    </element>
    <element id="SystemicTreatment.systemicTreatmentHospital">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.systemicTreatmentHospital"/>
      <short value="SystemicTreatment Hospital (M)"/>
      <definition
                  value="In which hospital was the SystemicTreatment performed"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element id="SystemicTreatment.typeOfSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.typeOfSystemicTreatment"/>
      <short value="type of systemic treatment (M)"/>
      <definition
                  value="Select the type of systemic treatment administered. It is possible to directly select the single treatment as appropriate."/>
      <comment
               value="Chemotherapy - 4273629
Immunotherapy - 40310107
Targeted therapy -  912065"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.intent">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.intent"/>
      <short value="Intent (O)"/>
      <definition
                  value="Clarifies the reasons why systemic 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…”"/>
      <comment
               value="Palliative - 4179711
Curative procedure intent - 4162591"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.setting">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.setting"/>
      <short value="Setting (O)"/>
      <definition
                  value="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 and radiotherapy)."/>
      <comment
               value="Neo-adjuvant - 44808409
Concomitant - 2000100028
 Adjuvant - 44804498
Systemic treatment alone - 2000100029"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.chemotherapyInfo">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.chemotherapyInfo"/>
      <short value="Chemotherapy info (O)"/>
      <definition value="Information for chemotherapy"/>
      <comment
               value="Preoperative - 4119031
Postoperative period - 4118656
Hyperthermic intraperitoneal chemotherapy - 3184898
Therapeutic - 4133895"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.startDateSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.startDateSystemicTreatment"/>
      <short value="Start date systemic treatment (M)"/>
      <definition value="Specifies when systemic treatment begins"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.endDateSystemicTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.endDateSystemicTreatment"/>
      <short value="End date systemic treatment (M)"/>
      <definition value="Specifies when systemic treatment ends"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.numberOfCycles">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.numberOfCycles"/>
      <short value="Number of cycles/ administrations (O)"/>
      <definition
                  value="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."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Quantity"/>
      </type>
    </element>
    <element id="SystemicTreatment.regimen">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.regimen"/>
      <short value="Regimen (O)"/>
      <definition
                  value="The regimen applied to the patient. If this is not present, or the specific regimen is not listed here, use the DrugsForTreatments entity."/>
      <comment
               value="Doxorubicin and Ifosfamide - 35806965
Ifosfamide and Paclitaxel - 35805248
doxorubicin and vincristine - 2000100054
Epirubicin monotherapy - 35804228
Etoposide monotherapy - 35803691
Gemcitabine monotherapy - 35804135
Ifosfamide and Gemcitabine - 35806435
gemcitabine and vincristine - 2000100055
high dose cisplatin - 2000100056
Ifosfamide monotherapy - 35804542
ifosfamide and etoposide - 2000100057
Irinotecan liposomal monotherapy - 35805368
Lenvatinib monotherapy - 35805795
Methotrexate monotherapy - 35804095
Nivolumab monotherapy - 35803677
ADT (other androgen deprivation therapy) - 35806821
Oxaliplatin monotherapy - 35805078
Paclitaxel monotherapy - 35804166
Gemcitabine and Paclitaxel - 35804158
Ifosfamide and Paclitaxel - 35805248
Paclitaxel and Trastuzumab (TH) - 35804201
Paclitaxel and Vinorelbine - 35101452
  Pembrolizumab monotherapy - 35803678
Sorafenib monotherapy - 35803487
Trastuzumab emtansine monotherapy (TDM1) - 35805230
Trastuzumab monotherapy - 35804222
Vinorelbine monotherapy - 35804241
weekly carboplatin - 2000100058
weekly cisplatin - 2000100059

Epirubicin and Ifosfamide - 35806948
Vincristine and Doxorubicin and Ifosfamide - 2000100060
Vincristine,  Actinomycin D, Ifosfamide (
VAI) - 35805452
Docetaxel and Gemcitabine - 35803577
Dacarbazine and Doxorubicin - 35806964
Methotrexate and Doxorubicin and Cisplatin - 2000100061
Methotrexate and Doxorubicin and Ifosfamide - 2000100062
Doxorubicin and Cisplatin and Ifosfamide - 2000100063
Cisplatin and Doxorubicin - 35804819
Methotrexate and Vinorelbine - 2000100064
Ifosfamide and Etoposide (IE) - 35805454
Vincristine and Doxorubicin and Cyclophosphamide - 2000100065
Cyclophosphamide and Etoposide - 35806476
Doxorubicin and Ifosfamide and Dacarbazine - 2000100066
Dacarbazine and Gemcitabine - 35806969
Cyclophosphamide and Topotecan - 35805453
Irinotecan and Vincristine - 2000100067
Irinotecan and Temozolomide - 35805455
Busulfan and Melphalan - 35804000
TNF and Melphalan - 2000100068
Cyclophosphamide and Vinorelbine - 2000100069
Vincristine, Ifosfamide, Doxorubicin, Etoposide (VIDE) - 35805451
Pazopanib monotherapy - 35805690
Regorafenib monotherapy - 35804569
high dose Ifosfamide - 2000100070"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.startDateRegimenChanged">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.startDateRegimenChanged"/>
      <short value="Start date regimen changed (M)"/>
      <definition
                  value="Specifies when the new systemic treatment begins, if a combination please specify the start of the first drug"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.endDateRegimenChanged">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.endDateRegimenChanged"/>
      <short value="End date regimen changed (M)"/>
      <definition
                  value="Specifies when the new  systemic treatment ends,if a combination please specify the end of the last drug"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="SystemicTreatment.reasonForEndOfTreatment">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.reasonForEndOfTreatment"/>
      <short value="Reason for end of treatment (M)"/>
      <definition
                  value="Clarifies the reasons why the treatment ended or was interrupted"/>
      <comment
               value="Completed successfully - 44788181
Chemotherapy changed acute chemotherapy toxicity - 4162594 
Treatment ended due to comorbidity - 2000100030
Intolerance to drug - 4240582
Procedure discontinued by patient - 37017062
Death - 4306655"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="SystemicTreatment.treatmentResponse">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="SystemicTreatment.treatmentResponse"/>
      <short
             value="Treatment response (based on imaging alone; no recist or other criteria) (M)"/>
      <definition
                  value="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"/>
      <comment
               value="Complete Remission - 32946
Partial Remission - 32947
Stable Disease - 32948
Progression - 32949
Not applicable - 4294169 (Not usable in OMOP)"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
  </differential>
</StructureDefinition>