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

This page is part of the ICHOM FHIR Implementation Guide: Breast Cancer (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Questionnaire: ClinicalResponseAnnualUpdate (Experimental)

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

Clinical response questionnaire at annual post-treatment follow-up

LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. AnnualClinicalResponseClinical response questionnaire at annual post-treatment follow-upQuestionnairehttp://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseAnnualUpdate#1.0.0
... General-Information-ClinicalGeneral information1..1group
.... NA-ClinicalWhat is the patient's medical record number?1..1string
.... LastName-ClinicalWhat is the patient's last name?1..1string
... Tumor-FactorsTumor factors1..1group
.... MUTBCIndicate if the patient carries a genetic mutation predisposing breast cancer1..*choiceValue Set: Germline Mutation ValueSet
... Treatment-VariablesTreatment Variables1..1group
.... TREATMENT_BREASTIndicate whether the patient received one of the following treatment during the last year (select all that apply)1..*choiceValue Set: Type of treatments ValueSet
.... SURGERY_BREASTIndicate whether the patient received surgery during the last year1..1choiceEnable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003)
Value Set: Types of breast surgery ValueSet
.... SurgeryDateKnownIs the date of surgery known?1..1booleanEnable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003)
.... SurgeryDatePlease provide the date of surgery1..1dateEnable When: SurgeryDateKnown = true
.... SURGERYAXIndicate whether the patient received surgery to the axilla1..1choiceEnable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008)
Value Set: Axilla surgery ValueSet
.... SURGERYAXDATE-KnownIs the date of surgery to the axilla known?1..1booleanEnable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008)
.... SURGERYAXDATEPlease provide the date of surgery to the axilla1..1dateEnable When: SURGERYAXDATE-Known = true
.... SURGERYAX2Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year1..1choiceEnable When:
  • SURGERYAX = Sentinel lymph node biopsy (SNOMED CT#396487001)
  • SURGERYAX = Excision of axillary lymph node (SNOMED CT#234262008)

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

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

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

Value Set: Type of chemotherapy ValueSet
.... ChemoTxStartDate-KnownIs the start date of chemotherapy known?1..1booleanEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
.... ChemoTxStartDatePlease provide the start date of chemotherapy1..1dateEnable When: ChemoTxStartDate-Known = true
.... ChemoTxStopdate-KnownIs the stop date of chemotherapy known?1..1booleanEnable When:
  • TREATMENT_BREAST = Adjuvant chemotherapy (Treatment variables CodeSytem#adjuvant-chemotherapy)
  • TREATMENT_BREAST = Neoadjuvant chemotherapy (Treatment variables CodeSytem#neoadjuvant-chemotherapy)
.... ChemoTxStopdatePlease provide the stop date of chemotherapy1..1dateEnable When: ChemoTxStopdate-Known = true
.... HORMONTX_BREASTIndicate the intent of hormonal therapy1..1choiceEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
Value Set: Intent of therapy ValueSet
.... HORMONTXTYPEIndicate the type of hormonal therapy (select all that apply)1..*choiceEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
Value Set: Type of hormonal therapy ValueSet
.... HORMONTXSTARTDATE-KnownIs the start date of hormonal therapy known?1..1booleanEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
.... HORMONTXSTARTDATEPlease provide the start date of hormonal therapy1..1dateEnable When: HORMONTXSTARTDATE-Known = true
.... HORMONTXSTOPDATE-KnownIs the stop date of hormonal therapy known?1..1booleanEnable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002)
.... HORMONTXSTOPDATEPlease provide the stop date of hormonal therapy, if applicable1..1dateEnable When: HORMONTXSTOPDATE-Known = true
.... TARGETTX_BREASTIndicate the type of targeted therapy1..1choiceEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
Value Set: Type of targeted therapy ValueSet
.... TargetTxStartDate-KnownIs the start date of targeted therapy known?1..1booleanEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
.... TargetTxStartDatePlease provide the start date of targeted therapy1..1dateEnable When: TargetTxStartDate-Known = true
.... TargetTxStopDate-KnownIs the stop date of targeted therapy known?1..1booleanEnable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy)
.... TargetTxStopDatePlease provide the stop date of targeted therapy1..1dateEnable When: TargetTxStopDate-Known = true
.... SURGERYPATIENTIndicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply)1..*choiceValue Set: Type of re-operation
.... SURGERYDATEPATIENT-KnownIs the date of the reoperation known?1..1booleanEnable When:
.... SURGERYDATEPATIENTPlease provide the date of the reoperation1..1dateEnable When: SURGERYDATEPATIENT-Known = true
... Survival-and-Disease-controlSurvival and disease control1..1group
.... Survival-Q0Was the intent of the treatment curative?1..1boolean
.... MalignancyRecurIs there evidence of local, regional or distant recurrence of neoplasm?1..1choiceEnable When: Survival-Q0 = true
Value Set: Recurrence of neoplasm ValueSet
.... RecurMethodWhat was the method of confirming recurrence of neoplasm?1..1choiceEnable When:
  • MalignancyRecur = Yes, local recurrence (Recurrence of neoplasm CodeSystem#local-recurrence)
  • MalignancyRecur = Yes, regional recurrence (Recurrence of neoplasm CodeSystem#regional-recurrence)
  • MalignancyRecur = Yes, distant recurrence (Recurrence of neoplasm CodeSystem#distant-recurrence)

Value Set: Recurrence method ValueSet
.... RecurDateCancer-KnownIs the date of cancer recurrence known?1..1booleanEnable When:
  • MalignancyRecur = Yes, local recurrence (Recurrence of neoplasm CodeSystem#local-recurrence)
  • MalignancyRecur = Yes, regional recurrence (Recurrence of neoplasm CodeSystem#regional-recurrence)
  • MalignancyRecur = Yes, distant recurrence (Recurrence of neoplasm CodeSystem#distant-recurrence)
.... RecurDateCancerWhat is the date of cancer recurrence?1..1dateEnable When: RecurDateCancer-Known = true
.... VitalStatusIndicate if the person has deceased, regardless of cause1..1choiceValue Set: Yes, No and Unknown Valueset
.... DeceasedDate-KnownIs the date of death of the patient known?1..1booleanEnable When: VitalStatus = Yes (expandedYes-NoIndicator#Y)
.... DeceasedDatePlease provide the date of death of the patient1..1dateEnable When: DeceasedDate-Known = true
.... DEATHBCIs the death attributable to breast cancer?1..1choiceEnable When: VitalStatus = Yes (expandedYes-NoIndicator#Y)
Value Set: Yes, No and Unknown Valueset

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