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60A02 Appendices

60A02 Appendices A Phase II Randomized Placebo Controlled, Double Blinded Trial to Evaluate the Effects of Fruit and Vegetable Extracts on Intermediate Biomarkers in Head and Neck Cancer Patients Appendices by Visit: Screening    ®    Run-In/Baseline    ®    Weeks 1-4, 8    ®    12 Week Appendices: Combined Appendices 1.      Data Submission Checklist 2.      Eligibility Checklist and Registration Form 3.      Flow Sheet 4.      CES-D 5.      Perceived Stress Scale 6.      Patient Medication Diary 7.      Pill Count 8.      Common Toxicity Criteria 9.      Performance Status Criteria 10.    ADR Contacts 11.    Med Watch 12.    Baseline Head and Neck Questionnaire 13.    Food Questionnaire 14.    GI Questionnaire 15.    Post Treatment Head and Neck Questionnaire 16.    Off Treatment Follow-up Form 17.    Blood Sampling for Biomarkers 18.    AJCC Staging System *The contact information for patients seeking the 5 year supply of Juice Plus has changed. Please have patients contact Anita Boddie, RD, PhD by phone at (901) 850-2883 or fax at (901) 850-3055. *All invoices for biopsies must be submitted to the Research Base PIO attn: Gina Enevold for payment processing. Payments for invoices submitted to other offices will be delayed or may not go through the processing system at all. Please submit all invoices to the following address:   CCCWFU CCOP Research Base Attn: Gina Enevold 2000 West First Street, Suite 401 Winston-Salem, NC  27104 or fax them in to 336-716-6275.                                                                                 Back to 60A02 page CCCWFU CCOP Research Base Home  l  Protocols  l  Welcome  l  Patient Registration  l  Accruals    Annual Meeting  l  Results  l  Adverse Events  l  Newsletter    Quick Reference Guides  l  Links  l  Sites  l  Staff  l  Contact Us