| Project identification |
| Project title |
|
| Date of request |
|
| Name of requestor |
|
| Institution where the research is conducted |
|
| 1 Description of the research project |
| Background/rationale of the project |
|
| Objectives of the project |
|
| 2 EORTC trials involved |
| EORTC study numbers (or titles) |
|
3 Persons in charge of the research outside the EORTC
Headquarters
|
| Scientific leader of the project |
Usually the clinician or researcher responsible for the project,
This person must sign the request form |
| Name and title |
|
| Institution |
|
| e-mail address |
|
| |
In case the research is performed by a PhD student or trainee specify
his contact details |
| Name and title |
|
| Institution |
|
| e-mail address |
|
| 3.2 Methodologist or statistician responsible for the
data analysis and methodology of the project |
| |
This person must sign the request form |
| Name and title |
|
| Institution |
|
| e-mail address |
|
| Abbreviated Curriculum Vitae of the statistician (or send CV by
e-mail to ERP@eortc.be) |
|
| 3.3 Other persons involved in the project |
| Name and title |
|
| Institution |
|
| e-mail address |
|
| Role and responsibilities in the project |
|
| Name and title |
|
| Institution |
|
| e-mail address |
|
| Role and responsibilities in the project |
|
| Name and title |
|
| Institution |
|
| e-mail address |
|
| Role and responsibilities in the project |
|
| 4 Persons involved in the project at the EORTC
Headquarters (if applicable) |
| Name and title |
|
| Responsibilities |
|
| Time required and degree of involvement |
|
| Name and title |
|
| Responsibilities |
|
| Time required and degree of involvement |
|
| 5 Statistical methods and analysis plan |
| |
Detail here the methodology that will be used for the project,
including endpoints and methods (if a project protocol is available, please send
it by e-mail to ERP@eortc.be and indicate
herebelow) |
| |
|
| 6 Practical details of the project |
| 6.1 Timelines |
| |
Indicate expected timelines of the project. |
| Data analysis |
|
| First publication of results |
|
| Expected completion date |
|
| 6.2 Financing |
| |
If applicable specify any financial resources that are available to
cover the project costs |
| |
|
| 6.3 Data specifications |
| |
By default, the trial data are transferred to you in the form of a
SAS-readable set of files. However, if you are unable to read that format,
please specify an alternative format you prefer (Excel, Text..)
Specify here which variables you need. Indicate “all data” if you need the
complete database
(If specific coding is required, please send specifications by e-mail to
ERP@eortc.be )
Please note that the EORTC will not update the trial database for any specific
purpose of your project |
Format of transfer file,
if different from SAS |
|
| Variables to be transferred |
|
| 6.4 Other conditions on the data transfer, if the request
includes trials the final results of which are not yet published |
| |
If applicable, specify here if data is requested for trials that have
not yet been published. In this case, the data transfer of these trials will be
deferred until the trial results are published. |
| |
|
| 7 Publications |
| 7.1 Expected publications resulting from the research
project |
| |
Indicate the number of publications that you anticipate and for
each of them, the subject of the publication |
| Number of publications anticipated |
|
| Subject of the publications (list) |
|
| 7.2 Authorship for EORTC representatives |
| |
By default, the EORTC does not claim authorship positions on papers
resulting from your research. However, if one or several positions should be
attributed to EORTC members, please indicate them below. |
| |
|
| 7.3 Acknowledgements |
| |
The following acknowledgement to the EORTC will appear in the
publication:
“The authors thank the European Organization for Research and Treatment of Cancer
for permission to use the data from EORTC trial <number> for this
research.”
The following disclaimer will appear in the publication, unless an EORTC member
is co-authoring the publication:
“The contents of this publication and methods used are solely the responsibility
of the authors and do not necessarily represent the official views of the
EORTC.” |
| |
|
| 8. Signatures |
| 8.1 Agreement from the requestor and methodologist |
| |
The undersigned approves the present project and release of the
EORTC data under the conditions set in EORTC Policy 008 “Release of data from
EORTC studies for use in External Research Projects” |
| From the research institution |
|
| Scientific leader |
Name
date
|
| Methodologist |
Name
date
|
| |
|