Updated: 10/18/05

	News and Events

714-X: Request for Cases

National Cancer Institute (NCI)
Office of Cancer Complementary and Alternative Medicine (OCCAM)
Privacy Act Notification Statement

Patients who have used 714-X for the treatment of cancer

Background

The NCI is involved in a review of information about the outcomes of United States (US) cancer patients who have used the product 714-X as the sole treatment of their cancer. The information obtained will be helpful to determine if the NCI should initiate research of 714-X.

Government Authorization

Section 285 of Title 42 of the U.S. Code authorizes collection of this information.

Purpose of Information Collection

The OCCAM is seeking information on certain kinds of patients who have used 714-X for the treatment of their cancer. The information provided on this electronic form will allow a staff member of the OCCAM to contact you to ask further questions and obtain more information about your cancer and its treatment. You may seek the assistance of your doctor in responding to this form. Providing this information is voluntary, however, your refusal to complete the required fields will exclude you from eligibility for further review.

Your volunteered personal information will not be available for public use, and will remain confidential, to the extent permitted by law. Government files are subject to Freedom of Information Act requests. If such a request is made that includes files with your information, every effort will be made to remove all personal identifying information on any documents released. If you desire not to submit your information during your visit to this website, please do not select the "Submit" button.

* Indicates a field that must be completed for the form to be accepted for submission.

* Are you a U.S. Resident

Yes

* Name:

* Address:

* Phone Number:

E-mail address:

* Cancer Diagnosis:

* Year of Diagnosis:

* Year 714-X Initiated:

Yes

* Did you have documented objective evidence of cancer at the time 714-X was initiated? For solid tumors (e.g. lung, breast, colon, etc.) this means tumor visible on X-ray or CT scan or MRI or PET scan, or photographs of skin tumors. For leukemia or other cancers of blood cells this means tests indicating leukemic cells in the blood and/or bone marrow. For multiple myeloma this means myeloma cells present on bone marrow biopsy and lab tests showing abnormal protein levels in blood and/or urine.

Yes

* Was there a repeat evaluation of the cancer after starting 714-X that demonstrated an objective improvement? (Solid Tumors - decrease in size of tumors seen on medical imaging studies mentioned above; Leukemia or other cancers of blood cells - decrease in number of leukemic or abnormal cells in the blood and/or bone marrow; Multiple myeloma - decrease in abnormal protein levels and/or numbers of myeloma cells on bone marrow biopsy.)

Yes

* Did you receive any conventional anticancer therapy (e.g. surgery, chemotherapy, hormonal therapy [eg. Tamoxifen, Lupron, etc.), antibody therapy [e.g. Rituxan], biological therapy [e.g. interleukin-2, interferon]) or experimental therapy at or near the same time (i.e. within 4 weeks) that you received the 714-X?

If it is determined that your case is eligible for further evaluation, you will receive a mailed request for the release of your medical records. You should return the signed form to the indicated address. Your medical records, films, and slides will be securely maintained at the NCI during the review. Transmission of your private health information for the request of records, diagnostic imaging, and pathologic slides will be conducted according to the appropriate government regulations.

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