Call for applications Letter of intent
Name of the coordinator Click here to enter text
Specialty Click here to enter text
Unit or Department Click here to enter text Name and address of the
hospital/institution
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Phone number Click here to enter text
E-mail Click here to enter text
Medical Oncologist, Postgraduated School in Medical Oncology, Phd Oncology
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AIOM member
Yes ☐ No ☐
(Non-members are eligible for the application only if they have applied for AIOM membership before the deadline of this project application).
Research domain
-Organ, tumor location : -Others:
Click here to enter text Click here to enter text Level of funding required (Euros) Click here to enter text Project title
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Name of the methodologist (if any) Click
here to enter text Name and address of the hospital Click here to enter text
Phone number Click here to enter text
E-mail Click here to enter text
Anticipated number of recruiting centers (approximate)
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N° Surname Name Town Hospital
/Institution E-mail Phone
1 2 3 4 5
References
List of the main publications from literature (5 maximum) justifying the project in the national and international context
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Rationale (max 300 words) Click here to enter text
Originality and innovative aspects Click here to enter text
Main objective Click here to enter text
Secondary objectives Click here to enter text
The exploratory objectives are (if any): Click here to enter text Primary end point
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Secondary end points Click here to enter text
Study population (if needed in the study design) Main inclusion criteria
Click here to enter text Main exclusion criteria Click here to enter text Design
Systematic reviews - Meta analysis Yes ☐ No ☐ Randomized clinical trial Yes ☐ No ☐
if yes: Open☐ Single blind ☐ Double blind☐
Non randomized trial ☐
Prospective cohort study ☐ Case-control study ☐ Cross-sectional study ☐ Retrospective cohort ☐ Administrative / hospital inpatient database research ☐ Modelisation ☐ Case series ☐ Pure preclinical studies☐ Others ☐ Please detail:
Click here to enter text If comparison groups : Click here to enter text
Duration (the maximum duration is 2 years) Click here to enter text
Statistical design
Total number of scheduled patients / observations to be recruited (if any) Click here to enter text
Participation of a research network (if any) Click here to enter text
Others aspects to insure the feasibility of the project Click here to enter text
Expected patient or public health benefit (max 300 words) Click here to enter text
