Request for analysis

Feasibility assessment form

Use this form to request a feasibility assessment regarding a potential research project. 

cancer du sein métastatique 1

This assessment includes:

  • An estimate of the number of patients who meet the inclusion and exclusion criteria of your project.
  • An overview of the quality and completeness of the available data variables needed for the project.
  • When possible, information on missing data and possible data imputations.

For any questions, contact us at info@breastcancerregistry.org

If applicable, after receiving your application, we will send you an email with the following information:

  • Feasibility assessment fee. 
  • How to proceed with the payment of this fee.
  • A request for electronic confirmation of your commitment to pay this fee.
    • This confirmation is required before starting the feasibility assessment process.
Demande d’analyse – FORMULAIRE D’ÉVALUATION DE LA FAISABILITÉ - EN

1. Applicant

2. Applicant type
3. Source of funding
4. Type of request
Includes study type, purpose (research question or hypothesis), product name, (if applicable).

7. Population

Note: For all data prior to 2012, a search in the clinical chart will be required.

8. Epidemiological variables and measures

The information in the Registry’s database relates to participants’ health status, including hospitalizations, diagnoses, medications, medical procedures and imaging, pathology, or laboratory results. It also contains demographic information (gender, age, ethnic origin, lifestyle).

For a specific research project requiring it, the data can be completed through the Dossier Santé Québec and the RAMQ (Régie de l’assurance maladie du Québec) file. There is an additional charge associated with this search for off-register data.

Please indicate all variables of interest for this request.

9. Confirmation and signature of the applicant

The applicant certifies that the information reported on this form is accurate and agrees to abide by the terms and conditions listed on this form.

Improving the fight against breast cancer by increasing access to and participation in clinical research studies.

info@breastcancerregistry.org

+1 514 509 8855

+1 514 509 8855

+1 514 509 8855