A Study to Compare Two Surgical Procedures in Individuals With BRCA1 Mutations to Assess Reduced Risk of Ovarian Cancer

Not Applicable

Recruiting

• Conditions: Ovarian Carcinoma
• Interventions: Procedure: Bilateral Salpingectomy; Procedure: Bilateral Salpingectomy with Oophorectomy; Procedure: Biospecimen Collection; Other: Quality-of-Life Assessment; Other: Questionnaire Administration; Procedure: Transvaginal Ultrasound; Procedure: Ultrasound Imaging

• Registration Number: NCT04251052
• Lead Sponsor: NRG Oncology

Brief Summary

This study evaluates how well two surgical procedures (bilateral salpingectomy and bilateral salpingo-oophorectomy) work in reducing the risk of ovarian cancer for individuals with BRCA1 mutations. Bilateral salpingectomy involves the surgical removal of fallopian tubes, and bilateral salpingo-oophorectomy involves the surgical removal of both the fallopian tubes and ovaries. This study may help doctors determine if the two surgical procedures are nearly the same for ovarian cancer risk reduction for women with BRCA1 mutations.

Detailed Description

PRIMARY OBJECTIVE:

I. To compare the non-inferiority of bilateral salpingectomy (BLS) with delayed oophorectomy to bilateral salpingo-oophorectomy (BSO) to reduce the risk of ovarian cancer among individuals with deleterious BRCA1 germline mutations.

SECONDARY OBJECTIVES:

I. To prospectively assess estrogen deprivation symptoms in pre-menopausal BLS patients as measured by the Functional Assessment of Cancer Therapy - Endocrine Symptom (FACT-ES) subscale compared to pre-menopausal patients in the BSO arm.

II. To determine if health-related quality of life (QOL) (FACT) is negatively impacted by menopausal symptoms (menopausal symptom checklist-Menopausal Symptom Checklist \[MSCL\]) and sexual dysfunction (Female Sexual Function Index \[FSFI\]) in pre-menopausal patients who have undergone BLS, in comparison to normative data (MSCL/FACT-ES) and data from pre-menopausal BSO patients.

III. To determine if health-related QOL (FACT) is negatively impacted by cancer distress (Impact of Event Scale \[IES\]) in individuals who have undergone BLS, in comparison to BSO patients.

IV. To assess medical decision making, as measured by the Shared Decision Making Questionnaire (SDM-Q-9) and Decision Regret Scale (DRS), and determine factors associated with the risk of reducing surgical treatment choice.

V. To assess adverse events, graded using Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0.

EXPLORATORY OBJECTIVES:

I. Sexual dysfunction, as measured by selected Patient-Reported Outcomes Measurement Information System (PROMIS) screener and external sexual function items (pre-menopausal patients).

II. To estimate the cost-effectiveness of BLS compared to BSO for ovarian cancer risk reduction.

III. To assess medical decision making, as measured by the Risk-Reducing Medical Decision Making (RR-MDM) survey, a targeted set of questions on risk reducing surgical treatment choice.

TRANSLATIONAL RESEARCH OBJECTIVE:

I. To bank tissue and blood biospecimens for future research.

OUTLINE: This is an observational study. Patients choose between 1 of 2 groups.

GROUP I: Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery.

GROUP II: Patients undergo bilateral salpingo-oophorectomy.

Patients in both groups also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.

After completion of study, patients are followed up at 10-60 days, 6, 12, and 24 months, and then annually for up to 20 years.

Study Timeline

• Study First Submitted: 2020-01-14
• Study First Submitted QC: 2020-01-30
• Study First Posted: 2020-01-31
• Study Start: 2020-09-01
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-15
• Last Update Posted: 2025-05-20
• Primary Completion: 2047-04-30
• Study Completion: 2047-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: Female
• Target Recruitment: 2262

Inclusion Criteria

• Individuals 35-50 years of age, inclusive
• Patients who will undergo risk-reducing salpingo-oophorectomy (RRSO) (for the BSO arm) and patients who have declined or elected to defer BSO after proper counselling to clearly explain the standard of care for BRCA1 mutation carriers and are undergoing salpingectomy (for the BLS arm with delayed oophorectomy arm). Concurrently planned hysterectomy with either arm is permitted
• At least one intact ovary and fallopian tube is in situ at the time of counseling, consent, and registration. Prior hysterectomy is allowed provided it did not include bilateral salpingectomy. Prior tubal ligation is allowed if one ovary and fallopian tube (with fimbria not removed) are present
• Positive Clinical Laboratory Improvement Act (CLIA)-approved test results for pathogenic or likely pathogenic germline BRCA1 mutation in the patient. Documentation of the result is required
• Patients may be premenopausal or menopausal
• Pelvic ultrasound (transvaginal imaging preferred, but transabdominal imaging is acceptable) and CA-125 within 180 days of registration
• The patient or a legally authorized representative must provide study-specific informed consent prior to study entry
• Individuals who are currently pregnant or plan to become pregnant in the future through assisted reproductive technologies and who have received proper counseling are eligible. Individuals who are currently pregnant and plan bilateral salpingectomy at the time of a planned cesarean section are eligible. Patients must understand that they will not be able to become pregnant naturally in the future

Exclusion Criteria

• Individuals with a history of any prior cancer who have received cytotoxic chemotherapy within the past 30 days or radiotherapy to abdomen or pelvis at any prior time. Endocrine therapy or maintenance ERBB2/HER2 targeted therapy is allowed. Maintenance immune checkpoint inhibitor therapy is allowed. Maintenance therapy with PARP in inhibitor is allowed.

• Prior history of ovarian cancer, including low malignant potential neoplasms (LMP), primary peritoneal carcinoma, or fallopian tube carcinoma

• Patients medically unfit for the planned surgical procedure

• Patients with abnormal screening tests (pelvic ultrasound, CA-125) suspicious for occult or gross pelvic malignancy within the past 180 days

  • An abnormal pelvic ultrasound is defined as morphologic or structural variations suspicious for ovarian malignancy. Complex cystic lesions felt to represent a benign lesion are not exclusionary. Simple cysts of any size are not exclusionary
  • An abnormal CA-125 is defined as a level > 50U/ml in premenopausal individuals if they are not current users of oral contraceptives; an abnormal CA-125 is defined as a level > 40U/ml for premenopausal individuals who are current users of oral contraceptives (Skates 2011). An abnormal CA-125 is defined as a level > 35 U/ml in postmenopausal individuals

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Group I (bilateral salpingectomy)	Bilateral Salpingectomy	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group I (bilateral salpingectomy)	Biospecimen Collection	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group I (bilateral salpingectomy)	Quality-of-Life Assessment	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group I (bilateral salpingectomy)	Questionnaire Administration	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Questionnaire Administration	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group I (bilateral salpingectomy)	Transvaginal Ultrasound	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group I (bilateral salpingectomy)	Ultrasound Imaging	Patients undergo bilateral salpingectomy. Patients may then undergo oophorectomy after initial surgery. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Bilateral Salpingectomy with Oophorectomy	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Biospecimen Collection	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Quality-of-Life Assessment	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Transvaginal Ultrasound	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.
Group II (bilateral salpingo-oophorectomy)	Ultrasound Imaging	Patients undergo bilateral salpingo-oophorectomy. Patients also undergo a pelvic or transvaginal ultrasound during screening and blood sample collection throughout the trial.

Primary Outcome Measures

Name	Time	Method
Time to development of incident high-grade serous carcinomas (HGSC), specifically ovarian, primary peritoneal, or fallopian tube cancers	Up to 20 years	Will be assessed using a stratified log rank test, stratifying for age. The effects of other covariates, such as familial history of gynecologic cancer, time to crossover for bilateral salpingectomy (BLS) patients, and age at study entry, will be adjusted for in Cox proportional hazard models. Patients who crossover will be analyzed according to the initial surgery received at study enrollment as this will reflect actual practice.

Secondary Outcome Measures

Name	Time	Method
Sexual dysfunction (pre-menopausal patients only)	Up to 24 months post-surgery	Will be measured by the FSFI. Scores range from 0 to 36. Higher scores indicate better functioning for the FSFI total score.
Health-related quality of life (QOL)	Up to 24 months post-surgery	Will be measured by the Functional Assessment of Cancer Therapy - Endocrine Symptom (FACT-ES). The FACT total score (calculated from the physical, functional, social and emotional well-being subscales) and ES subscale will be assessed. Scores range from 0 to 76. Higher scores indicate better QOL for the FACT-ES and better functioning for the Female Sexual Function Index (FSFI) total score.
Cancer distress	Up to 24 months post-surgery	Will be measured by the Impact of Events Scale (IES). The total score can range from 0 to 88, with higher scores indicating a greater impact of the event.
Medical decision making	Up to 24 months post-surgery	Will be measured by the Shared Decision Making Questionnaire (SDM-Q-9) and, Decisional Regret Scale. The SDM-Q-9 total score and Decisional Regret Scale total score at each time point of collection will be compared between arms using a t-test with a significance level of 0.05. A linear model will be used to assess the association of the SDM-Q-9 total score with treatment arm and patient characteristics such as age and race. A similar model will be used to assess the association of the Decisional Regret Scale total score with treatment arm and patient characteristics such as age, race, crossover from BLS arm, and hysterectomy status. minimum score of 0 and a maximum score of 45. A higher score indicates a greater level of perceived shared decision-making in a consultation.
Incidence of adverse events	Up to 20 years	Will be graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Counts and frequencies will be provided for the worst grade adverse event (AE) experienced by the patient by treatment arm. The distribution of AE grade in the BLS arm will be compared to the bilateral salpingo-oophorectomy arm using a chi-square test, or Fisher's exact test if cell frequencies are \< 5, at the one-sided 0.05 significance level.
Estrogen deprivation symptoms (pre-menopaused patients only)	Up to 24 months post-surgery	Will be measured by the FACT-ES. The FACT total score (calculated from the physical, functional, social and emotional well-being subscales) and ES subscale will be assessed. Scores range from 0 to 76. Higher scores indicate better QOL for the FACT-ES and better functioning for the FSFI total score. Models will also include hormonal therapy as a covariate.
Menopausal symptoms (pre-menopausal patients only)	Up to 24 months post-surgery	Will be measured by the Menopausal Symptom Checklist (MSCL). Models will also include hormonal therapy as a covariate. The MSCL total score and individual items will be compared between groups using the t-test and Wilcoxon test, respectively. The change from baseline in total score will be compared between groups at each follow-up time point. The change form baseline in the 3 items not included in the subscale scores will be compared between groups using the Wilcoxon test at each follow-up time point.

Trial Locations

Locations (509)

University of Alabama at Birmingham Cancer Center; 🇺🇸 Birmingham, Alabama, United States

Anchorage Associates in Radiation Medicine; 🇺🇸 Anchorage, Alaska, United States

Anchorage Radiation Therapy Center; 🇺🇸 Anchorage, Alaska, United States

Alaska Breast Care and Surgery LLC; 🇺🇸 Anchorage, Alaska, United States

Alaska Oncology and Hematology LLC; 🇺🇸 Anchorage, Alaska, United States

Alaska Women's Cancer Care; 🇺🇸 Anchorage, Alaska, United States

Katmai Oncology Group; 🇺🇸 Anchorage, Alaska, United States

Providence Alaska Medical Center; 🇺🇸 Anchorage, Alaska, United States

CTCA at Western Regional Medical Center; 🇺🇸 Goodyear, Arizona, United States

Banner University Medical Center - Tucson; 🇺🇸 Tucson, Arizona, United States

University of Arizona Cancer Center-North Campus; 🇺🇸 Tucson, Arizona, United States

University of Arkansas for Medical Sciences; 🇺🇸 Little Rock, Arkansas, United States

Kaiser Permanente-Deer Valley Medical Center; 🇺🇸 Antioch, California, United States

Tower Cancer Research Foundation; 🇺🇸 Beverly Hills, California, United States

Keck Medicine of USC Buena Park; 🇺🇸 Buena Park, California, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center; 🇺🇸 Burbank, California, United States

City of Hope Comprehensive Cancer Center; 🇺🇸 Duarte, California, United States

Kaiser Permanente Dublin; 🇺🇸 Dublin, California, United States

Kaiser Permanente-Fremont; 🇺🇸 Fremont, California, United States

Fresno Cancer Center; 🇺🇸 Fresno, California, United States

Kaiser Permanente-Fresno; 🇺🇸 Fresno, California, United States

City of Hope Seacliff; 🇺🇸 Huntington Beach, California, United States

Keck Medicine of USC Huntington Beach; 🇺🇸 Huntington Beach, California, United States

City of Hope at Irvine Lennar; 🇺🇸 Irvine, California, United States

Kaiser Permanente-Irvine; 🇺🇸 Irvine, California, United States

City of Hope Antelope Valley; 🇺🇸 Lancaster, California, United States

Keck Medicine of USC Koreatown; 🇺🇸 Los Angeles, California, United States

Kaiser Permanente Los Angeles Medical Center; 🇺🇸 Los Angeles, California, United States

Los Angeles General Medical Center; 🇺🇸 Los Angeles, California, United States

USC / Norris Comprehensive Cancer Center; 🇺🇸 Los Angeles, California, United States

Cedars Sinai Medical Center; 🇺🇸 Los Angeles, California, United States

UCLA / Jonsson Comprehensive Cancer Center; 🇺🇸 Los Angeles, California, United States

Kaiser Permanente-Modesto; 🇺🇸 Modesto, California, United States

Providence Queen of The Valley; 🇺🇸 Napa, California, United States

USC Norris Oncology/Hematology-Newport Beach; 🇺🇸 Newport Beach, California, United States

Kaiser Permanente Oakland-Broadway; 🇺🇸 Oakland, California, United States

Kaiser Permanente-Oakland; 🇺🇸 Oakland, California, United States

Kaiser Permanente - Panorama City; 🇺🇸 Panorama City, California, United States

Huntington Memorial Hospital; 🇺🇸 Pasadena, California, United States

Keck Medical Center of USC Pasadena; 🇺🇸 Pasadena, California, United States

Kaiser Permanente-Rancho Cordova Cancer Center; 🇺🇸 Rancho Cordova, California, United States

Kaiser Permanente- Marshall Medical Offices; 🇺🇸 Redwood City, California, United States

Kaiser Permanente-Redwood City; 🇺🇸 Redwood City, California, United States

Kaiser Permanente-Richmond; 🇺🇸 Richmond, California, United States

Kaiser Permanente-Riverside; 🇺🇸 Riverside, California, United States

Rohnert Park Cancer Center; 🇺🇸 Rohnert Park, California, United States

Kaiser Permanente-Roseville; 🇺🇸 Roseville, California, United States

The Permanente Medical Group-Roseville Radiation Oncology; 🇺🇸 Roseville, California, United States

Kaiser Permanente Downtown Commons; 🇺🇸 Sacramento, California, United States

University of California Davis Comprehensive Cancer Center; 🇺🇸 Sacramento, California, United States

Kaiser Permanente-South Sacramento; 🇺🇸 Sacramento, California, United States

South Sacramento Cancer Center; 🇺🇸 Sacramento, California, United States

Kaiser Permanente-San Francisco; 🇺🇸 San Francisco, California, United States

UCSF Medical Center-Mission Bay; 🇺🇸 San Francisco, California, United States

Kaiser Permanente-Santa Teresa-San Jose; 🇺🇸 San Jose, California, United States

Kaiser Permanente San Leandro; 🇺🇸 San Leandro, California, United States

Kaiser San Rafael-Gallinas; 🇺🇸 San Rafael, California, United States

Kaiser Permanente Medical Center - Santa Clara; 🇺🇸 Santa Clara, California, United States

Kaiser Permanente-Santa Rosa; 🇺🇸 Santa Rosa, California, United States

Providence Medical Foundation - Santa Rosa; 🇺🇸 Santa Rosa, California, United States

Providence Santa Rosa Memorial Hospital; 🇺🇸 Santa Rosa, California, United States

City of Hope South Pasadena; 🇺🇸 South Pasadena, California, United States

Kaiser Permanente Cancer Treatment Center; 🇺🇸 South San Francisco, California, United States

Kaiser Permanente-South San Francisco; 🇺🇸 South San Francisco, California, United States

Kaiser Permanente-Stockton; 🇺🇸 Stockton, California, United States

City of Hope South Bay; 🇺🇸 Torrance, California, United States

Torrance Memorial Physician Network - Cancer Care; 🇺🇸 Torrance, California, United States

City of Hope Upland; 🇺🇸 Upland, California, United States

Kaiser Permanente Medical Center-Vacaville; 🇺🇸 Vacaville, California, United States

Kaiser Permanente-Vallejo; 🇺🇸 Vallejo, California, United States

Kaiser Permanente-Walnut Creek; 🇺🇸 Walnut Creek, California, United States

UCHealth University of Colorado Hospital; 🇺🇸 Aurora, Colorado, United States

Penrose-Saint Francis Healthcare; 🇺🇸 Colorado Springs, Colorado, United States

UCHealth Memorial Hospital Central; 🇺🇸 Colorado Springs, Colorado, United States

Memorial Hospital North; 🇺🇸 Colorado Springs, Colorado, United States

UCHealth Highlands Ranch Hospital; 🇺🇸 Highlands Ranch, Colorado, United States

Longmont United Hospital; 🇺🇸 Longmont, Colorado, United States

Danbury Hospital; 🇺🇸 Danbury, Connecticut, United States

Smilow Cancer Hospital Care Center at Greenwich; 🇺🇸 Greenwich, Connecticut, United States

Hartford Hospital; 🇺🇸 Hartford, Connecticut, United States

The Hospital of Central Connecticut; 🇺🇸 New Britain, Connecticut, United States

Smilow Cancer Center/Yale-New Haven Hospital; 🇺🇸 New Haven, Connecticut, United States

Yale University; 🇺🇸 New Haven, Connecticut, United States

Norwalk Hospital; 🇺🇸 Norwalk, Connecticut, United States

Smilow Cancer Hospital Care Center - Waterford; 🇺🇸 Waterford, Connecticut, United States

Beebe Medical Center; 🇺🇸 Lewes, Delaware, United States

Delaware Clinical and Laboratory Physicians PA; 🇺🇸 Newark, Delaware, United States

Helen F Graham Cancer Center; 🇺🇸 Newark, Delaware, United States

Medical Oncology Hematology Consultants PA; 🇺🇸 Newark, Delaware, United States

Christiana Care Health System-Christiana Hospital; 🇺🇸 Newark, Delaware, United States

Beebe Health Campus; 🇺🇸 Rehoboth Beach, Delaware, United States

Sarasota Memorial Hospital; 🇺🇸 Sarasota, Florida, United States

Christiana Care Health System-Wilmington Hospital; 🇺🇸 Wilmington, Delaware, United States

George Washington University Medical Center; 🇺🇸 Washington, District of Columbia, United States

UM Sylvester Comprehensive Cancer Center at Aventura; 🇺🇸 Aventura, Florida, United States

Florida Cancer Specialists - Bradenton Cancer Center; 🇺🇸 Bradenton, Florida, United States

UM Sylvester Comprehensive Cancer Center at Coral Gables; 🇺🇸 Coral Gables, Florida, United States

UM Sylvester Comprehensive Cancer Center at Deerfield Beach; 🇺🇸 Deerfield Beach, Florida, United States

UM Sylvester Comprehensive Cancer Center at Doral; 🇺🇸 Doral, Florida, United States

GenesisCare USA - FGO; 🇺🇸 Fort Myers, Florida, United States

Regional Cancer Center-Lee Memorial Health System; 🇺🇸 Fort Myers, Florida, United States

University of Florida Health Science Center - Gainesville; 🇺🇸 Gainesville, Florida, United States

Jackson Memorial Hospital-Holtz Children's Hospital; 🇺🇸 Miami, Florida, United States

University of Miami Miller School of Medicine-Sylvester Cancer Center; 🇺🇸 Miami, Florida, United States

UM Sylvester Comprehensive Cancer Center at Kendall; 🇺🇸 Miami, Florida, United States

Sarasota Memorial Hospital-Venice; 🇺🇸 N. Venice, Florida, United States

UM Sylvester Comprehensive Cancer Center at Plantation; 🇺🇸 Plantation, Florida, United States

Florida Cancer Specialists - Sarasota; 🇺🇸 Sarasota, Florida, United States

Intercoastal Medical Group - Cattleridge II; 🇺🇸 Sarasota, Florida, United States

Florida Cancer Specialists - Sarasota Downtown; 🇺🇸 Sarasota, Florida, United States

First Physicians Group - Urology Robotic and Minimally Invasive Surgery; 🇺🇸 Sarasota, Florida, United States

First Physicians Group-Sarasota; 🇺🇸 Sarasota, Florida, United States

Sarasota Memorial Health Care Center at University Parkway; 🇺🇸 Sarasota, Florida, United States

Florida Cancer Specialists - Venice Pinebrook; 🇺🇸 Venice, Florida, United States

Florida Cancer Specialists - Venice Island; 🇺🇸 Venice, Florida, United States

Grady Health System; 🇺🇸 Atlanta, Georgia, United States

Emory University Hospital Midtown; 🇺🇸 Atlanta, Georgia, United States

Emory University Hospital/Winship Cancer Institute; 🇺🇸 Atlanta, Georgia, United States

Emory Saint Joseph's Hospital; 🇺🇸 Atlanta, Georgia, United States

Northside Hospital; 🇺🇸 Atlanta, Georgia, United States

Augusta University Medical Center; 🇺🇸 Augusta, Georgia, United States

CTCA at Southeastern Regional Medical Center; 🇺🇸 Newnan, Georgia, United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler; 🇺🇸 Savannah, Georgia, United States

Hawaii Cancer Care - Westridge; 🇺🇸 'Aiea, Hawaii, United States

Pali Momi Medical Center; 🇺🇸 'Aiea, Hawaii, United States

Queen's Cancer Center - Pearlridge; 🇺🇸 'Aiea, Hawaii, United States

The Cancer Center of Hawaii-Pali Momi; 🇺🇸 'Aiea, Hawaii, United States

The Queen's Medical Center - West Oahu; 🇺🇸 'Ewa Beach, Hawaii, United States

Hawaii Cancer Care Inc - Waterfront Plaza; 🇺🇸 Honolulu, Hawaii, United States

Island Urology; 🇺🇸 Honolulu, Hawaii, United States

Queen's Cancer Cenrer - POB I; 🇺🇸 Honolulu, Hawaii, United States

Queen's Medical Center; 🇺🇸 Honolulu, Hawaii, United States

Straub Clinic and Hospital; 🇺🇸 Honolulu, Hawaii, United States

University of Hawaii Cancer Center; 🇺🇸 Honolulu, Hawaii, United States

Hawaii Cancer Care Inc-Liliha; 🇺🇸 Honolulu, Hawaii, United States

Kuakini Medical Center; 🇺🇸 Honolulu, Hawaii, United States

Queen's Cancer Center - Kuakini; 🇺🇸 Honolulu, Hawaii, United States

The Cancer Center of Hawaii-Liliha; 🇺🇸 Honolulu, Hawaii, United States

Kaiser Permanente Moanalua Medical Center; 🇺🇸 Honolulu, Hawaii, United States

Kapiolani Medical Center for Women and Children; 🇺🇸 Honolulu, Hawaii, United States

Wilcox Memorial Hospital and Kauai Medical Clinic; 🇺🇸 Lihue, Hawaii, United States

Saint Luke's Cancer Institute - Boise; 🇺🇸 Boise, Idaho, United States

Saint Luke's Cancer Institute - Fruitland; 🇺🇸 Fruitland, Idaho, United States

Saint Luke's Cancer Institute - Meridian; 🇺🇸 Meridian, Idaho, United States

Saint Luke's Cancer Institute - Nampa; 🇺🇸 Nampa, Idaho, United States

Saint Luke's Cancer Institute - Twin Falls; 🇺🇸 Twin Falls, Idaho, United States

Rush - Copley Medical Center; 🇺🇸 Aurora, Illinois, United States

Advocate Outpatient Center - Aurora; 🇺🇸 Aurora, Illinois, United States

Advocate Good Shepherd Hospital; 🇺🇸 Barrington, Illinois, United States

Carle BroMenn Outpatient Center; 🇺🇸 Bloomington, Illinois, United States

Northwestern University; 🇺🇸 Chicago, Illinois, United States

Rush University Medical Center; 🇺🇸 Chicago, Illinois, United States

University of Illinois; 🇺🇸 Chicago, Illinois, United States

University of Chicago Comprehensive Cancer Center; 🇺🇸 Chicago, Illinois, United States

Advocate Illinois Masonic Medical Center; 🇺🇸 Chicago, Illinois, United States

AMG Crystal Lake - Oncology; 🇺🇸 Crystal Lake, Illinois, United States

Carle at The Riverfront; 🇺🇸 Danville, Illinois, United States

Northwestern Medicine Cancer Center Kishwaukee; 🇺🇸 DeKalb, Illinois, United States

Advocate Good Samaritan Hospital; 🇺🇸 Downers Grove, Illinois, United States

Carle Physician Group-Effingham; 🇺🇸 Effingham, Illinois, United States

Advocate Sherman Hospital; 🇺🇸 Elgin, Illinois, United States

Elmhurst Memorial Hospital; 🇺🇸 Elmhurst, Illinois, United States

NorthShore University HealthSystem-Evanston Hospital; 🇺🇸 Evanston, Illinois, United States

Northwestern Medicine Cancer Center Delnor; 🇺🇸 Geneva, Illinois, United States

NorthShore University HealthSystem-Glenbrook Hospital; 🇺🇸 Glenview, Illinois, United States

Northwestern Medicine Glenview Outpatient Center; 🇺🇸 Glenview, Illinois, United States

Northwestern Medicine Grayslake Outpatient Center; 🇺🇸 Grayslake, Illinois, United States

Advocate South Suburban Hospital; 🇺🇸 Hazel Crest, Illinois, United States

NorthShore University HealthSystem-Highland Park Hospital; 🇺🇸 Highland Park, Illinois, United States

Sudarshan K Sharma MD Limited-Gynecologic Oncology; 🇺🇸 Hinsdale, Illinois, United States

Northwestern Medicine Lake Forest Hospital; 🇺🇸 Lake Forest, Illinois, United States

AMG Libertyville - Oncology; 🇺🇸 Libertyville, Illinois, United States

Condell Memorial Hospital; 🇺🇸 Libertyville, Illinois, United States

Carle Physician Group-Mattoon/Charleston; 🇺🇸 Mattoon, Illinois, United States

Edward Hospital/Cancer Center; 🇺🇸 Naperville, Illinois, United States

UC Comprehensive Cancer Center at Silver Cross; 🇺🇸 New Lenox, Illinois, United States

Carle BroMenn Medical Center; 🇺🇸 Normal, Illinois, United States

Carle Cancer Institute Normal; 🇺🇸 Normal, Illinois, United States

Advocate Christ Medical Center; 🇺🇸 Oak Lawn, Illinois, United States

Oak Park Hospital; 🇺🇸 Oak Park, Illinois, United States

University of Chicago Medicine-Orland Park; 🇺🇸 Orland Park, Illinois, United States

Advocate Lutheran General Hospital; 🇺🇸 Park Ridge, Illinois, United States

Edward Hospital/Cancer Center?Plainfield; 🇺🇸 Plainfield, Illinois, United States

Springfield Memorial Hospital; 🇺🇸 Springfield, Illinois, United States

Carle Cancer Center; 🇺🇸 Urbana, Illinois, United States

The Carle Foundation Hospital; 🇺🇸 Urbana, Illinois, United States

Northwestern Medicine Cancer Center Warrenville; 🇺🇸 Warrenville, Illinois, United States

Rush-Copley Healthcare Center; 🇺🇸 Yorkville, Illinois, United States

Midwestern Regional Medical Center; 🇺🇸 Zion, Illinois, United States

IU Health North Hospital; 🇺🇸 Carmel, Indiana, United States

UChicago Medicine Northwest Indiana; 🇺🇸 Crown Point, Indiana, United States

Goshen Center for Cancer Care; 🇺🇸 Goshen, Indiana, United States

Indiana University/Melvin and Bren Simon Cancer Center; 🇺🇸 Indianapolis, Indiana, United States

Community Cancer Center North; 🇺🇸 Indianapolis, Indiana, United States

Ascension Saint Vincent Indianapolis Hospital; 🇺🇸 Indianapolis, Indiana, United States

Baptist Health Floyd; 🇺🇸 New Albany, Indiana, United States

Heartland Oncology and Hematology LLP; 🇺🇸 Council Bluffs, Iowa, United States

Methodist Jennie Edmundson Hospital; 🇺🇸 Council Bluffs, Iowa, United States

Nebraska Cancer Specialists/Oncology Hematology West PC - MEJ; 🇺🇸 Council Bluffs, Iowa, United States

University of Iowa/Holden Comprehensive Cancer Center; 🇺🇸 Iowa City, Iowa, United States

University of Kansas Clinical Research Center; 🇺🇸 Fairway, Kansas, United States

University of Kansas Cancer Center; 🇺🇸 Kansas City, Kansas, United States

University of Kansas Hospital-Indian Creek Campus; 🇺🇸 Overland Park, Kansas, United States

University of Kansas Hospital-Westwood Cancer Center; 🇺🇸 Westwood, Kansas, United States

Baptist Health Corbin; 🇺🇸 Corbin, Kentucky, United States

Saint Elizabeth Healthcare Edgewood; 🇺🇸 Edgewood, Kentucky, United States

Baptist Health Hardin; 🇺🇸 Elizabethtown, Kentucky, United States

Baptist Health Lexington; 🇺🇸 Lexington, Kentucky, United States

Norton Hospital Pavilion and Medical Campus; 🇺🇸 Louisville, Kentucky, United States

Baptist Health Louisville; 🇺🇸 Louisville, Kentucky, United States

Norton Suburban Hospital and Medical Campus; 🇺🇸 Louisville, Kentucky, United States

Baptist Health Madisonville/Merle Mahr Cancer Center; 🇺🇸 Madisonville, Kentucky, United States

Baptist Health Paducah; 🇺🇸 Paducah, Kentucky, United States

Baptist Health Richmond; 🇺🇸 Richmond, Kentucky, United States

Mercy Hospital Saint Louis; 🇺🇸 Saint Louis, Missouri, United States

West Jefferson Medical Center; 🇺🇸 Marrero, Louisiana, United States

Louisiana State University Health Science Center; 🇺🇸 New Orleans, Louisiana, United States

University Medical Center New Orleans; 🇺🇸 New Orleans, Louisiana, United States

Willis-Knighton Medical and Cancer Center; 🇺🇸 Shreveport, Louisiana, United States

MaineHealth Maine Medical Center - Portland; 🇺🇸 Portland, Maine, United States

MaineHealth Maine Medical Center- Scarborough; 🇺🇸 Scarborough, Maine, United States

University of Maryland/Greenebaum Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Johns Hopkins University/Sidney Kimmel Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Walter Reed National Military Medical Center; 🇺🇸 Bethesda, Maryland, United States

Christiana Care - Union Hospital; 🇺🇸 Elkton, Maryland, United States

UM Baltimore Washington Medical Center/Tate Cancer Center; 🇺🇸 Glen Burnie, Maryland, United States

Baystate Medical Center; 🇺🇸 Springfield, Massachusetts, United States

Corewell Health Dearborn Hospital; 🇺🇸 Dearborn, Michigan, United States

Wayne State University/Karmanos Cancer Institute; 🇺🇸 Detroit, Michigan, United States

Weisberg Cancer Treatment Center; 🇺🇸 Farmington Hills, Michigan, United States

Corewell Health Farmington Hills Hospital; 🇺🇸 Farmington Hills, Michigan, United States

McLaren Cancer Institute-Flint; 🇺🇸 Flint, Michigan, United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital; 🇺🇸 Grand Rapids, Michigan, United States

Bronson Methodist Hospital; 🇺🇸 Kalamazoo, Michigan, United States

West Michigan Cancer Center; 🇺🇸 Kalamazoo, Michigan, United States

Ascension Borgess Hospital; 🇺🇸 Kalamazoo, Michigan, United States

Trinity Health Muskegon Hospital; 🇺🇸 Muskegon, Michigan, United States

Oakland Colon Rectal Associates; 🇺🇸 Royal Oak, Michigan, United States

Cancer Care Associates PC; 🇺🇸 Royal Oak, Michigan, United States

Comprehensive Medical Center PLLC; 🇺🇸 Royal Oak, Michigan, United States

Corewell Health William Beaumont University Hospital; 🇺🇸 Royal Oak, Michigan, United States

Hematology Oncology Consultants PC-Royal Oak; 🇺🇸 Royal Oak, Michigan, United States

Oakland Medical Group; 🇺🇸 Royal Oak, Michigan, United States

Premier Hematology Oncology Care; 🇺🇸 Sterling Heights, Michigan, United States

Michigan Institute of Urology-Town Center; 🇺🇸 Troy, Michigan, United States

Corewell Health Beaumont Troy Hospital; 🇺🇸 Troy, Michigan, United States

Hematology Oncology Consultants PC-Troy; 🇺🇸 Troy, Michigan, United States

Minnesota Oncology - Burnsville; 🇺🇸 Burnsville, Minnesota, United States

Cambridge Medical Center; 🇺🇸 Cambridge, Minnesota, United States

Mercy Hospital; 🇺🇸 Coon Rapids, Minnesota, United States

Fairview Southdale Hospital; 🇺🇸 Edina, Minnesota, United States

Unity Hospital; 🇺🇸 Fridley, Minnesota, United States

Fairview Clinics and Surgery Center Maple Grove; 🇺🇸 Maple Grove, Minnesota, United States

Minnesota Oncology Hematology PA-Maplewood; 🇺🇸 Maplewood, Minnesota, United States

Saint John's Hospital - Healtheast; 🇺🇸 Maplewood, Minnesota, United States

Abbott-Northwestern Hospital; 🇺🇸 Minneapolis, Minnesota, United States

Hennepin County Medical Center; 🇺🇸 Minneapolis, Minnesota, United States

Health Partners Inc; 🇺🇸 Minneapolis, Minnesota, United States

University of Minnesota/Masonic Cancer Center; 🇺🇸 Minneapolis, Minnesota, United States

Monticello Cancer Center; 🇺🇸 Monticello, Minnesota, United States

New Ulm Medical Center; 🇺🇸 New Ulm, Minnesota, United States

Fairview Northland Medical Center; 🇺🇸 Princeton, Minnesota, United States

North Memorial Medical Health Center; 🇺🇸 Robbinsdale, Minnesota, United States

Mayo Clinic in Rochester; 🇺🇸 Rochester, Minnesota, United States

Park Nicollet Clinic - Saint Louis Park; 🇺🇸 Saint Louis Park, Minnesota, United States

Regions Hospital; 🇺🇸 Saint Paul, Minnesota, United States

United Hospital; 🇺🇸 Saint Paul, Minnesota, United States

Saint Francis Regional Medical Center; 🇺🇸 Shakopee, Minnesota, United States

Lakeview Hospital; 🇺🇸 Stillwater, Minnesota, United States

Ridgeview Medical Center; 🇺🇸 Waconia, Minnesota, United States

Rice Memorial Hospital; 🇺🇸 Willmar, Minnesota, United States

Minnesota Oncology Hematology PA-Woodbury; 🇺🇸 Woodbury, Minnesota, United States

Fairview Lakes Medical Center; 🇺🇸 Wyoming, Minnesota, United States

University of Kansas Cancer Center at North Kansas City Hospital; 🇺🇸 North Kansas City, Missouri, United States

Washington University School of Medicine; 🇺🇸 Saint Louis, Missouri, United States

Mercy Hospital South; 🇺🇸 Saint Louis, Missouri, United States

Missouri Baptist Medical Center; 🇺🇸 Saint Louis, Missouri, United States

Mercy Hospital Springfield; 🇺🇸 Springfield, Missouri, United States

CoxHealth South Hospital; 🇺🇸 Springfield, Missouri, United States

Billings Clinic Cancer Center; 🇺🇸 Billings, Montana, United States

Bozeman Health Deaconess Hospital; 🇺🇸 Bozeman, Montana, United States

Saint Patrick Hospital - Community Hospital; 🇺🇸 Missoula, Montana, United States

Community Medical Center; 🇺🇸 Missoula, Montana, United States

Nebraska Cancer Specialists/Oncology Hematology West PC - MECC; 🇺🇸 Omaha, Nebraska, United States

Nebraska Methodist Hospital; 🇺🇸 Omaha, Nebraska, United States

Oncology Associates PC; 🇺🇸 Omaha, Nebraska, United States

Nebraska Medicine-Village Pointe; 🇺🇸 Omaha, Nebraska, United States

Alegent Health Bergan Mercy Medical Center; 🇺🇸 Omaha, Nebraska, United States

University of Nebraska Medical Center; 🇺🇸 Omaha, Nebraska, United States

Women's Cancer Center of Nevada; 🇺🇸 Las Vegas, Nevada, United States

Memorial Sloan Kettering Basking Ridge; 🇺🇸 Basking Ridge, New Jersey, United States

Cooper Hospital University Medical Center; 🇺🇸 Camden, New Jersey, United States

Jersey City Medical Center; 🇺🇸 Jersey City, New Jersey, United States

Saint Barnabas Medical Center; 🇺🇸 Livingston, New Jersey, United States

Memorial Sloan Kettering Monmouth; 🇺🇸 Middletown, New Jersey, United States

Memorial Sloan Kettering Bergen; 🇺🇸 Montvale, New Jersey, United States

Morristown Medical Center; 🇺🇸 Morristown, New Jersey, United States

Virtua Memorial; 🇺🇸 Mount Holly, New Jersey, United States

Rutgers Cancer Institute of New Jersey; 🇺🇸 New Brunswick, New Jersey, United States

Rutgers New Jersey Medical School; 🇺🇸 Newark, New Jersey, United States

Capital Health Medical Center-Hopewell; 🇺🇸 Pennington, New Jersey, United States

Penn Medicine Princeton Health; 🇺🇸 Plainsboro, New Jersey, United States

Robert Wood Johnson University Hospital Somerset; 🇺🇸 Somerville, New Jersey, United States

Overlook Hospital; 🇺🇸 Summit, New Jersey, United States

Virtua Voorhees; 🇺🇸 Voorhees, New Jersey, United States

University of New Mexico Cancer Center; 🇺🇸 Albuquerque, New Mexico, United States

Presbyterian Kaseman Hospital; 🇺🇸 Albuquerque, New Mexico, United States

Presbyterian Rust Medical Center/Jorgensen Cancer Center; 🇺🇸 Rio Rancho, New Mexico, United States

Women's Cancer Care Associates LLC; 🇺🇸 Albany, New York, United States

Northwell Health Imbert Cancer Center; 🇺🇸 Bay Shore, New York, United States

South Shore University Hospital; 🇺🇸 Bay Shore, New York, United States

Island Gynecologic Oncology; 🇺🇸 Brightwaters, New York, United States

Memorial Sloan Kettering Commack; 🇺🇸 Commack, New York, United States

Northwell Health Physician Partners at Flushing; 🇺🇸 Flushing, New York, United States

Memorial Sloan Kettering Westchester; 🇺🇸 Harrison, New York, United States

Huntington Hospital; 🇺🇸 Huntington, New York, United States

Northwell Health/Center for Advanced Medicine; 🇺🇸 Lake Success, New York, United States

North Shore University Hospital; 🇺🇸 Manhasset, New York, United States

NYU Langone Hospital - Long Island; 🇺🇸 Mineola, New York, United States

Northern Westchester Hospital; 🇺🇸 Mount Kisco, New York, United States

Long Island Jewish Medical Center; 🇺🇸 New Hyde Park, New York, United States

Northwell Health Physician Partners; 🇺🇸 New Hyde Park, New York, United States

Mount Sinai Chelsea; 🇺🇸 New York, New York, United States

Laura and Isaac Perlmutter Cancer Center at NYU Langone; 🇺🇸 New York, New York, United States

Mount Sinai West; 🇺🇸 New York, New York, United States

Mount Sinai Hospital; 🇺🇸 New York, New York, United States

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center; 🇺🇸 New York, New York, United States

Memorial Sloan Kettering Cancer Center; 🇺🇸 New York, New York, United States

NYP/Weill Cornell Medical Center; 🇺🇸 New York, New York, United States

Lenox Hill Hospital; 🇺🇸 New York, New York, United States

Vassar Brothers Medical Center; 🇺🇸 Poughkeepsie, New York, United States

Northwell Physician Partners at Rego Park; 🇺🇸 Rego Park, New York, United States

Queens Cancer Center; 🇺🇸 Rego Park, New York, United States

Highland Hospital; 🇺🇸 Rochester, New York, United States

University of Rochester; 🇺🇸 Rochester, New York, United States

Phelps Memorial Hospital Center; 🇺🇸 Sleepy Hollow, New York, United States

Stony Brook University Medical Center; 🇺🇸 Stony Brook, New York, United States

State University of New York Upstate Medical University; 🇺🇸 Syracuse, New York, United States

Memorial Sloan Kettering Nassau; 🇺🇸 Uniondale, New York, United States

Duke Cancer Center Cary; 🇺🇸 Cary, North Carolina, United States

UNC Lineberger Comprehensive Cancer Center; 🇺🇸 Chapel Hill, North Carolina, United States

Duke University Medical Center; 🇺🇸 Durham, North Carolina, United States

Duke Women's Cancer Care Raleigh; 🇺🇸 Raleigh, North Carolina, United States

Duke Cancer Center Raleigh; 🇺🇸 Raleigh, North Carolina, United States

Wake Forest University Health Sciences; 🇺🇸 Winston-Salem, North Carolina, United States

Cleveland Clinic Akron General; 🇺🇸 Akron, Ohio, United States

Aultman Alliance Community Hospital; 🇺🇸 Alliance, Ohio, United States

OhioHealth O'Bleness Hospital; 🇺🇸 Athens, Ohio, United States

Aultman Health Foundation; 🇺🇸 Canton, Ohio, United States

Miami Valley Hospital South; 🇺🇸 Centerville, Ohio, United States

University of Cincinnati Cancer Center-UC Medical Center; 🇺🇸 Cincinnati, Ohio, United States

Good Samaritan Hospital - Cincinnati; 🇺🇸 Cincinnati, Ohio, United States

Bethesda North Hospital; 🇺🇸 Cincinnati, Ohio, United States

TriHealth Cancer Institute-Westside; 🇺🇸 Cincinnati, Ohio, United States

TriHealth Cancer Institute-Anderson; 🇺🇸 Cincinnati, Ohio, United States

MetroHealth Medical Center; 🇺🇸 Cleveland, Ohio, United States

Cleveland Clinic Cancer Center/Fairview Hospital; 🇺🇸 Cleveland, Ohio, United States

Cleveland Clinic Foundation; 🇺🇸 Cleveland, Ohio, United States

Prisma Health Cancer Institute - Seneca; 🇺🇸 Seneca, South Carolina, United States

Ohio State University Comprehensive Cancer Center; 🇺🇸 Columbus, Ohio, United States

Columbus Oncology and Hematology Associates Inc; 🇺🇸 Columbus, Ohio, United States

Riverside Methodist Hospital; 🇺🇸 Columbus, Ohio, United States

Grant Medical Center; 🇺🇸 Columbus, Ohio, United States

Doctors Hospital; 🇺🇸 Columbus, Ohio, United States

Miami Valley Hospital; 🇺🇸 Dayton, Ohio, United States

Miami Valley Hospital North; 🇺🇸 Dayton, Ohio, United States

Delaware Health Center-Grady Cancer Center; 🇺🇸 Delaware, Ohio, United States

Grady Memorial Hospital; 🇺🇸 Delaware, Ohio, United States

Columbus Oncology and Hematology Associates; 🇺🇸 Dublin, Ohio, United States

Dublin Methodist Hospital; 🇺🇸 Dublin, Ohio, United States

Atrium Medical Center-Middletown Regional Hospital; 🇺🇸 Franklin, Ohio, United States

Miami Valley Cancer Care and Infusion; 🇺🇸 Greenville, Ohio, United States

OhioHealth Mansfield Hospital; 🇺🇸 Mansfield, Ohio, United States

OhioHealth Marion General Hospital; 🇺🇸 Marion, Ohio, United States

Hillcrest Hospital Cancer Center; 🇺🇸 Mayfield Heights, Ohio, United States

OhioHealth Pickerington Methodist Hospital; 🇺🇸 Pickerington, Ohio, United States

ProMedica Flower Hospital; 🇺🇸 Sylvania, Ohio, United States

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital; 🇺🇸 Toledo, Ohio, United States

Upper Valley Medical Center; 🇺🇸 Troy, Ohio, United States

University of Cincinnati Cancer Center-West Chester; 🇺🇸 West Chester, Ohio, United States

OhioHealth Westerville Medical Campus/Westerville Cancer Center; 🇺🇸 Westerville, Ohio, United States

University of Oklahoma Health Sciences Center; 🇺🇸 Oklahoma City, Oklahoma, United States

Mercy Hospital Oklahoma City; 🇺🇸 Oklahoma City, Oklahoma, United States

Saint Charles Health System; 🇺🇸 Bend, Oregon, United States

Clackamas Radiation Oncology Center; 🇺🇸 Clackamas, Oregon, United States

Providence Cancer Institute Clackamas Clinic; 🇺🇸 Clackamas, Oregon, United States

Bay Area Hospital; 🇺🇸 Coos Bay, Oregon, United States

Providence Newberg Medical Center; 🇺🇸 Newberg, Oregon, United States

Providence Willamette Falls Medical Center; 🇺🇸 Oregon City, Oregon, United States

Legacy Good Samaritan Hospital and Medical Center; 🇺🇸 Portland, Oregon, United States

Providence Portland Medical Center; 🇺🇸 Portland, Oregon, United States

Providence Saint Vincent Medical Center; 🇺🇸 Portland, Oregon, United States

Oregon Health and Science University; 🇺🇸 Portland, Oregon, United States

Saint Charles Health System-Redmond; 🇺🇸 Redmond, Oregon, United States

Legacy Meridian Park Hospital; 🇺🇸 Tualatin, Oregon, United States

Jefferson Abington Hospital; 🇺🇸 Abington, Pennsylvania, United States

Christiana Care Health System-Concord Health Center; 🇺🇸 Chadds Ford, Pennsylvania, United States

Penn State Milton S Hershey Medical Center; 🇺🇸 Hershey, Pennsylvania, United States

Jefferson Hospital; 🇺🇸 Jefferson Hills, Pennsylvania, United States

Lancaster General Ann B Barshinger Cancer Institute; 🇺🇸 Lancaster, Pennsylvania, United States

Lancaster General Hospital; 🇺🇸 Lancaster, Pennsylvania, United States

Forbes Hospital; 🇺🇸 Monroeville, Pennsylvania, United States

Allegheny Valley Hospital; 🇺🇸 Natrona Heights, Pennsylvania, United States

University of Pennsylvania/Abramson Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

Thomas Jefferson University Hospital; 🇺🇸 Philadelphia, Pennsylvania, United States

Fox Chase Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

Allegheny General Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

UPMC-Magee Womens Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

West Penn Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

University of Pittsburgh Cancer Institute (UPCI); 🇺🇸 Pittsburgh, Pennsylvania, United States

Chester County Hospital; 🇺🇸 West Chester, Pennsylvania, United States

Wexford Health and Wellness Pavilion; 🇺🇸 Wexford, Pennsylvania, United States

Asplundh Cancer Pavilion; 🇺🇸 Willow Grove, Pennsylvania, United States

Women and Infants Hospital; 🇺🇸 Providence, Rhode Island, United States

Saint Joseph's/Candler - Bluffton Campus; 🇺🇸 Bluffton, South Carolina, United States

Medical University of South Carolina; 🇺🇸 Charleston, South Carolina, United States

Gibbs Cancer Center-Gaffney; 🇺🇸 Gaffney, South Carolina, United States

Prisma Health Cancer Institute - Faris; 🇺🇸 Greenville, South Carolina, United States

Prisma Health Greenville Memorial Hospital; 🇺🇸 Greenville, South Carolina, United States

Gibbs Cancer Center-Pelham; 🇺🇸 Greer, South Carolina, United States

Spartanburg Medical Center; 🇺🇸 Spartanburg, South Carolina, United States

SMC Center for Hematology Oncology Union; 🇺🇸 Union, South Carolina, United States

Sanford Cancer Center Oncology Clinic; 🇺🇸 Sioux Falls, South Dakota, United States

Sanford USD Medical Center - Sioux Falls; 🇺🇸 Sioux Falls, South Dakota, United States

Vanderbilt-Ingram Cancer Center at Franklin; 🇺🇸 Franklin, Tennessee, United States

Vanderbilt-Ingram Cancer Center Cool Springs; 🇺🇸 Franklin, Tennessee, United States

Vanderbilt Breast Center at One Hundred Oaks; 🇺🇸 Nashville, Tennessee, United States

Vanderbilt University/Ingram Cancer Center; 🇺🇸 Nashville, Tennessee, United States

Parkland Memorial Hospital; 🇺🇸 Dallas, Texas, United States

UT Southwestern/Simmons Cancer Center-Dallas; 🇺🇸 Dallas, Texas, United States

Brooke Army Medical Center; 🇺🇸 Fort Sam Houston, Texas, United States

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center; 🇺🇸 Houston, Texas, United States

Ben Taub General Hospital; 🇺🇸 Houston, Texas, United States

Memorial Hermann Texas Medical Center; 🇺🇸 Houston, Texas, United States

University of Texas Health Science Center at San Antonio; 🇺🇸 San Antonio, Texas, United States

University of Utah Sugarhouse Health Center; 🇺🇸 Salt Lake City, Utah, United States

Huntsman Cancer Institute/University of Utah; 🇺🇸 Salt Lake City, Utah, United States

University of Virginia Cancer Center; 🇺🇸 Charlottesville, Virginia, United States

Inova Schar Cancer Institute; 🇺🇸 Fairfax, Virginia, United States

Inova Fair Oaks Hospital; 🇺🇸 Fairfax, Virginia, United States

Inova Fairfax Hospital; 🇺🇸 Falls Church, Virginia, United States

Henrico Doctor's Hospital; 🇺🇸 Richmond, Virginia, United States

VCU Massey Cancer Center at Stony Point; 🇺🇸 Richmond, Virginia, United States

Virginia Commonwealth University/Massey Cancer Center; 🇺🇸 Richmond, Virginia, United States

Carilion Roanoke Memorial Hospital; 🇺🇸 Roanoke, Virginia, United States

Providence Regional Cancer System-Aberdeen; 🇺🇸 Aberdeen, Washington, United States

PeaceHealth Saint Joseph Medical Center; 🇺🇸 Bellingham, Washington, United States

Providence Regional Cancer System-Centralia; 🇺🇸 Centralia, Washington, United States

Swedish Cancer Institute-Edmonds; 🇺🇸 Edmonds, Washington, United States

Providence Regional Cancer Partnership; 🇺🇸 Everett, Washington, United States

Swedish Cancer Institute-Issaquah; 🇺🇸 Issaquah, Washington, United States

Kadlec Clinic Hematology and Oncology; 🇺🇸 Kennewick, Washington, United States

Providence Regional Cancer System-Lacey; 🇺🇸 Lacey, Washington, United States

PeaceHealth Saint John Medical Center; 🇺🇸 Longview, Washington, United States

Skagit Regional Health Cancer Care Center; 🇺🇸 Mount Vernon, Washington, United States

Swedish Medical Center-Ballard Campus; 🇺🇸 Seattle, Washington, United States

Fred Hutchinson Cancer Center; 🇺🇸 Seattle, Washington, United States

Swedish Medical Center-Cherry Hill; 🇺🇸 Seattle, Washington, United States

Swedish Medical Center-First Hill; 🇺🇸 Seattle, Washington, United States

University of Washington Medical Center - Northwest; 🇺🇸 Seattle, Washington, United States

Women's Cancer Center of Seattle; 🇺🇸 Seattle, Washington, United States

University of Washington Medical Center - Montlake; 🇺🇸 Seattle, Washington, United States

PeaceHealth United General Medical Center; 🇺🇸 Sedro-Woolley, Washington, United States

Providence Regional Cancer System-Shelton; 🇺🇸 Shelton, Washington, United States

Legacy Salmon Creek Hospital; 🇺🇸 Vancouver, Washington, United States

Providence Saint Mary Regional Cancer Center; 🇺🇸 Walla Walla, Washington, United States

Providence Regional Cancer System-Yelm; 🇺🇸 Yelm, Washington, United States

United Hospital Center; 🇺🇸 Bridgeport, West Virginia, United States

West Virginia University Charleston Division; 🇺🇸 Charleston, West Virginia, United States

WVUH-Berkely Medical Center; 🇺🇸 Martinsburg, West Virginia, United States

West Virginia University Healthcare; 🇺🇸 Morgantown, West Virginia, United States

Camden Clark Medical Center; 🇺🇸 Parkersburg, West Virginia, United States

Princeton Community Hospital; 🇺🇸 Princeton, West Virginia, United States

Wheeling Hospital/Schiffler Cancer Center; 🇺🇸 Wheeling, West Virginia, United States

Aurora Cancer Care-Southern Lakes VLCC; 🇺🇸 Burlington, Wisconsin, United States

Aurora Saint Luke's South Shore; 🇺🇸 Cudahy, Wisconsin, United States

Aurora Health Care Germantown Health Center; 🇺🇸 Germantown, Wisconsin, United States

Aurora Cancer Care-Grafton; 🇺🇸 Grafton, Wisconsin, United States

Saint Vincent Hospital Cancer Center Green Bay; 🇺🇸 Green Bay, Wisconsin, United States

Aurora BayCare Medical Center; 🇺🇸 Green Bay, Wisconsin, United States

Aurora Cancer Care-Kenosha South; 🇺🇸 Kenosha, Wisconsin, United States

University of Wisconsin Carbone Cancer Center - Eastpark Medical Center; 🇺🇸 Madison, Wisconsin, United States

University of Wisconsin Carbone Cancer Center - University Hospital; 🇺🇸 Madison, Wisconsin, United States

Aurora Bay Area Medical Group-Marinette; 🇺🇸 Marinette, Wisconsin, United States

Marshfield Medical Center-Marshfield; 🇺🇸 Marshfield, Wisconsin, United States

Aurora Cancer Care-Milwaukee; 🇺🇸 Milwaukee, Wisconsin, United States

Aurora Saint Luke's Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

Medical College of Wisconsin; 🇺🇸 Milwaukee, Wisconsin, United States

Aurora Sinai Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

ProHealth D N Greenwald Center; 🇺🇸 Mukwonago, Wisconsin, United States

Cancer Center of Western Wisconsin; 🇺🇸 New Richmond, Wisconsin, United States

ProHealth Oconomowoc Memorial Hospital; 🇺🇸 Oconomowoc, Wisconsin, United States

Vince Lombardi Cancer Clinic - Oshkosh; 🇺🇸 Oshkosh, Wisconsin, United States

Aurora Cancer Care-Racine; 🇺🇸 Racine, Wisconsin, United States

Vince Lombardi Cancer Clinic-Sheboygan; 🇺🇸 Sheboygan, Wisconsin, United States

Aurora Medical Center in Summit; 🇺🇸 Summit, Wisconsin, United States

Vince Lombardi Cancer Clinic-Two Rivers; 🇺🇸 Two Rivers, Wisconsin, United States

ProHealth Waukesha Memorial Hospital; 🇺🇸 Waukesha, Wisconsin, United States

UW Cancer Center at ProHealth Care; 🇺🇸 Waukesha, Wisconsin, United States

Aurora Cancer Care-Milwaukee West; 🇺🇸 Wauwatosa, Wisconsin, United States

Aurora West Allis Medical Center; 🇺🇸 West Allis, Wisconsin, United States

BCCA-Vancouver Cancer Centre; 🇨🇦 Vancouver, British Columbia, Canada

Keimyung University-Dongsan Medical Center; 🇰🇷 Dalseo-gu, Daegu, Korea, Republic of

Samsung Changwon Hospital; 🇰🇷 Seoul, Gyeongsangnam-do, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam City, Kyeonggi-do, Korea, Republic of

Chung-Ang University Gwangmyeong Hospital; 🇰🇷 Gwangmyeong-si, Korea, Republic of

Asan Medical Center; 🇰🇷 Seoul, Korea, Republic of

Gangnam Severance Hospital; 🇰🇷 Seoul, Korea, Republic of

Yonsei University Health System-Severance Hospital; 🇰🇷 Seoul, Korea, Republic of