Comprehensive Patient Questionnaires in Predicting Complications in Older Patients With Gynecologic Cancer Undergoing Surgery
- Conditions
- Fallopian Tube CarcinomaStage IIIB Uterine Corpus Cancer AJCC v7Primary Peritoneal CarcinomaStage IIIC Uterine Corpus Cancer AJCC v7Stage IVA Uterine Corpus Cancer AJCC v7Ovarian CarcinomaEndometrial Serous AdenocarcinomaMalignant Female Reproductive System NeoplasmStage IIIA Uterine Corpus Cancer AJCC v7Stage IVB Uterine Corpus Cancer AJCC v7
- Interventions
- Other: Comprehensive Geriatric AssessmentOther: Questionnaire Administration
- Registration Number
- NCT02315469
- Lead Sponsor
- NRG Oncology
- Brief Summary
This research trial studies comprehensive patient questionnaires in predicting complications in older patients with gynecologic cancer undergoing surgery. Comprehensive patient questionnaires completed before surgery may help identify complications, such as the need for assistance in taking medications, decreased mobility, decreased social activity, and falls, and may improve outcomes for older patients with gynecologic cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine whether the preoperative geriatric assessment (GA)-gynecology (GYN) score will be associated with major post-operative complications in elderly patients undergoing open primary cytoreduction surgery.
SECONDARY OBJECTIVES:
I. To explore associations between individual variables of the preoperative geriatric assessment and major post-operative complications in patients undergoing open primary cytoreduction surgery.
II. To assess the association between the preoperative GA-GYN score and cytoreducibility defined by extent of residual disease in patients undergoing open primary cytoreduction surgery.
TERTIARY OBJECTIVES :
I. To evaluate whether the preoperative GA-GYN scores obtained before and after neoadjuvant chemotherapy will be associated with major postoperative complications in elderly patients undergoing open interval cytoreduction surgery.
II. To describe reasons why surgeons at centers where open cytoreduction surgery is the standard of care choose to perform interval surgery vs primary surgery, and to explore the association of the preoperative GA-GYN score with the decision to perform primary surgery or interval surgery or no surgery.
III. To collect the following specific information on how elderly women with suspected ovarian, fallopian tube, primary peritoneal carcinomas or advanced stage papillary serous uterine carcinoma are treated at centers that consider open cytoreduction surgery the standard of care: (1) the percentage of patients treated with primary open cytoreduction vs. interval open cytoreduction vs. no surgery and (2) to ascertain the extent of cytoreduction.
IV. To determine whether neoadjuvant chemotherapy will be associated with changes in the GA-GYN score to change by comparing the GA-GYN scores obtained before and after neoadjuvant chemotherapy.
V. To determine whether 30-day readmission rates after cytoreductive surgery correlate with the GA-GYN score.
OUTLINE:
At time of consent and within 14 days of surgery, patients complete a pre-operative geriatric assessment that evaluates functional status, comorbid medical conditions, psychological state, social support, and nutritional status. Post-operative complications are also collected for 6 weeks after surgery or until the date patients initiate or restart chemotherapy whichever is first.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 190
-
Patients with suspected ovarian, fallopian tube, primary peritoneal carcinomas or advanced stage papillary serous uterine carcinoma irrespective of performance status; this clinical determination is made by the treating physician
-
Patients must have signed an approved informed consent and authorization permitting release of personal health information
-
Patients who can understand sufficiently to be able to respond to questions posed by the study instruments
-
Patients and/or caregiver (durable power of attorney) can give consent and caregiver can assist with the responses to questionnaire
- NOTE: it is the intent of this trial that all patients 70 years or older presenting to the participating physician/center be offered enrollment onto this study; eligible patients may enroll and subsequently receive neoadjuvant chemotherapy followed by interval surgery, primary cytoreductive surgery or no surgery at all
-
Post-operative pathology will not exclude patients from this study
- Patients whose circumstances at the time of study entry do not permit completion of the study or required follow-up
- Patients who would have planned surgery performed by the minimally invasive technique; institutions which perform cytoreductive surgery via the minimally invasive technique should not participate in this study; the minimally invasive surgery (MIS) technique is also not considered standard technique for primary cytoreductive surgery for advanced stage ovarian, fallopian tube or peritoneal cancers
- Patients who receive chemotherapy treatment (for a gynecologic malignancy) prior to consideration of enrollment into this trial and taking the geriatric assessment will be excluded
- Patients who have a known pre-operative primary uterine cancer, confirmed by endometrial biopsy
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Observational (geriatric assessment) Comprehensive Geriatric Assessment At time of consent and within 14 days of surgery, patients complete a pre-operative geriatric assessment that evaluates functional status, comorbid medical conditions, psychological state, social support, and nutritional status. Post-operative complications are also collected for 6 weeks after surgery or until the date patients initiate or restart chemotherapy whichever is first. Observational (geriatric assessment) Questionnaire Administration At time of consent and within 14 days of surgery, patients complete a pre-operative geriatric assessment that evaluates functional status, comorbid medical conditions, psychological state, social support, and nutritional status. Post-operative complications are also collected for 6 weeks after surgery or until the date patients initiate or restart chemotherapy whichever is first.
- Primary Outcome Measures
Name Time Method GA-GYN score, defined as the summation of the risk score for each risk factor derived from the predictive model including 5 risk factors from the GA and 3 other risk factors Up to 14 days before surgery Geriatric assessment variables are used in the predictive model; the risk factors will be used to derive the total score.
Occurrence of major post-operative complications outlined in The American College of Surgeons' National Surgical Quality Improvement Program Up to 6 weeks after surgery
- Secondary Outcome Measures
Name Time Method Social support, as measured by the MOS Social Support Survey Up to 14 days before surgery Patient's overall functioning, as measured by the self-reported performance rating scale Up to 14 days before surgery Psychological status, as measured by the Mental Health Inventory (MHI) that is based upon the General Well-Being Scale Up to 14 days before surgery The full length MHI consists of 38 items grouped into the following five subscales and three global scores: anxiety, depression, general positive affect, emotional ties, and loss of behavioral emotional control, Psychological Distress (negative affect), Psychological Well-Being (positive affect), and the MHI total score a 17 item version of the MHI will be used, which will yield three global scores of Psychological Distress, Psychological Well-Being and MHI total score, as in the original 38 item MHI.
Social functioning, as measured by the Medical Outcomes Study (MOS) Social Activity Limitations Measure Up to 14 days before surgery The four-item subscale identifies the extent to which physical or emotional problems interfere with an individual's social activities. All items are rated on a 5-point Likert scale, with response categories varying in each item. The mean of the total score is transformed to a scale of 0-100, with a higher number indicating greater support.
Extent of residual disease in patients undergoing open primary cytoreduction surgery 6 weeks after surgery The association between the preoperative GA-GYN score and cytoreducibility defined by extent of residual disease in patients undergoing open primary cytoreduction surgery will be assessed. Cytoreducibility is defined as complete cytoreduction (maximum dimension of residual disease =\< 0.1 cm), optimal cytoreduction (maximum dimension of residual disease greater than 0.1 cm but less than or equal to 1.0 cm), or suboptimal cytoreduction (maximum dimension of residual disease greater than 1.0 cm) according to extent of residual disease.
Functional status, as measured by Activities of Daily Living (ADL) Up to 14 days before surgery The ALD uses a subscale of the Medical Outcomes Study physical health with 10 questions rated on a 3-point scale.
Patient's overall functioning, as measured by the physician rated performance rating scale Up to 14 days before surgery Nutritional status, as measured by BMI Up to 14 days before surgery Functional status, as measured by Instrumental Activities of Daily Living (IADL) Up to 14 days before surgery The IADL subscale consists of 7 questions rated on a 3-point Likert scale measuring the degree to which an activity can be performed independently.
Number of falls in last 6 months Up to 14 days before surgery Comorbidity, as measured by the Older American Resources and Services (OARS) Physical Health section Up to 14 days before surgery The OARS Physical Health Section is a comorbidity scale that contains a list of current illnesses and conditions an individual might have, and the degree to which they impair daily activities, rated on a 3-point scale of " not at all" to " a great deal."
Nutritional status, as measured by percentage unintentional weight loss in last 6 months Up to 14 days before surgery
Trial Locations
- Locations (393)
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
Prisma Health Cancer Institute - Easley
🇺🇸Easley, South Carolina, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Southwest Oncology PC
🇺🇸Durango, Colorado, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸Park Ridge, Illinois, United States
Flaget Memorial Hospital
🇺🇸Bardstown, Kentucky, United States
MD Anderson Cancer Center at Cooper-Voorhees
🇺🇸Voorhees, New Jersey, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
Ascension Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸Wausau, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸Weston, Wisconsin, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Good Samaritan Hospital - Cincinnati
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Eden Park
🇺🇸Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸Cincinnati, Ohio, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Big Horn Basin Cancer Center
🇺🇸Cody, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Kaiser Permanente-San Francisco
🇺🇸San Francisco, California, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
McGill University Department of Oncology
🇨🇦Montreal, Quebec, Canada
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
SCL Health Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸Denver, Colorado, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Hematology and Oncology Consultants PC
🇺🇸Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸Antioch, California, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
John Muir Medical Center-Concord Campus
🇺🇸Concord, California, United States
Kaiser Permanente-Fremont
🇺🇸Fremont, California, United States
Kaiser Permanente-Fresno
🇺🇸Fresno, California, United States
Kaiser Permanente-Irvine
🇺🇸Irvine, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
UCLA / Jonsson Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Kaiser Permanente-Modesto
🇺🇸Modesto, California, United States
Kaiser Permanente-Richmond
🇺🇸Richmond, California, United States
Kaiser Permanente-Redwood City
🇺🇸Redwood City, California, United States
Kaiser Permanente-Oakland
🇺🇸Oakland, California, United States
Kaiser Permanente-South Sacramento
🇺🇸Sacramento, California, United States
Kaiser Permanente-Roseville
🇺🇸Roseville, California, United States
Kaiser Permanente - Sacramento
🇺🇸Sacramento, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸San Jose, California, United States
Kaiser Permanente-San Rafael
🇺🇸San Rafael, California, United States
Kaiser Permanente San Leandro
🇺🇸San Leandro, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸Santa Rosa, California, United States
Kaiser Permanente-South San Francisco
🇺🇸South San Francisco, California, United States
Kaiser Permanente-Stockton
🇺🇸Stockton, California, United States
Olive View-University of California Los Angeles Medical Center
🇺🇸Sylmar, California, United States
Kaiser Permanente-Vallejo
🇺🇸Vallejo, California, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸Vacaville, California, United States
John Muir Medical Center-Walnut Creek
🇺🇸Walnut Creek, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸Walnut Creek, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸Englewood, Colorado, United States
Mercy Medical Center
🇺🇸Durango, Colorado, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Western States Cancer Research NCORP
🇺🇸Denver, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Mountain Blue Cancer Care Center
🇺🇸Golden, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Greenwood Village
🇺🇸Greenwood Village, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Rocky Mountain Cancer Centers-Parker
🇺🇸Parker, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸Longmont, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Rocky Mountain Cancer Centers - Pueblo
🇺🇸Pueblo, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸Thornton, Colorado, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Lakeland Regional Health Hollis Cancer Center
🇺🇸Lakeland, Florida, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Sacred Heart Hospital
🇺🇸Pensacola, Florida, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸New Lenox, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸O'Fallon, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Radiation Oncology of Northern Illinois
🇺🇸Ottawa, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Central Illinois Hematology Oncology Center
🇺🇸Springfield, Illinois, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Radiation Oncology Associates PC
🇺🇸Fort Wayne, Indiana, United States
Michiana Hematology Oncology PC-Crown Point
🇺🇸Crown Point, Indiana, United States
Sidney and Lois Eskenazi Hospital
🇺🇸Indianapolis, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Alegent Health Mercy Hospital
🇺🇸Council Bluffs, Iowa, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Saint Elizabeth Medical Center South
🇺🇸Edgewood, Kentucky, United States
Baptist Health Corbin
🇺🇸Corbin, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸Corbin, Kentucky, United States
Baptist Health Hardin
🇺🇸Elizabethtown, Kentucky, United States
Jewish Hospital
🇺🇸Louisville, Kentucky, United States
Saints Mary and Elizabeth Hospital
🇺🇸Louisville, Kentucky, United States
Baptist Health Madisonville/Merle Mahr Cancer Center
🇺🇸Madisonville, Kentucky, United States
Baptist Health Paducah
🇺🇸Paducah, Kentucky, United States
Jewish Hospital Medical Center Northeast
🇺🇸Louisville, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸Shepherdsville, Kentucky, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Weisberg Cancer Treatment Center
🇺🇸Farmington Hills, Michigan, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Lakeland Hospital Niles
🇺🇸Niles, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital
🇺🇸Saint Cloud, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Saint Cloud Hospital
🇺🇸Saint Cloud, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Parkland Health Center-Bonne Terre
🇺🇸Bonne Terre, Missouri, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Capital Region Southwest Campus
🇺🇸Jefferson City, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
CHI Health Saint Francis
🇺🇸Grand Island, Nebraska, United States
Heartland Hematology and Oncology
🇺🇸Kearney, Nebraska, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
CHI Health Good Samaritan
🇺🇸Kearney, Nebraska, United States
Saint Elizabeth Regional Medical Center
🇺🇸Lincoln, Nebraska, United States
Midlands Community Hospital
🇺🇸Papillion, Nebraska, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸Basking Ridge, New Jersey, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Wentworth-Douglass Hospital
🇺🇸Dover, New Hampshire, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Women's Cancer Care Associates LLC
🇺🇸Albany, New York, United States
Memorial Sloan Kettering Westchester
🇺🇸Harrison, New York, United States
Memorial Sloan Kettering Commack
🇺🇸Commack, New York, United States
Memorial Sloan Kettering Sleepy Hollow
🇺🇸Sleepy Hollow, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, 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
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸Cincinnati, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸Marion, Ohio, United States
UH Seidman Cancer Center at Landerbrook Health Center
🇺🇸Mayfield Heights, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
University Hospitals Sharon Health Center
🇺🇸Wadsworth, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Wright-Patterson Medical Center
🇺🇸Wright-Patterson Air Force Base, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸Lewisburg, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸Greenville, South Carolina, United States
Prisma Health Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Pulmonary Medicine Center of Chattanooga-Hixson
🇺🇸Hixson, Tennessee, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
Memorial GYN Plus
🇺🇸Ooltewah, Tennessee, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸American Fork, Utah, United States
Sandra L Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Dixie Medical Center Regional Cancer Center
🇺🇸Saint George, Utah, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Overlake Medical Center
🇺🇸Bellevue, Washington, United States
MultiCare Auburn Medical Center
🇺🇸Auburn, Washington, United States
Virginia Mason Bainbridge Island Medical Center
🇺🇸Bainbridge Island, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Harrison Medical Center
🇺🇸Bremerton, Washington, United States
Highline Medical Center-Main Campus
🇺🇸Burien, Washington, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Virginia Mason Federal Way Medical Center
🇺🇸Federal Way, Washington, United States
Saint Elizabeth Hospital
🇺🇸Enumclaw, Washington, United States
Northwest Cancer Clinic
🇺🇸Kennewick, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Gig Harbor
🇺🇸Gig Harbor, Washington, United States
MultiCare Gig Harbor Medical Park
🇺🇸Gig Harbor, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Virginia Mason Lynnwood Medical Center
🇺🇸Lynnwood, Washington, United States
Peninsula Cancer Center
🇺🇸Poulsbo, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Puyallup
🇺🇸Puyallup, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸Poulsbo, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸Tacoma, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Jackson Hall
🇺🇸Tacoma, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸Tacoma, Washington, United States
Northwest NCI Community Oncology Research Program
🇺🇸Tacoma, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Saint Joe's
🇺🇸Tacoma, Washington, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸Marshfield, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸Oconomowoc, Wisconsin, United States
ProHealth D N Greenwald Center
🇺🇸Mukwonago, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸Rice Lake, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Saint Luke's Cancer Institute - Boise
🇺🇸Boise, Idaho, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Dominic-Jackson Memorial Hospital
🇺🇸Jackson, Mississippi, United States
Memorial Hospital
🇺🇸Chattanooga, Tennessee, United States
Monongalia Hospital
🇺🇸Morgantown, West Virginia, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸Colorado Springs, Colorado, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸Honolulu, Hawaii, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center-Weiler Hospital
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Dell Seton Medical Center at The University of Texas
🇺🇸Austin, Texas, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸Lexington, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸Lexington, Kentucky, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States