Bupropion Hydrochloride in Improving Sexual Desire in Women With Breast or Gynecologic Cancer

Phase 2

Completed

Conditions: Uterine Corpus Cancer
Vaginal Carcinoma
Ovarian Carcinoma
Postmenopausal
Vulvar Carcinoma
Breast Carcinoma
Cervical Carcinoma

Interventions: Drug: Bupropion 150 mg XL
Drug: Placebo

Registration Number: NCT03180294

Lead Sponsor: NRG Oncology

Brief Summary: This phase II randomized trial studies how well bupropion hydrochloride works in improving sexual desire in women with breast or gynecological cancer. Bupropion hydrochloride may work by boosting sexual desire, energy, or motivation without causing intolerable or undesirable side effects.

Detailed Description: PRIMARY OBJECTIVES:

I. Measure the ability of two dose levels of bupropion hydrochloride (bupropion), 150 or 300 mg of extended release, to improve sexual desire more than a placebo at 9 weeks (8 weeks on the target dose) as measured by the desire subscale of the female sexual function index (FSFI).

SECONDARY OBJECTIVES:

I. Evaluate the side effects of 150 and 300 mg bupropion extended release and differentiate these side effects from those observed in the placebo arm.

II. Evaluate the effect of 150 and 300 mg of bupropion extended release on the Patient Reported Outcomes Measurement Information System (PROMIS) fatigue scale, PROMIS sexual desire and satisfaction measure, patient health questionnaire (PHQ)-4, and the FSFI total score, at 5 and 9 weeks, as well as the desire subscale score of the FSFI at 5 weeks.

III. Evaluate the effect of 150 and 300 mg of bupropion extended release on the global impression of change scale and the patient's perception of risk versus (vs.) benefit at 5 weeks (4 weeks at target dose) and 9 weeks (8 weeks at target dose).

Patients are randomized to 1 of 3 arms.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 230

Inclusion Criteria

PRIOR TO STEP 1 REGISTRATION
Score of < 9 on the PHQ-4
Patients must have a FSFI desire subscale baseline score less than 3.3
- NOTE-Both the PHQ-4 and FSFI must be completed by the patient and data entered in Oncology Patient Enrollment Network (OPEN) at Step 1 registration to determine eligibility
Diagnosis of breast or gynecologic cancer [examples are lobular carcinoma in situ (LCIS),ductal carcinoma in situ (DCIS), invasive breast, ovarian, endometrial, vulvar, cervical and vaginal]
Completed definitive therapy consisting of surgery, chemotherapy or radiation therapy at least 180 days ago (may continue on Herceptin or endocrine therapy)
Post menopausal as defined by at least ONE of the following:
- 12 months (365 days) without a period;
- Bilateral oophorectomy;
- Chemically induced menopause as long as there are no plans to stop during the study;
- For women 57 and under, if at least one ovary and woman has had hysterectomy, must have follicle stimulating hormone (FSH) (> 30 mIU/mL) and estradiol in menopausal range per institution?s laboratory (< 10 for ultra sensitive assay: < 25-30 otherwise);
- At least one ovary intact and 180 days without a period with FSH (> 30 mIU/mL) and estradiol in menopausal range per institution's laboratory (< 10 for ultra sensitive assay: < 25-30 otherwise); Note: Women 58 and older do not have to have hormonal tests.
History, physical and performance status of 2 or less within 180 days prior to registration
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN)
Total bilirubin =< 1.5 x ULN
Glomerular filtration rate > 90ml/min
For breast cancer patients only, endocrine therapies are allowed (such as aromatase inhibitors, but not current tamoxifen. Prior tamoxifen is permitted with a 30 day wash out period). )
Vaginal estrogen is allowed, for all protocol disease sites, if dose equal to or less than that in estring (< 7.5 mcg) and it has been used for at least 30 days with no plans to stop or alter use during the course of the study
Antidepressants for mood and hot flashes, including selective serotonin reuptake inhibitors (SSRIs) will be allowed if patients have been on a stable dose for the last 60 days and the dose is not expected to change during the course of the study; only subthreshold or low dose antidepressants will be allowed (e.g. Effexor up to 75 mg or Lexapro 5-10 mg or Celexa 10- 20 mg)
The patient must provide study-specific informed consent prior to study entry/screening
Women who report that their motivation/desire for sexual intimacy has decreased since her cancer diagnosis
Able to swallow whole capsules
Proficient in English (due to number of questionnaires not validated in other languages)
Completion of the FSFI and PHQ-4; both questionnaires will be required and data entered at the time of step 1 registration
PRIOR TO STEP 2 RANDOMIZATION
Completion of the following baseline quality of life forms: PHQ-4, FSFI, PROMIS sexual function and satisfaction, PROMIS fatigue short form 8a, Impact of Treatment Scale, patient reported outcomes (PRO)-Common Terminology Criteria for Adverse Events (CTCAE) items, and revised dyadic adjustment scale; these quality of life forms will be required and data must be entered in Medidata Rave at step 2 registration; if available at the time of step 1 registration, step 2 registration can take place immediately after step 1; women who do not currently have a partner do not have to complete the revised dyadic adjustment scale; enter "no partner" for this form

Exclusion Criteria

Untreated depression, major depressive disorder (MDD), suicidal ideations or anxiety disorders in the past 5 years per the medical chart based on Diagnostic and Statistical Manual (DSM) IV diagnoses
Seizure disorders
Current or history of anorexia or bulimia in the past 5 years
Allergy to bupropion
Use of drugs metabolized by CYP2D6
Stage IV cancer
History of Parkinson's disease, multiple sclerosis or fibromyalgia
Extensive pelvic exenteration surgery, surgeries which include partial or total vaginectomy with or without reconstruction; radical vulvectomy with or without remove of clitoris
Women who are currently undergoing or planning to undergo reconstruction surgery during the course of the study; women who have completed reconstruction surgery must be 30 days from surgery
Oral or transdermal estrogen therapy is not allowed
Males are not permitted to participate
Patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs after chronic use
Patients who discontinue monoamine oxidase (MAO)-inhibitor (I)'s within 14 days prior to starting the investigational drug
Poorly controlled hypertension (systolic blood pressure [BP] >= 160 mmHg or diastolic BP >= 100 mmHg) on three or more readings in the past 12 months
Patients with active bipolar disorder
Patients with impaired decision making as determined by the treating physician
Concurrent use of bupropion
Concomitant invasive malignancy requiring treatment other than non-melanomatous skin cancer.
Previous or concurrent use of flibanserin.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Bupropion 150 mg	Placebo	One Bupropion 150 mg XL capsule by mouth (PO) in a.m. daily for one week; one Bupropion 150 mg XL capsule and one placebo capsule daily for 8 weeks; one placebo capsule daily for one 1 week (titration off).
Bupropion 300 mg	Bupropion 150 mg XL	One Bupropion 150 mg XL capsule PO in a.m. daily for one week; two Bupropion 150 mg XL capsules PO in a.m. daily for 8 weeks (300 mg target dose); one Bupropion 150 mg XL capsule PO in a.m. daily for 1 week (titration off)
Placebo	Placebo	One placebo capsule PO in a.m. daily for 1 week; two placebo capsules PO in a.m. daily for 8 weeks; one placebo capsule PO in a.m. daily for 1 week (titration off)
Bupropion 150 mg	Bupropion 150 mg XL	One Bupropion 150 mg XL capsule by mouth (PO) in a.m. daily for one week; one Bupropion 150 mg XL capsule and one placebo capsule daily for 8 weeks; one placebo capsule daily for one 1 week (titration off).

Primary Outcome Measures

Name	Time	Method
Change From Baseline at 9 Weeks in the Desire Subscore of the Female Sexual Function Index ("Sexual Desire")	Baseline (prior to randomization) and 9 weeks from start of study treatment (within 21 days of randomization)	The desire subscore of the female sexual function index (FSFI) measures self-reported sexual desire. Possible scores range from 1.2 to 6, with higher scores indicating increased desire. Change score is calculated by subtracting baseline from later score, with a positive change score indicating increased desire. This measure is referred to as "sexual desire" in the protocol.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in the Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Score	Baseline (prior to randomization) and 5 and 9 weeks from start of study treatment (within 21 days of randomization)	The PROMIS fatigue score measures self-reported fatigue symptoms over the past 7 days. Possible scores range from 33.1 to 77.8, with higher scores indicating more fatigue. Change score is calculated by subtracting baseline from later score, with a positive change score indicating increased fatigue.
Change From Baseline at 5 Weeks in Desire Subscore of the FSFI ("Sexual Desire")	Baseline (prior to randomization) and 5 weeks from start of study treatment (within 21 days of randomization)	The desire subscore of the female sexual function index (FSFI) measures self-reported sexual desire. Possible scores range from 1.2 to 6, with higher scores indicating increased desire. Change score is calculated by subtracting baseline from later score, with a positive change score indicating increased desire. This measure is referred to as "sexual desire" in the protocol.
Change From Baseline in the PROMIS Global Satisfaction With Sex Life Subscore of Sexual Function and Satisfaction Measure ("Sexual Desire and Satisfaction")	Baseline (prior to randomization) and 5 and 9 weeks from start of study treatment (within 21 days of randomization)	The PROMIS Global Satisfaction with Sex Life subscore measures self-reported global satisfaction, interest, and interference in sexual health over the past 7 days. Possible scores range from 3 to 30, with higher scores indicating more satisfaction with sex life. Change score is calculated by subtracting baseline from later score, with a positive change score indicating increased satisfaction. This score is referred to as the "PROMIS sexual desire and satisfaction measure" in the protocol.
Change From Baseline in FSFI Total Score ("Sexual Functioning")	Baseline (prior to randomization) and 5 and 9 weeks from start of treatment (within 21 days of randomization)	The FSFI total score measures self-reported female sexual functioning covering the major domains arousal, satisfaction, and orgasm, and including lubrication and pain. Possible scores range from 2 to 36, with higher scores indicating better functioning. Change score is calculated by subtracting baseline from later score, with a positive change score indicating increased functioning. This measure is referred to as "sexual functioning" in the protocol.
Change From Baseline in the Patient Health Questionnaire (PHQ)-4 Score ("Depressive Mood")	Baseline (prior to randomization) and 5 and 9 weeks from start of treatment (within 21 days of randomization)	The PHQ-4 is a brief screening questionnaire for depression. Possible scores range from 0 to 12, with higher scores indicating more severe depression. Change score is calculated by subtracting baseline from later score, with a negative change score indicating decreased severity of depression. This measure is referred to as "depressive mood" in the protocol.
Global Impression of Change at 9 Weeks ("Perception of Change")	9 weeks from start of study treatment (within 21 days of randomization)	Participants are asked, "Since beginning the study agent, my desire of sexual intimacy is:" with seven possible answers of "very much better," "moderately better," "a little better," "about the same," "a little worse," "moderately worse," and "very much worse." The first three answers have been categorized as "Better' and the last three answers as "Not Better". This measure is referred to as "perception of change" in the protocol.
Perception of Risk vs. Benefit at 9 Weeks	9 weeks from start of study treatment (within 21 days of randomization)	Participants are asked, "Were the benefits of this treatment greater than any side effects?"
Number of Participants With a Grade 3 or Higher Adverse Event Over the Course of the Study	Adverse events were evaluated 1,2,5,7, and 9 weeks from start of study treatment (within 21 days of randomization).	Common Terminology Criteria for Adverse Events (version 4) grades adverse event severity from 1=mild to 5=death. Summary data is provided in this outcome measure.; see Adverse Events Module for specific adverse event data.
Number of Participants With Most Severe Response for Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) at 9 Weeks	9 weeks from start of study treatment (within 21 days of randomization).	Questions refer to the participants' experiences for the past 7 days of a given symptom in terms of frequency (never, rarely, occasionally, frequently, almost constantly), severity (none, mild, moderate, severe, very severe), interference with usual or daily activities (not at all, a little bit, somewhat, quite a bit, very much).

Trial Locations

Locations (362): Trinity Regional Medical Center
🇺🇸
Fort Dodge, Iowa, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸
Jacksonville, North Carolina, United States
Saint Vincent Hospital Cancer Center at Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
Prisma Health Cancer Institute - Easley
🇺🇸
Easley, South Carolina, United States
Aurora West Allis Medical Center
🇺🇸
West Allis, Wisconsin, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Kaiser Permanente-San Diego Zion
🇺🇸
San Diego, California, 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
Kaiser Permanente-Modesto
🇺🇸
Modesto, California, United States
Kaiser Permanente Dublin
🇺🇸
Dublin, California, United States
Kaiser Permanente-Fontana
🇺🇸
Fontana, California, United States
Kaiser Permanente-Ontario
🇺🇸
Ontario, California, United States
Kaiser Permanente-Riverside
🇺🇸
Riverside, California, United States
Kaiser Permanente-Stockton
🇺🇸
Stockton, California, United States
Kaiser Permanente-Oakland
🇺🇸
Oakland, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸
San Jose, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸
Los Angeles, California, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Kaiser Permanente-South San Francisco
🇺🇸
South San Francisco, California, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Carle on Vermilion
🇺🇸
Danville, Illinois, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
John H Stroger Jr Hospital of Cook County
🇺🇸
Chicago, Illinois, United States
Saint Joseph Mercy Brighton
🇺🇸
Brighton, Michigan, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Physicians' Clinic of Iowa PC
🇺🇸
Cedar Rapids, Iowa, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Saint Joseph Mercy Canton
🇺🇸
Canton, Michigan, United States
21st Century Oncology-Pontiac
🇺🇸
Pontiac, Michigan, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸
Canton, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸
Brighton, Michigan, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸
Chelsea, Michigan, United States
Essentia Health - Deer River Clinic
🇺🇸
Deer River, Minnesota, United States
Saint Joseph Mercy Chelsea
🇺🇸
Chelsea, Michigan, United States
Michigan Breast Specialists-Macomb Township
🇺🇸
Macomb, Michigan, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸
Escanaba, Michigan, United States
Lakeland Hospital Niles
🇺🇸
Niles, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸
Macomb, Michigan, United States
Essentia Health - Fosston
🇺🇸
Fosston, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
🇺🇸
Detroit Lakes, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Spectrum Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
Northwell Health Imbert Cancer Center
🇺🇸
Bay Shore, New York, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Dayton Physicians LLC-Wayne
🇺🇸
Greenville, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
OhioHealth Mansfield Hospital
🇺🇸
Mansfield, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
AtlantiCare Surgery Center
🇺🇸
Egg Harbor Township, New Jersey, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Greater Dayton Cancer Center
🇺🇸
Kettering, Ohio, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Dayton Physicians LLC-Upper Valley
🇺🇸
Troy, Ohio, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Dayton Physician LLC-Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
First Dayton Cancer Care
🇺🇸
Kettering, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Dayton Veterans Affairs Medical Center
🇺🇸
Dayton, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Indu and Raj Soin Medical Center
🇺🇸
Beavercreek, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸
Centerville, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸
Franklin, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Tidelands Georgetown Memorial Hospital
🇺🇸
Georgetown, South Carolina, United States
Geisinger Medical Oncology-Selinsgrove
🇺🇸
Selinsgrove, Pennsylvania, United States
MultiCare Auburn Medical Center
🇺🇸
Auburn, Washington, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Aurora Cancer Care-Kenosha South
🇺🇸
Kenosha, Wisconsin, United States
Prisma Health Cancer Institute - Laurens
🇺🇸
Clinton, South Carolina, United States
Marshfield Clinic - Ladysmith Center
🇺🇸
Ladysmith, Wisconsin, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸
Marinette, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Marshfield Clinic Stevens Point Center
🇺🇸
Stevens Point, Wisconsin, United States
Aurora Cancer Care-Racine
🇺🇸
Racine, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸
Summit, Wisconsin, United States
Kaiser Permanente-San Francisco
🇺🇸
San Francisco, California, United States
Kaiser Permanente San Leandro
🇺🇸
San Leandro, California, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cheyenne Regional Medical Center-West
🇺🇸
Cheyenne, Wyoming, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Kansas Institute of Medicine Cancer and Blood Center
🇺🇸
Lenexa, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸
Great Bend, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Minimally Invasive Surgery Hospital
🇺🇸
Lenexa, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas-Manhattan
🇺🇸
Manhattan, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸
McPherson, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
The Women's Imaging Center
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸
Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
Ascension Saint John Hospital
🇺🇸
Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Essentia Health Hibbing Clinic
🇺🇸
Hibbing, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
National Jewish Health-Main Campus
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸
Aurora, Colorado, United States
Aurora Sinai Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
Aurora Cancer Care-Milwaukee
🇺🇸
Milwaukee, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸
Wausau, Wisconsin, United States
Great Lakes Cancer Management Specialists-Rochester Hills
🇺🇸
Rochester Hills, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸
Warren, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸
Ypsilanti, Michigan, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Kaiser Permanente - Harbor City
🇺🇸
Harbor City, California, United States
UCLA / Jonsson Comprehensive Cancer Center
🇺🇸
Los Angeles, California, United States
Kaiser Permanente-Roseville
🇺🇸
Roseville, California, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Marinette
🇺🇸
Marinette, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸
Clinton, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸
Goldsboro, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸
Reidsville, North Carolina, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Aurora Saint Luke's Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸
Two Rivers, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸
Antioch, California, United States
Kaiser Permanente-Bellflower
🇺🇸
Bellflower, California, United States
Kaiser Permanente-Anaheim
🇺🇸
Anaheim, California, United States
Kaiser Permanente-Fremont
🇺🇸
Fremont, California, United States
Kaiser Permanente-Fresno
🇺🇸
Fresno, California, United States
Kaiser Permanente-Irvine
🇺🇸
Irvine, California, United States
Kaiser Permanente-Cadillac
🇺🇸
Los Angeles, California, United States
Kaiser Permanente-Richmond
🇺🇸
Richmond, California, United States
Kaiser Permanente - Panorama City
🇺🇸
Panorama City, California, United States
Kaiser Permanente-Redwood City
🇺🇸
Redwood City, California, United States
Kaiser Permanente-San Marcos
🇺🇸
San Marcos, California, United States
Kaiser Permanente-San Rafael
🇺🇸
San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸
Santa Clara, California, United States
Kaiser San Rafael-Gallinas
🇺🇸
San Rafael, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸
Santa Rosa, California, United States
Kaiser Permanente-Vallejo
🇺🇸
Vallejo, California, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸
Vacaville, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸
Walnut Creek, California, United States
Kaiser Permanente-Woodland Hills
🇺🇸
Woodland Hills, California, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸
Boulder, Colorado, United States
Kaiser Permanente-Franklin
🇺🇸
Denver, Colorado, United States
Denver Health Medical Center
🇺🇸
Denver, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸
Englewood, Colorado, United States
National Jewish Health-Western Hematology Oncology
🇺🇸
Golden, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Kaiser Permanente-Rock Creek
🇺🇸
Lafayette, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸
Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸
Lone Tree, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸
Seaford, Delaware, United States
Regional Cancer Center-Lee Memorial Health System
🇺🇸
Fort Myers, Florida, United States
Florida Gynecologic Oncology
🇺🇸
Fort Myers, Florida, United States
Augusta University Medical Center
🇺🇸
Augusta, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, 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
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Willis-Knighton Medical and Cancer Center
🇺🇸
Shreveport, Louisiana, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Hematology Oncology Consultants-Clarkston
🇺🇸
Clarkston, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸
East China Township, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Academic Hematology Oncology Specialists
🇺🇸
Grosse Pointe Woods, Michigan, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸
Grosse Pointe Woods, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸
Pontiac, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸
Saginaw, Michigan, United States
Metro Health Hospital
🇺🇸
Wyoming, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Essentia Health - Park Rapids
🇺🇸
Park Rapids, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Essentia Health Virginia Clinic
🇺🇸
Virginia, Minnesota, United States
Gulfport Memorial Hospital
🇺🇸
Gulfport, Mississippi, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
AtlantiCare Health Park-Cape May Court House
🇺🇸
Cape May Court House, New Jersey, United States
Northwell Health/Center for Advanced Medicine
🇺🇸
Lake Success, New York, United States
Lenox Hill Hospital
🇺🇸
New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Cone Heath Cancer Center at Mebane
🇺🇸
Mebane, North Carolina, United States
Randolph Hospital
🇺🇸
Asheboro, North Carolina, United States
Cone Health Cancer Center
🇺🇸
Greensboro, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Springfield Regional Cancer Center
🇺🇸
Springfield, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
Bryn Mawr Hospital
🇺🇸
Bryn Mawr, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸
Lewisburg, Pennsylvania, United States
Lewistown Hospital
🇺🇸
Lewistown, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸
Pottsville, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸
Paoli, Pennsylvania, United States
Community Medical Center
🇺🇸
Scranton, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
Gibbs Cancer Center-Gaffney
🇺🇸
Gaffney, South Carolina, United States
Saint Francis Hospital
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸
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
South Carolina Cancer Specialists PC
🇺🇸
Hilton Head Island, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
MGC Hematology Oncology-Union
🇺🇸
Union, South Carolina, United States
Spartanburg Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Saint Joseph Regional Cancer Center
🇺🇸
Bryan, Texas, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸
American Fork, Utah, United States
Intermountain Medical Center
🇺🇸
Murray, Utah, United States
Utah Valley Regional Medical Center
🇺🇸
Provo, Utah, United States
McKay-Dee Hospital Center
🇺🇸
Ogden, Utah, United States
Logan Regional Hospital
🇺🇸
Logan, Utah, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Northwest Cancer Clinic
🇺🇸
Kennewick, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
Duluth Clinic Ashland
🇺🇸
Ashland, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Aurora Health Care Germantown Health Center
🇺🇸
Germantown, Wisconsin, United States
Marshfield Clinic-Chippewa Center
🇺🇸
Chippewa Falls, Wisconsin, United States
Aurora Health Center-Fond du Lac
🇺🇸
Fond Du Lac, Wisconsin, United States
Aurora Cancer Care-Grafton
🇺🇸
Grafton, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸
Green Bay, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸
Oshkosh, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸
Sheboygan, Wisconsin, United States
Aurora Cancer Care-Milwaukee West
🇺🇸
Wauwatosa, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸
Weston, Wisconsin, United States
Newland Medical Associates-Clarkston
🇺🇸
Clarkston, Michigan, United States
National Jewish Health-Northern Hematology Oncology
🇺🇸
Thornton, Colorado, United States
Kaiser Permanente-Baldwin Park
🇺🇸
Baldwin Park, California, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Kaiser Permanente-Lone Tree
🇺🇸
Lone Tree, Colorado, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸
Nampa, Idaho, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸
Flint, Michigan, United States
Macomb Hematology Oncology PC
🇺🇸
Warren, Michigan, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸
Fargo, North Dakota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Essentia Health - Jamestown Clinic
🇺🇸
Jamestown, North Dakota, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸
Burlington, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Delaware Health Center-Grady Cancer Center
🇺🇸
Delaware, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸
Marion, Ohio, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Riddle Memorial Hospital
🇺🇸
Media, Pennsylvania, United States
MultiCare Gig Harbor Medical Park
🇺🇸
Gig Harbor, Washington, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
MultiCare Good Samaritan Hospital
🇺🇸
Puyallup, Washington, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸
Burlington, Wisconsin, United States
Kaiser Permanente Downtown Commons
🇺🇸
Sacramento, California, United States
Kaiser Permanente-South Sacramento
🇺🇸
Sacramento, California, United States
Kaiser Permanente - Sacramento
🇺🇸
Sacramento, California, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
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
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
Louisiana State University Health Science Center
🇺🇸
New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸
New Orleans, Louisiana, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
Gibbs Cancer Center-Pelham
🇺🇸
Greer, South Carolina, United States
Lakeland Medical Center Saint Joseph
🇺🇸
Saint Joseph, Michigan, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States