MedPath

Antiemetic Therapy With or Without Olanzapine in Preventing Chemotherapy-Induced Nausea and Vomiting in Patients With Cancer Receiving Highly Emetogenic Chemotherapy

Phase 3
Completed
Conditions
Hematopoietic/Lymphoid Cancer
Nausea and Vomiting
Unspecified Adult Solid Tumor, Protocol Specific
Interventions
Registration Number
NCT02116530
Lead Sponsor
Alliance for Clinical Trials in Oncology
Brief Summary

This randomized phase III trial studies antiemetic therapy with olanzapine to see how well they work compared to antiemetic therapy alone in preventing chemotherapy-induced nausea and vomiting in patients with cancer receiving highly emetogenic (causes vomiting) chemotherapy. Antiemetic drugs, such as palonosetron hydrochloride, ondansetron, and granisetron hydrochloride, may help lessen or prevent nausea and vomiting in patients treated with chemotherapy. Olanzapine may help prevent chemotherapy-induced nausea and vomiting by blocking brain receptors that appear to be involved in nausea and vomiting.

Detailed Description

Patients with cancer may receive chemotherapy that may cause nausea and vomiting. The purpose of this study is to determine if the use of olanzapine in combination with antiemetic therapy can significantly reduce nausea and vomiting in a large number of patients receiving chemotherapy. Patients are randomized to one of two treatment arms. Please see the "Arms and Intervention" sections for more detailed information. The primary objective is to compare the number of patients with no nausea for the acute (0-24 hours post-chemotherapy), delayed (24-120 hours post-chemotherapy) and overall periods (0-120 hours post-chemotherapy) for patients receiving HEC. The secondary objectives are:

1. To compare the complete response (CR) (no emetic episodes and no use of rescue medication) in the acute, delayed and overall periods

2. To compare the incidences of potential toxicities ascribed to olanzapine

Protocol treatment is to begin ≤ 14 days of registration. Patients will receive treatment on Days 1-4. Patients will be permitted to take rescue therapy of the treating investigator's choice for nausea and/or emesis/retching, based on clinical circumstances. After completing treatment, patients will be monitored for side effects.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
401
Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Placebo + Chemotherapy + Antiemetic treatmentAntiemetic treatment (ondansetron or granisetron or palonosetron; plus dexamethasone; plus fosaprepitant or aprepitant)Patients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as usual anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * placebo
Placebo + Chemotherapy + Antiemetic treatmentPlaceboPatients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as usual anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * placebo
Olanzapine + Chemotherapy + Antiemetic treatmentChemotherapy (cisplatin or cyclophosphamide and doxorubicin)Patients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as the following anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * olanzapine (10 mg orally on the day of chemotherapy and 10 mg orally on days 2, 3, 4 post chemotherapy)
Placebo + Chemotherapy + Antiemetic treatmentChemotherapy (cisplatin or cyclophosphamide and doxorubicin)Patients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as usual anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * placebo
Olanzapine + Chemotherapy + Antiemetic treatmentAntiemetic treatment (ondansetron or granisetron or palonosetron; plus dexamethasone; plus fosaprepitant or aprepitant)Patients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as the following anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * olanzapine (10 mg orally on the day of chemotherapy and 10 mg orally on days 2, 3, 4 post chemotherapy)
Olanzapine + Chemotherapy + Antiemetic treatmentOlanzapinePatients will receive the chemotherapy drugs cisplatin or cyclophosphamide and doxorubicin as well as the following anti-nausea/vomiting drugs: * Ondansetron (8 mg orally or intravenously) or granisetron (1 mg intravenously or 2 mg orally) or palonosetron (0.25 mg intravenously) on the day of chemotherapy, plus * Dexamethasone (12 mg orally on the day of chemotherapy and 8 mg orally days 2, 3, 4 post chemotherapy), plus * Fosaprepitant (150 mg intravenously on the day of chemotherapy) or aprepitant (125 mg orally on the day of chemotherapy and 80 mg orally on days 2 and 3 post chemotherapy), plus * olanzapine (10 mg orally on the day of chemotherapy and 10 mg orally on days 2, 3, 4 post chemotherapy)
Primary Outcome Measures
NameTimeMethod
Proportion of Patients With no Nausea0 to 120 hours after chemotherapy

No nausea was defined as a response of 0 in the nausea item of Nausea and Vomiting Daily Diary/Questionnaire in the acute (0-24 hours), delayed (25-120 hours) and overall (0-120 hours) periods after chemotherapy.

Secondary Outcome Measures
NameTimeMethod
Median Nausea ScoresBaseline and Day 2 to Day 6 after chemotherapy

Nausea scores was measured using a visual-analogue scale ranging from 0 (none) to 10 (as bad as it can be).

Proportion of Patients With Complete Response0 to 120 hours after chemotherapy

Complete response was defined as no emetic episodes and no use of rescue medication during the acute (0-24 hours), delayed (25-120 hours) and overall (0-120 hours) periods as measured by the Nausea and Vomiting Daily Diary/Questionnaire.

Mean Scores of Potential Toxicities Related to Olanzapine as Measured by the Nausea and Vomiting Daily Diary/QuestionnaireBaseline and day 2 to 6 days after chemotherapy

Patients were asked to record daily levels of undesired sedation and appetite increase using a visual-analogue scale ranging from 0 (none) to 10 (as bad as it can be).

Frequency of Rescue MedicationDay 2 to Day 6 after chemotherapy

Patients were asked to record daily number of extra nausea/vomiting pills taken because they developed nausea/vomiting in the following categories: None, One, Two, More than two in Nausea and Vomiting Daily Diary Questionnaire.

Trial Locations

Locations (177)

Southwest Oncology PC

🇺🇸

Durango, Colorado, United States

Saint Luke's Mountain States Tumor Institute - Nampa

🇺🇸

Nampa, Idaho, United States

Illinois CancerCare Galesburg

🇺🇸

Galesburg, Illinois, United States

Western Illinois Cancer Treatment Center

🇺🇸

Galesburg, Illinois, United States

Good Samaritan Regional Health Center

🇺🇸

Mount Vernon, Illinois, United States

Phelps County Regional Medical Center

🇺🇸

Rolla, Missouri, United States

Southeastern Medical Oncology Center-Jacksonville

🇺🇸

Jacksonville, North Carolina, United States

Bay Area Medical Center

🇺🇸

Marinette, Wisconsin, United States

Green Bay Oncology - Oconto Falls

🇺🇸

Oconto Falls, Wisconsin, United States

Marshfield Clinic

🇺🇸

Marshfield, Wisconsin, United States

Marshfield Clinic Cancer Care at Saint Michael's Hospital

🇺🇸

Stevens Point, Wisconsin, United States

Katmai Oncology Group

🇺🇸

Anchorage, Alaska, United States

Providence Alaska Medical Center

🇺🇸

Anchorage, Alaska, United States

Anchorage Associates in Radiation Medicine

🇺🇸

Anchorage, Alaska, United States

Marshfield Clinic - Weston Center

🇺🇸

Weston, Wisconsin, United States

Wilcox Memorial Hospital and Kauai Medical Clinic

🇺🇸

Lihue, Hawaii, United States

Rocky Mountain Cancer Centers-Boulder

🇺🇸

Boulder, Colorado, United States

Rocky Mountain Cancer Centers-Longmont

🇺🇸

Longmont, Colorado, United States

McFarland Clinic PC-William R Bliss Cancer Center

🇺🇸

Ames, Iowa, United States

Mercy Hospital

🇺🇸

Cedar Rapids, Iowa, United States

Medical Oncology and Hematology Associates-Des Moines

🇺🇸

Des Moines, Iowa, United States

OSF Saint Anthony Medical Center

🇺🇸

Rockford, Illinois, United States

Rocky Mountain Cancer Centers-Aurora

🇺🇸

Aurora, Colorado, United States

Porter Adventist Hospital

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Midtown

🇺🇸

Denver, Colorado, United States

Exempla Saint Joseph Hospital

🇺🇸

Denver, Colorado, United States

Presbyterian - Saint Lukes Medical Center - Health One

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Rose

🇺🇸

Denver, Colorado, United States

Colorado Blood Cancer Institute

🇺🇸

Denver, Colorado, United States

Rose Medical Center

🇺🇸

Denver, Colorado, United States

Froedtert and the Medical College of Wisconsin

🇺🇸

Milwaukee, Wisconsin, United States

Alaska Regional Hospital

🇺🇸

Anchorage, Alaska, United States

Anchorage Radiation Therapy Center

🇺🇸

Anchorage, Alaska, United States

Alaska Oncology and Hematology LLC

🇺🇸

Anchorage, Alaska, United States

Anchorage Oncology Centre

🇺🇸

Anchorage, Alaska, United States

Alaska Breast Care and Surgery LLC

🇺🇸

Anchorage, Alaska, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

🇺🇸

Burbank, California, United States

Alaska Women's Cancer Care

🇺🇸

Anchorage, Alaska, United States

UC San Diego Moores Cancer Center

🇺🇸

La Jolla, California, United States

Epic Care-Dublin

🇺🇸

Dublin, California, United States

Bay Area Breast Surgeons Inc

🇺🇸

Emeryville, California, United States

Epic Care Partners in Cancer Care

🇺🇸

Emeryville, California, United States

Contra Costa Regional Medical Center

🇺🇸

Martinez, California, United States

Alta Bates Summit Medical Center - Summit Campus

🇺🇸

Oakland, California, United States

Hematology and Oncology Associates-Oakland

🇺🇸

Oakland, California, United States

Bay Area Tumor Institute

🇺🇸

Oakland, California, United States

Saint Mary Corwin Medical Center

🇺🇸

Pueblo, California, United States

The Medical Center of Aurora

🇺🇸

Aurora, Colorado, United States

Boulder Community Hospital

🇺🇸

Boulder, Colorado, United States

Penrose-Saint Francis Healthcare

🇺🇸

Colorado Springs, Colorado, United States

Mercy Medical Center

🇺🇸

Durango, Colorado, United States

Mountain Blue Cancer Care Center

🇺🇸

Golden, Colorado, United States

Rocky Mountain Cancer Centers-Greenwood Village

🇺🇸

Greenwood Village, Colorado, United States

Comprehensive Cancer Care and Research Institute of Colorado LLC

🇺🇸

Englewood, Colorado, United States

North Colorado Medical Center

🇺🇸

Greeley, Colorado, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

Rocky Mountain Cancer Centers-Littleton

🇺🇸

Littleton, Colorado, United States

Littleton Adventist Hospital

🇺🇸

Littleton, Colorado, United States

Saint Anthony Hospital

🇺🇸

Lakewood, Colorado, United States

Rocky Mountain Cancer Centers-Lakewood

🇺🇸

Lakewood, 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

McKee Medical Center

🇺🇸

Loveland, Colorado, United States

Parker Adventist Hospital

🇺🇸

Parker, Colorado, United States

Rocky Mountain Cancer Centers-Parker

🇺🇸

Parker, Colorado, United States

Saint Francis Hospital and Medical Center

🇺🇸

Hartford, Connecticut, United States

Rocky Mountain Cancer Centers - Pueblo

🇺🇸

Pueblo, Colorado, United States

Rocky Mountain Cancer Centers-Thornton

🇺🇸

Thornton, Colorado, United States

Exempla Lutheran Medical Center

🇺🇸

Wheat Ridge, Colorado, United States

Beebe Medical Center

🇺🇸

Lewes, Delaware, United States

Medical Oncology Hematology Consultants PA

🇺🇸

Newark, Delaware, United States

Delaware Clinical and Laboratory Physicians PA

🇺🇸

Newark, Delaware, United States

Helen F Graham Cancer Center

🇺🇸

Newark, Delaware, United States

Christiana Care Health System-Christiana Hospital

🇺🇸

Newark, Delaware, United States

MedStar Washington Hospital Center

🇺🇸

Washington, District of Columbia, United States

Christiana Gynecologic Oncology LLC

🇺🇸

Newark, Delaware, United States

Beebe Health Campus

🇺🇸

Rehoboth Beach, Delaware, United States

Oncare Hawaii Inc-Pali Momi

🇺🇸

'Aiea, Hawaii, United States

Regional Hematology and Oncology PA

🇺🇸

Newark, Delaware, United States

Florida Hospital Memorial Medical Center

🇺🇸

Daytona Beach, Florida, United States

Pali Momi Medical Center

🇺🇸

'Aiea, Hawaii, United States

Nanticoke Memorial Hospital

🇺🇸

Sanford, Delaware, United States

Christiana Care Health System-Wilmington Hospital

🇺🇸

Wilmington, Delaware, United States

MedStar Georgetown University Hospital

🇺🇸

Washington, District of Columbia, United States

Oncare Hawaii Inc-POB II

🇺🇸

Honolulu, Hawaii, United States

Phoebe Putney Memorial Hospital

🇺🇸

Albany, Georgia, United States

The Cancer Center of Hawaii-Leeward

🇺🇸

'Ewa Beach, Hawaii, United States

Straub Clinic and Hospital

🇺🇸

Honolulu, Hawaii, United States

Queen's Medical Center

🇺🇸

Honolulu, Hawaii, United States

University of Hawaii Cancer Center

🇺🇸

Honolulu, Hawaii, United States

Kuakini Medical Center

🇺🇸

Honolulu, Hawaii, United States

The Cancer Center of Hawaii-Liliha

🇺🇸

Honolulu, Hawaii, United States

Saint Alphonsus Cancer Care Center-Boise

🇺🇸

Boise, Idaho, United States

Oncare Hawaii Inc-Kuakini

🇺🇸

Honolulu, Hawaii, United States

Tripler Army Medical Center

🇺🇸

Honolulu, Hawaii, United States

OnCare Hawaii-Liliha

🇺🇸

Honolulu, Hawaii, United States

Saint Luke's Mountain States Tumor Institute - Fruitland

🇺🇸

Fruitland, Idaho, United States

Saint Luke's Mountain States Tumor Institute

🇺🇸

Boise, Idaho, United States

Saint Luke's Mountain States Tumor Institute - Meridian

🇺🇸

Meridian, Idaho, United States

Saint Luke's Mountain States Tumor Institute-Twin Falls

🇺🇸

Twin Falls, Idaho, United States

Saint Joseph Medical Center

🇺🇸

Bloomington, Illinois, United States

Memorial Hospital of Carbondale

🇺🇸

Carbondale, Illinois, United States

Decatur Memorial Hospital

🇺🇸

Decatur, Illinois, United States

Cancer Care Specialists of Central Illinois

🇺🇸

Decatur, Illinois, United States

Advocate Sherman Hospital

🇺🇸

Elgin, Illinois, United States

Ingalls Memorial Hospital

🇺🇸

Harvey, Illinois, United States

Oconomowoc Memorial Hospital-ProHealth Care Inc

🇺🇸

Oconomowoc, Illinois, United States

OSF Saint Francis Medical Center

🇺🇸

Peoria, Illinois, United States

Valley Radiation Oncology

🇺🇸

Peru, Illinois, United States

Methodist Medical Center of Illinois

🇺🇸

Peoria, Illinois, United States

Illinois CancerCare-Peoria

🇺🇸

Peoria, Illinois, United States

Southern Illinois University School of Medicine

🇺🇸

Springfield, Illinois, United States

Waukesha Memorial Hospital

🇺🇸

Waukesha, Illinois, United States

Memorial Regional Cancer Center Day Road

🇺🇸

Mishawaka, Indiana, United States

Memorial Hospital of South Bend

🇺🇸

South Bend, Indiana, United States

Mary Greeley Medical Center

🇺🇸

Ames, Iowa, United States

Iowa Methodist Medical Center

🇺🇸

Des Moines, Iowa, United States

McFarland Clinic PC-Boone

🇺🇸

Boone, Iowa, United States

Physicians' Clinic of Iowa PC

🇺🇸

Cedar Rapids, Iowa, United States

Oncology Associates at Mercy Medical Center

🇺🇸

Cedar Rapids, Iowa, United States

Iowa Lutheran Hospital

🇺🇸

Des Moines, Iowa, United States

Mercy Medical Center-Sioux City

🇺🇸

Des Moines, Iowa, United States

McFarland Clinic PC-Trinity Cancer Center

🇺🇸

Fort Dodge, Iowa, United States

McFarland Clinic PC-Jefferson

🇺🇸

Jefferson, Iowa, United States

Mercy Medical Center - North Iowa

🇺🇸

Mason City, Iowa, United States

McFarland Clinic PC-Marshalltown

🇺🇸

Marshalltown, Iowa, United States

Siouxland Regional Cancer Center

🇺🇸

Sioux City, Iowa, United States

Methodist West Hospital

🇺🇸

West Des Moines, Iowa, United States

Saint Luke's Regional Medical Center

🇺🇸

Sioux City, Iowa, United States

Baptist Health Lexington

🇺🇸

Lexington, Kentucky, United States

Hardin Memorial Hospital

🇺🇸

Elizabethtown, Kentucky, United States

Baptist Health Corbin

🇺🇸

Corbin, Kentucky, United States

Newton-Wellesley Hospital

🇺🇸

Newton, Massachusetts, United States

Mercy Hospital-Joplin

🇺🇸

Joplin, Missouri, United States

William Beaumont Hospital - Troy

🇺🇸

Troy, Michigan, United States

Botsford Hospital

🇺🇸

Farmington, Michigan, United States

Mercy Clinic-Rolla-Cancer and Hematology

🇺🇸

Rolla, Missouri, United States

Saint Louis Cancer and Breast Institute-South City

🇺🇸

Saint Louis, Missouri, United States

CoxHealth South Hospital

🇺🇸

Springfield, Missouri, United States

Mercy Hospital Saint Louis

🇺🇸

Saint Louis, Missouri, United States

Wayne Memorial Hospital

🇺🇸

Goldsboro, North Carolina, United States

Southeastern Medical Oncology Center-Clinton

🇺🇸

Clinton, North Carolina, United States

Southeastern Medical Oncology Center-Goldsboro

🇺🇸

Goldsboro, North Carolina, United States

Southeastern Medical Oncology Center-Wilson

🇺🇸

Wilson, North Carolina, United States

Dayton NCI Community Oncology Research Program

🇺🇸

Dayton, Ohio, United States

Central Vermont Medical Center

🇺🇸

Berlin, Vermont, United States

Miriam Hospital

🇺🇸

Providence, Rhode Island, United States

Marshfield Clinic Cancer Center at Sacred Heart

🇺🇸

Eau Claire, Wisconsin, United States

University of Vermont College of Medicine

🇺🇸

Burlington, Vermont, United States

Marshfield Clinic-Chippewa Center

🇺🇸

Chippewa Falls, Wisconsin, United States

Cheyenne Regional Medical Center-West

🇺🇸

Cheyenne, Wisconsin, United States

Edwards Comprehensive Cancer Center

🇺🇸

Huntington, West Virginia, United States

Providence Regional Cancer System-Yelm

🇺🇸

Yelm, Washington, United States

Green Bay Oncology at Saint Vincent Hospital

🇺🇸

Green Bay, Wisconsin, United States

Saint Agnes Hospital/Agnesian Cancer Center

🇺🇸

Fond Du Lac, Wisconsin, United States

Saint Vincent Hospital

🇺🇸

Green Bay, Wisconsin, United States

Green Bay Oncology Limited at Saint Mary's Hospital

🇺🇸

Green Bay, Wisconsin, United States

Saint Mary's Hospital

🇺🇸

Green Bay, Wisconsin, United States

Gundersen Lutheran Medical Center

🇺🇸

La Crosse, Wisconsin, United States

Holy Family Memorial Hospital

🇺🇸

Manitowoc, Wisconsin, United States

Marshfield Clinic-Minocqua Center

🇺🇸

Minocqua, Wisconsin, United States

Marshfield Clinic at James Beck Cancer Center

🇺🇸

Rhinelander, Wisconsin, United States

Westfields Hospital/Cancer Center of Western Wisconsin

🇺🇸

New Richmond, Wisconsin, United States

D N Greenwald Center

🇺🇸

Mukwonago, Wisconsin, United States

Lakeview Medical Center-Marshfield Clinic

🇺🇸

Rice Lake, Wisconsin, United States

William Beaumont Hospital-Royal Oak

🇺🇸

Royal Oak, Wisconsin, United States

Marshfield Clinic-Rice Lake Center

🇺🇸

Rice Lake, Wisconsin, United States

Saint Nicholas Hospital

🇺🇸

Sheboygan, Wisconsin, United States

Green Bay Oncology - Sturgeon Bay

🇺🇸

Sturgeon Bay, Wisconsin, United States

Marshfield Clinic-Wausau Center

🇺🇸

Wausau, Wisconsin, United States

Marshfield Clinic - Wisconsin Rapids Center

🇺🇸

Wisconsin Rapids, Wisconsin, United States

Mercy Hospital Springfield

🇺🇸

Springfield, Missouri, United States

Rocky Mountain Cancer Centers-Penrose

🇺🇸

Colorado Springs, Colorado, United States

Kapiolani Medical Center for Women and Children

🇺🇸

Honolulu, Hawaii, United States

Memorial Medical Center

🇺🇸

Springfield, Illinois, United States

Rhode Island Hospital

🇺🇸

Providence, Rhode Island, United States

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