MedPath

Treatment Effects on Development of Chemotherapy-Induced Peripheral Neuropathy in Patients With Cancer

Active, not recruiting
Conditions
Anatomic Stage IA Breast Cancer AJCC v8
Anatomic Stage IB Breast Cancer AJCC v8
Anatomic Stage IIB Breast Cancer AJCC v8
Anatomic Stage I Breast Cancer AJCC v8
Anatomic Stage II Breast Cancer AJCC v8
Anatomic Stage IIIA Breast Cancer AJCC v8
Anatomic Stage IIIC Breast Cancer AJCC v8
Prognostic Stage IA Breast Cancer AJCC v8
Prognostic Stage IB Breast Cancer AJCC v8
Prognostic Stage IIA Breast Cancer AJCC v8
Interventions
Drug: Chemotherapy
Other: Functional Assessment
Other: Questionnaire Administration
Registration Number
NCT03939481
Lead Sponsor
SWOG Cancer Research Network
Brief Summary

This trial studies treatment effects on development of chemotherapy-induced peripheral neuropathy in patients with cancer. Treatments for cancer can cause a problem to the nervous system (called peripheral neuropathy) that can lead to tingling or less feeling in hands and feet. Studying certain risk factors, such as age, gender, pre-existing conditions, and the type of treatment for cancer may help doctors estimate how likely patients are to develop the nerve disorder.

Detailed Description

PRIMARY OBJECTIVES:

I. To develop and validate a clinical risk prediction model using clinical factors for the development of peripheral neuropathy in patients receiving taxane-based chemotherapy regimens.

SECONDARY OBJECTIVES:

I. To examine patient-reported outcomes (PROs) and objective measures of chemotherapy induced peripheral neuropathy (CIPN) to better define the phenotype of peripheral neuropathy in this patient population.

II. To assess the incidence of CIPN within one year in this patient population. III. To identify predictors of treatment dose reductions, delays, and discontinuations associated with CIPN symptoms in this patient population.

OTHER OBJECTIVES:

I. To collect serum and plasma samples for future testing for biomarker and mechanistic studies of CIPN.

OUTLINE:

Patients receive chemotherapy regimen per treating physician for 52 weeks in the absence of disease progression or unacceptable toxicity. Patients also complete questionnaires at weeks 4, 8, 12, 24 and 52.

Recruitment & Eligibility

Status
ACTIVE_NOT_RECRUITING
Sex
All
Target Recruitment
1336
Inclusion Criteria
  • Patients must have stage I, II, or III primary non-small cell lung, primary breast, or primary ovarian cancer based on clinical or pathologic evaluation. Patients with Stage IV disease are not eligible.

  • Patients must be planning to start treatment with a taxane-based chemotherapy as part of one of the study-approved taxane regimens (docetaxel chemotherapy regimens for treatment of breast or ovarian cancer, or paclitaxel chemotherapy regimen for treatment of breast, non-small cell lung, or ovarian cancer) within 14 days after registration. (Note that docetaxel or paclitaxel may be administered with a non-neurotoxic chemotherapy, such as cyclophosphamide, and/or biologic agent, such as trastuzumab, and/or carboplatin. Additionally, nab-paclitaxel may not be substituted for paclitaxel for purposes of this study.)

  • Patients who will receive treatment in the setting of any other clinical trial are eligible as long as it is one of the study-approved regimens. Patients may receive additional treatments (i.e., experimental therapy, immunotherapy, biologics, etc.) as part of another clinical trial in addition to any regimen approved in this study.

  • Patients must not have received a taxane (paclitaxel, docetaxel, or protein-bound paclitaxel), platinum (cisplatin, carboplatin, or oxaliplatin), vinca alkaloid (vinblastine, vincristine, or vinorelbine), or bortezomib-based chemotherapy regimen prior to registration. (Note that while patients must not have received carboplatin in the past, patients may receive a carboplatin-containing regimen after registration as part of the docetaxel or paclitaxel regimen.)

  • Patients who can complete Patient-Reported Outcome (PRO) instruments in English or Spanish must:

    • Agree to complete PROs at all scheduled assessments
    • Complete the baseline PRO forms prior to registration
  • Patients with pre-existing neuropathy are eligible, including those with diabetes and neurological conditions such as multiple sclerosis or Parkinson?s disease.

  • Patients must agree to submit required specimens for defined translational medicine.

  • Patients must be offered the opportunity to submit additional optional specimens for future, unspecified translational medicine and banking. With patient?s consent, specimens must be submitted.

  • Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines.

  • As a part of the OPEN registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system.

Exclusion Criteria

Not provided

Study & Design

Study Type
OBSERVATIONAL
Study Design
Not specified
Arm && Interventions
GroupInterventionDescription
Observational (non-study chemo, questionnaire, assessments)ChemotherapyPatients receive chemotherapy regimen per treating physician for 52 weeks in the absence of disease progression or unacceptable toxicity. Patients also complete questionnaires at weeks 4, 8, 12, 24 and 52.
Observational (non-study chemo, questionnaire, assessments)Functional AssessmentPatients receive chemotherapy regimen per treating physician for 52 weeks in the absence of disease progression or unacceptable toxicity. Patients also complete questionnaires at weeks 4, 8, 12, 24 and 52.
Observational (non-study chemo, questionnaire, assessments)Questionnaire AdministrationPatients receive chemotherapy regimen per treating physician for 52 weeks in the absence of disease progression or unacceptable toxicity. Patients also complete questionnaires at weeks 4, 8, 12, 24 and 52.
Primary Outcome Measures
NameTimeMethod
Development of peripheral neuropathyUp to 24 weeks

Will be measured as an absolute increase of \>= 8 points over the baseline chemotherapy-induced peripheral neuropathy (CIPN)-20 sensory neuropathy subscale score. Will be collected before or at the 24-week assessment as the taxane-based chemotherapy regimens in this study are expected to be completed within 8 to 18 weeks. The presence of CIPN will be captured at 52 weeks to evaluate the duration of neuropathy which is anticipated to wane after treatment discontinuation.

Secondary Outcome Measures
NameTimeMethod
Visual Analog Toxicity ScoreUp to 52 weeks

Assessed using the Visual Analog Toxicity Score. The Visual Analog Toxicity Score is a single question asking the physician to rate how the physician feels the patient's disease and treatment affects their daily life on a scale from 0 (no symptoms and no effect on life) to 10 (severe effects of treatment and patient would rather be dead).

CIPN symptomsUp to 52 weeks

Patients experiencing a treatment change attributed to CIPN symptoms

Leisure-time Exercise HabitsUp to 52 weeks

Assessed using the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). The GSLTPAQ is a brief 4 item self-administered questionnaire of usual leisure-time exercise habits over a typical 7-day period. The Leisure Score Index (LSI) is calculated based on the first 3 questions. The LSI scores can be used to classify respondents into active (LSI \> 24) and insufficiently active (LSI \< 23) categories.

Patient-Reported OutcomesUp to 52 weeks

Assessed using the Patient Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE \[CTCAE Version 5.0\]). PRO-CTCAE assesses 78 adverse events by self-report with 124 items. Each item uses a plain language term for the adverse event, the attribute of interest, and the standard recall period of "the past 7 days".

Dose ChangesUp to 52 weeks

Dose reductions, delays, and discontinuations of treatment (prior to completing the original treatment plan)

Health-related Quality of LifeUp to 52 weeks

Assessed using the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29). The PROMIS-29 is a well validated assessment tool that offers both qualitative and quantitative measures of health-related quality of life. The PROMIS-29 includes 29 questions evaluating areas of physical function, anxiety, depression, fatigue, sleep, social functioning, and pain interference. The PROMIS-29 assesses severity levels of symptoms and their effect on the patient's functioning.

Patient Reported SymptomUp to 52 weeks

Assessed using the Patient Reported Symptom Burden Score. The Patient Reported Symptom Score at baseline contains one question to assess how cancer symptoms affect the patient's life (scale 0 \[no burden at all\] to 10 \[a great burden\]). At follow-up, the Symptom Burden Score contains five questions: 1) to assess burden of side effects of cancer treatment on life (scale 0 \[no burden at all\] to 10 \[a great burden\]), 2) to assess severity of side effects from cancer treatment (scale 0 \[no side effects\]) to 10 \[side effects extremely severe and unbearable\]), 3) to assess tolerability of side effects for set time periods (yes/no), 4) to assess level at which treatment would be considered intolerable (scale 0 \[side effects not severe at all\] to 10 \[side effects extremely severe and unbearable\]), and 5) to assess the burden of cancer symptoms and treatment symptoms (scale 0 \[no burden at all\] to 10 \[a great burden\]).

National Cancer Institute-Common Terminology Criteria for Adverse EventsUp to 52 weeks

The NCI-CTCAE is a subjective method to evaluate CIPN performed by a healthcare professional. The treating physician will grade the subject's dysesthesia, paresthesia, neuralgia, peripheral sensory neuropathy, and peripheral motor neuropathy on a scale of 0 to 5 depending on the severity. The advantage of the NCI-CTCAE is that the assessment is quick and easy for providers to perform, (8) but it is limited by the subjectivity of interpretation, lack of detail about location, type, and severity of impairment, and narrow scoring range.

Assess incidence of CIPNUp to 52 weeks

Assessed using European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 (CIPN-20). The EORTC QLQ-CIPN20 is a 20-item questionnaire that evaluates CIPN using 3 subscales that assess sensory (9 items), motor (8 items), and autonomic (3 items) symptoms and functioning with each item measured on a 1-4 scale (1, not at all; 4, very much). The sensory subscale raw scores range from 1 to 36. The CIPN-20 subscale raw scores are linearly converted to a 0-100 scale such that a high score corresponds to a worse condition or more symptoms.

Trial Locations

Locations (168)

University of Virginia Cancer Center

🇺🇸

Charlottesville, Virginia, United States

Carle Physician Group-Mattoon/Charleston

🇺🇸

Mattoon, Illinois, United States

Maine Medical Center- Scarborough Campus

🇺🇸

Scarborough, Maine, United States

Cancer Care Center of O'Fallon

🇺🇸

O'Fallon, Illinois, United States

Kaiser San Rafael-Gallinas

🇺🇸

San Rafael, California, United States

Mercy Clinic-Rolla-Cancer and Hematology

🇺🇸

Rolla, Missouri, United States

Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

Flaget Memorial Hospital

🇺🇸

Bardstown, Kentucky, United States

Greater Baltimore Medical Center

🇺🇸

Baltimore, Maryland, United States

FirstHealth of the Carolinas-Moore Regional Hospital

🇺🇸

Pinehurst, North Carolina, United States

Lahey Hospital and Medical Center

🇺🇸

Burlington, Massachusetts, United States

Southeastern Medical Oncology Center-Jacksonville

🇺🇸

Jacksonville, North Carolina, United States

AnMed Health Cancer Center

🇺🇸

Anderson, South Carolina, United States

Gibbs Cancer Center-Gaffney

🇺🇸

Gaffney, South Carolina, United States

Prisma Health Cancer Institute - Butternut

🇺🇸

Greenville, South Carolina, United States

Prisma Health Cancer Institute - Faris

🇺🇸

Greenville, South Carolina, United States

Prisma Health Cancer Institute - Greer

🇺🇸

Greer, South Carolina, United States

McLeod Regional Medical Center

🇺🇸

Florence, South Carolina, United States

Saint Francis Hospital

🇺🇸

Greenville, South Carolina, United States

Saint Francis Cancer Center

🇺🇸

Greenville, South Carolina, United States

Prisma Health Cancer Institute - Seneca

🇺🇸

Seneca, South Carolina, United States

Spartanburg Medical Center

🇺🇸

Spartanburg, South Carolina, United States

MGC Hematology Oncology-Union

🇺🇸

Union, South Carolina, United States

Prisma Health Cancer Institute - Eastside

🇺🇸

Greenville, South Carolina, United States

Cookeville Regional Medical Center

🇺🇸

Cookeville, Tennessee, United States

Ballad Health Cancer Care - Kingsport

🇺🇸

Kingsport, Tennessee, United States

Cancer Center of Western Wisconsin

🇺🇸

New Richmond, Wisconsin, United States

Kaiser Permanente-San Francisco

🇺🇸

San Francisco, California, United States

Hennepin County Medical Center

🇺🇸

Minneapolis, Minnesota, United States

Good Samaritan Hospital - Cincinnati

🇺🇸

Cincinnati, Ohio, United States

Salina Regional Health Center

🇺🇸

Salina, Kansas, United States

North Memorial Medical Health Center

🇺🇸

Robbinsdale, Minnesota, United States

Pali Momi Medical Center

🇺🇸

'Aiea, Hawaii, United States

Essentia Health Cancer Center

🇺🇸

Duluth, Minnesota, United States

Wilcox Memorial Hospital and Kauai Medical Clinic

🇺🇸

Lihue, Hawaii, United States

HaysMed University of Kansas Health System

🇺🇸

Hays, Kansas, United States

Fairview Southdale Hospital

🇺🇸

Edina, Minnesota, United States

Olathe Health Cancer Center

🇺🇸

Olathe, Kansas, United States

Fairview Clinics and Surgery Center Maple Grove

🇺🇸

Maple Grove, Minnesota, United States

Essentia Health - Deer River Clinic

🇺🇸

Deer River, Minnesota, United States

Minnesota Oncology Hematology PA-Woodbury

🇺🇸

Woodbury, Minnesota, United States

Regions Hospital

🇺🇸

Saint Paul, Minnesota, United States

Essentia Health Sandstone

🇺🇸

Sandstone, Minnesota, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

Unity Hospital

🇺🇸

Fridley, Minnesota, United States

Fairview Lakes Medical Center

🇺🇸

Wyoming, Minnesota, United States

Park Nicollet Clinic - Saint Louis Park

🇺🇸

Saint Louis Park, Minnesota, United States

Saint John's Hospital - Healtheast

🇺🇸

Maplewood, Minnesota, United States

Lakeview Hospital

🇺🇸

Stillwater, Minnesota, United States

Rice Memorial Hospital

🇺🇸

Willmar, Minnesota, United States

Essentia Health Virginia Clinic

🇺🇸

Virginia, Minnesota, United States

United Hospital

🇺🇸

Saint Paul, Minnesota, United States

Trinity Cancer Care Center

🇺🇸

Minot, North Dakota, United States

Bayhealth Hospital Sussex Campus

🇺🇸

Milford, Delaware, United States

Florida Gynecologic Oncology

🇺🇸

Fort Myers, Florida, United States

Cancer Care Specialists of Illinois - Decatur

🇺🇸

Decatur, Illinois, United States

Kaiser Permanente-Oakland

🇺🇸

Oakland, California, United States

Lawrence Memorial Hospital

🇺🇸

Lawrence, Kansas, United States

Swedish Cancer Institute-Issaquah

🇺🇸

Issaquah, Washington, United States

Jefferson Healthcare

🇺🇸

Port Townsend, Washington, United States

Kaiser Permanente Northwest

🇺🇸

Portland, Oregon, United States

Rocky Mountain Regional VA Medical Center

🇺🇸

Aurora, Colorado, United States

Kaiser Permanente-Deer Valley Medical Center

🇺🇸

Antioch, California, United States

Desert Regional Medical Center

🇺🇸

Palm Springs, California, United States

Kaiser Permanente Dublin

🇺🇸

Dublin, California, United States

Kaiser Permanente-Fremont

🇺🇸

Fremont, California, United States

Kaiser Permanente-Fresno

🇺🇸

Fresno, California, United States

Kaiser Permanente-Santa Teresa-San Jose

🇺🇸

San Jose, 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-Vallejo

🇺🇸

Vallejo, California, United States

Kaiser Permanente Medical Center-Vacaville

🇺🇸

Vacaville, California, United States

Kaiser Permanente-Walnut Creek

🇺🇸

Walnut Creek, California, United States

Bayhealth Hospital Kent Campus

🇺🇸

Dover, Delaware, United States

Regional Cancer Center-Lee Memorial Health System

🇺🇸

Fort Myers, Florida, United States

Sacred Heart Hospital

🇺🇸

Pensacola, Florida, United States

Hawaii Cancer Care - Savio

🇺🇸

'Aiea, Hawaii, United States

Carle on Vermilion

🇺🇸

Danville, Illinois, United States

Centralia Oncology Clinic

🇺🇸

Centralia, Illinois, United States

Decatur Memorial Hospital

🇺🇸

Decatur, Illinois, United States

Carle Physician Group-Effingham

🇺🇸

Effingham, Illinois, United States

Crossroads Cancer Center

🇺🇸

Effingham, Illinois, United States

Little Company of Mary Hospital

🇺🇸

Evergreen Park, Illinois, United States

Edward Hines Jr VA Hospital

🇺🇸

Hines, Illinois, United States

Trinity Medical Center

🇺🇸

Moline, Illinois, United States

Carle Cancer Center

🇺🇸

Urbana, Illinois, United States

The Carle Foundation Hospital

🇺🇸

Urbana, Illinois, United States

McFarland Clinic PC - Ames

🇺🇸

Ames, Iowa, United States

Physicians' Clinic of Iowa PC

🇺🇸

Cedar Rapids, Iowa, United States

Oncology Associates at Mercy Medical Center

🇺🇸

Cedar Rapids, Iowa, United States

Medical Oncology and Hematology Associates-West Des Moines

🇺🇸

Clive, Iowa, United States

Mercy Cancer Center-West Lakes

🇺🇸

Clive, Iowa, United States

Greater Regional Medical Center

🇺🇸

Creston, Iowa, United States

Mercy Medical Center-West Lakes

🇺🇸

West Des Moines, Iowa, United States

University of Kansas Health System Saint Francis Campus

🇺🇸

Topeka, Kansas, United States

Saint Joseph London

🇺🇸

London, Kentucky, United States

LSU Health Sciences Center at Shreveport

🇺🇸

Shreveport, Louisiana, United States

Harold Alfond Center for Cancer Care

🇺🇸

Augusta, Maine, United States

MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford

🇺🇸

Biddeford, Maine, United States

Waldo County General Hospital

🇺🇸

Belfast, Maine, United States

Penobscot Bay Medical Center

🇺🇸

Rockport, Maine, United States

MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford

🇺🇸

Sanford, Maine, United States

University of Maryland Shore Medical Center at Easton

🇺🇸

Easton, Maryland, United States

Winchester Hospital

🇺🇸

Winchester, Massachusetts, United States

Mercy Health Saint Mary's

🇺🇸

Grand Rapids, Michigan, United States

Spectrum Health Reed City Hospital

🇺🇸

Reed City, Michigan, United States

Spectrum Health at Butterworth Campus

🇺🇸

Grand Rapids, Michigan, United States

Metro Health Hospital

🇺🇸

Wyoming, Michigan, United States

Munson Medical Center

🇺🇸

Traverse City, Michigan, United States

Minnesota Oncology - Burnsville

🇺🇸

Burnsville, Minnesota, United States

Essentia Health Hibbing Clinic

🇺🇸

Hibbing, Minnesota, United States

Minnesota Oncology Hematology PA-Maplewood

🇺🇸

Maplewood, Minnesota, United States

Abbott-Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Monticello Cancer Center

🇺🇸

Monticello, Minnesota, United States

Saint Joseph Hospital

🇺🇸

Nashua, New Hampshire, United States

Mercy Hospital Springfield

🇺🇸

Springfield, Missouri, United States

CHI Health Saint Francis

🇺🇸

Grand Island, Nebraska, United States

Missouri Baptist Medical Center

🇺🇸

Saint Louis, Missouri, United States

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

🇺🇸

New York, New York, United States

Randolph Hospital

🇺🇸

Asheboro, North Carolina, United States

Southeastern Medical Oncology Center-Clinton

🇺🇸

Clinton, North Carolina, United States

AdventHealth Infusion Center Asheville

🇺🇸

Asheville, North Carolina, United States

Cone Health Cancer Center at Alamance Regional

🇺🇸

Burlington, North Carolina, United States

CaroMont Regional Medical Center

🇺🇸

Gastonia, North Carolina, United States

Cone Health Cancer Center

🇺🇸

Greensboro, North Carolina, United States

Southeastern Medical Oncology Center-Goldsboro

🇺🇸

Goldsboro, North Carolina, United States

AdventHealth Infusion Center Haywood

🇺🇸

Clyde, North Carolina, United States

AdventHealth Hendersonville

🇺🇸

Hendersonville, North Carolina, United States

CarolinaEast Medical Center

🇺🇸

New Bern, North Carolina, United States

Nash General Hospital

🇺🇸

Rocky Mount, North Carolina, United States

NHRMC Radiation Oncology - Supply

🇺🇸

Supply, North Carolina, United States

New Hanover Regional Medical Center/Zimmer Cancer Center

🇺🇸

Wilmington, North Carolina, United States

Cleveland Clinic Akron General

🇺🇸

Akron, Ohio, United States

Phoenixville Hospital

🇺🇸

Phoenixville, Pennsylvania, United States

Kent Hospital

🇺🇸

Warwick, Rhode Island, United States

Prisma Health Cancer Institute - Spartanburg

🇺🇸

Boiling Springs, South Carolina, United States

Saint Joseph's/Candler - Bluffton Campus

🇺🇸

Bluffton, South Carolina, United States

South Carolina Cancer Specialists PC

🇺🇸

Hilton Head Island, South Carolina, United States

Gibbs Cancer Center-Pelham

🇺🇸

Greer, South Carolina, United States

UMC Cancer Center / UMC Health System

🇺🇸

Lubbock, Texas, United States

Wellmont Medical Associates-Bristol

🇺🇸

Bristol, Virginia, United States

Texas Tech University Health Sciences Center-Lubbock

🇺🇸

Lubbock, Texas, United States

Bon Secours Saint Francis Medical Center

🇺🇸

Midlothian, Virginia, United States

Bon Secours Memorial Regional Medical Center

🇺🇸

Mechanicsville, Virginia, United States

Duluth Clinic Ashland

🇺🇸

Ashland, Wisconsin, United States

Instituto Nacional del Cancer

🇨🇱

Independence, Chile

Instituto Nacional De Cancerologia

🇨🇴

Bogota, Colombia

Instituto Nacional De Cancerologia de Mexico

🇲🇽

Mexico City, Tlalpan, Mexico

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

🇺🇸

Savannah, Georgia, United States

Hawaii Cancer Care Inc - Waterfront Plaza

🇺🇸

Honolulu, Hawaii, United States

Straub Clinic and Hospital

🇺🇸

Honolulu, Hawaii, United States

University of Hawaii Cancer Center

🇺🇸

Honolulu, Hawaii, United States

Kaiser Permanente Moanalua Medical Center

🇺🇸

Honolulu, Hawaii, United States

Kapiolani Medical Center for Women and Children

🇺🇸

Honolulu, Hawaii, 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

Medical Oncology and Hematology Associates-Laurel

🇺🇸

Des Moines, Iowa, United States

Mercy Medical Center - Des Moines

🇺🇸

Des Moines, Iowa, United States

Associates In Womens Health

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas-Wichita Medical Arts Tower

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas - Wichita

🇺🇸

Wichita, Kansas, United States

Saint Joseph Hospital East

🇺🇸

Lexington, Kentucky, United States

Louisiana State University Health Science Center

🇺🇸

New Orleans, Louisiana, United States

Tulane University Health Sciences Center

🇺🇸

New Orleans, Louisiana, United States

University Medical Center New Orleans

🇺🇸

New Orleans, Louisiana, United States

Bon Secours Saint Mary's Hospital

🇺🇸

Richmond, Virginia, United States

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