Doxepin and a Topical Rinse in the Treatment of Acute Oral Mucositis Pain in Patients Receiving Radiotherapy With or Without Chemotherapy
- Conditions
- Acute Oral Mucositis Pain
- Interventions
- Drug: DLA (diphenhydramine, lidocaine and antacids) rinseOther: Placebo
- Registration Number
- NCT02229539
- Lead Sponsor
- Alliance for Clinical Trials in Oncology
- Brief Summary
The purpose of this study is to test whether a mouthwash made with a drug called doxepin can reduce the pain caused by mouth sores resulting from radiation therapy. A number of mouth rinse preparations exist for patients with treatment-related oral mucositis pain such as the DLA rinse, an over-the-counter medication. This study will evaluate the effects of doxepin compared to DLA (diphenhydramine, lidocaine and antacids) and placebo.Doxepin is approved by the Food and Drug Administration (FDA) for the treatment of depression, anxiety, long-term pain management, as well as management of rash.
- Detailed Description
Patients are stratified according to sex (male vs. female), concurrent use of chemotherapy (no vs. yes), patient age at registration (\< 60 years old vs. ≥ 60 years old and RTOG acute radiation morbidity criteria (1 vs. 2 vs 3 or more). Protocol therapy will consist of 2 cycles. Patients are randomized to one of three treatment regimens, which include doxepin, DLA and placebo. Cycle One will consist of one day. The care provider or nurse will confirm that the oral pain is at least 4 out of 10 severity level at the time of the rinse on the first day of the study. Patient will be asked to complete the baseline evaluation in the Oral Symptoms booklet. If the pain score is less than 4 then administration will be delayed until the pain is at least 4. Cycle Two will consist of an optional continuation phase lasting up to 7 days. Initiation of the Cycle 2/Continuation Phase may be delayed up to one week after Cycle 1/Day 1.
Primary Objective:
1. Determine whether the doxepin rinse or DLA rinse is more effective than placebo in reducing OM-related pain in patients undergoing RT to the oral cavity, as measured by a patient-reported questionnaire at baseline, 5 minutes, 15 minutes, 30 minutes, 1 hour, 2 hours, and 4 hours.
Secondary Objectives:
1. Assess the adverse event profile of the doxepin rinse, the DLA rinse agent, and the placebo using a patient-reported questionnaire at 5 minutes, 15 minutes, 30 minutes, 1 hour, 2 hours, and 4 hours for domains of unpleasant taste, burning or stinging discomfort, and drowsiness.
2. Compare the incidence of using additional analgesics between 1 and 4 hours after the initial mouthwash, between the doxepin oral rinse, the DLA rinse agent, and the placebo arms.
3. Compare the length of time that each study product is used by patients in the one-week continuation phase.
4. Compare the daily pain scores in the one-week continuation phase for the three study arms.
5. Compare the 24-hour morphine equivalent dose used in the continuation phase for the three study arms.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 275
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description DLA (diphenhydramine, lidocaine and antacid) rinse DLA (diphenhydramine, lidocaine and antacids) rinse Patients receive 5.0 mL DLA orally. DLA is administered in the clinic on Day 1 (Cycle 1). There is an optional continuation phase within seven days following Day 1 (Cycle 1), patients will be encouraged to continue treatment with the study agent for an additional week (Cycle 2) where the patient takes the rinse at home every 4 hours. Chemotherapy is allowed during the continuation phase. Patients receiving DLA during the continuation phase of the study, they and/or caregivers may be aware that they are receiving DLA. Patients will complete the Oral Symptoms booklet per the protocol. doxepin rinse doxepin hydrochloride oral solution Patients receive 2.5 mL (25 mg) doxepin and 2.5 mL water orally. Doxepin rinse is administered in the clinic on Day 1 (Cycle 1). There is an optional continuation phase within seven days following Day 1 (Cycle 1), patients will be encouraged to continue treatment with the study agent for an additional week (Cycle 2) where the patient takes the rinse at home every 4 hours. Chemotherapy is allowed during the continuation phase. Patients randomized to doxepin or placebo, they and their caregivers will continue to be blinded to the treatment. Patients will complete the Oral Symptoms booklet per the protocol. placebo rinse Placebo Patients receive 2.5 mL placebo and 2.5 mL water orally. The placebo rinse is administered in the clinic on Day 1 (Cycle 1). There is an optional continuation phase within seven days following Day 1 (Cycle 1), patients will be encouraged to continue treatment with the study agent for an additional week (Cycle 2) where the patient takes the rinse at home every 4 hours. Chemotherapy is allowed during the continuation phase. Patients randomized to doxepin or placebo, they and their caregivers will continue to be blinded to the treatment. Patients will complete the Oral Symptoms booklet per the protocol.
- Primary Outcome Measures
Name Time Method Mean Area Under the Curve (AUC) of Total Pain Reduction Baseline, 5, 15, 30, 60, 120, 240 minutes post treatment Total pain reduction (mouth and throat) was measured by the numerical analogue scale of mouth pain on a scale of 0 to 10, with 0=no pain and 10=worst pain in the questionnaires taken at baseline, and 5, 15, 30, 60, 120, 240 minutes after assigned treatment for doxepin or DLA vs. placebo. The total pain reduction was calculated by the (average of mouth and throat) area under the curve (AUC) adjusting for baseline, with time scale (baseline, 5, 15, 30, 60, 120 and 240 minutes post treatment) replaced by a numerical scale of 0, 1, 2, 3, 4, 5 and 6 respectively. The AUC was prorated when there are terminal missing data. If the missing data were intermittent, simple imputation by trapezoidal rules were applied to calculate the AUC. If a patient cancelled, was missing baseline data, or only provided baseline data, he/she was excluded from the statistical analysis.
- Secondary Outcome Measures
Name Time Method Area Under the Curve (AUC) of Total Unpleasant Taste of the Oral Rinse 5, 15, 30, 60, 120, 240 minutes post treatment Total unpleasant taste was measured by the numerical analogue scale of taste of the oral rinse on a scale of 0 to 10, with 0=acceptable and 10=terrible in the questionnaires taken at 5, 15, 30, 60, 120, 240 minutes after assigned treatment for doxepin or DLA vs. placebo. The total unpleasant taste was calculated by the area under the curve (AUC) adjusting for 5 minutes post treatment, with time scale (5, 15, 30, 60, 120 and 240 minutes post treatment) replaced by a numerical scale of 1, 2, 3, 4 5 and 6 respectively. The AUC was prorated when there are terminal missing data. If the missing data were intermittent, simple imputation by trapezoidal rules were applied to calculate the AUC. If a patient cancelled, was missing 5 minutes after treatment data, or only provided 5 minutes after treatment data, he/she was excluded from the statistical analysis.
Area Under the Curve (AUC) of Total Stinging or Burning From the Oral Rinse 5, 15, 30, 60, 120, 240 minutes post treatment Total stinging or burning was measured by the numerical analogue scale of stinging or burning from the oral rinse on a scale of 0 to 10, with 0=no stinging or burning and 10=worst stinging or burning possible in the questionnaires taken at 5, 15, 30, 60, 120, 240 minutes after assigned treatment for doxepin or DLA vs. placebo. The total stinging or burning was calculated by the area under the curve (AUC) adjusting for 5 minutes post treatment, with time scale (5, 15, 30, 60, 120 and 240 minutes post treatment) replaced by a numerical scale of 1, 2, 3, 4 5 and 6 respectively. The AUC was prorated when there are terminal missing data. If the missing data were intermittent, simple imputation by trapezoidal rules were applied to calculate the AUC. If a patient cancelled, was missing 5 minutes after treatment data, or only provided 5 minutes after treatment data, he/she was excluded from the statistical analysis.
Area Under the Curve (AUC) of Total Drowsiness Baseline, 5, 15, 30, 60, 120, 240 minutes post treatment Total drowsiness was measured by the numerical analogue scale of drowsiness on a scale of 0 to 10, with 0=no drowsiness and 10=extreme drowsiness, leading to sleep in the questionnaires taken at baseline, and 5, 15, 30, 60, 120, 240 minutes after assigned treatment for doxepin or DLA vs. placebo. The total drowsiness was calculated by the area under the curve (AUC) adjusting for baseline, with time scale (baseline, 5, 15, 30, 60, 120 and 240 minutes post treatment) replaced by a numerical scale of 0, 1, 2, 3, 4, 5 and 6 respectively. The AUC was prorated when there are terminal missing data. If the missing data were intermittent, simple imputation by trapezoidal rules were applied to calculate the AUC. If a patient cancelled, was missing baseline data, or only provided baseline data, he/she was excluded from the statistical analysis.
The Incidence of Using Alternative Analgesics At 120 and 240 minutes post treatment Patients were asked if they have taken any other pain medications, if yes, to record the name, strength and when they have taken the pain medications in the 120 minutes and 240 minutes post treatment questionnaires.
Patient Preference for Continued Therapy With Oral Rinse After Initial Test Rinse Phase At 240 minutes post treatment Patients were asked: "Based on your experience with this current oral rinsing medication, would you want to take another dose now if it were available?" in the 240 minutes post treatment questionnaire.
Frequency of Study Rinse Used in the Continuation Phase Up to 7 days. Patients were asked: "Did you use the study rinse today?" daily questionnaire during the optional continuation phase (Cycle 2).
Median Mouth Pain Score in the Continuation Phase Day 1 to Day 7 in the Continuation Phase Mouth pain scores was measured using the numerical analogue scale ranging from scale of 0 to 10, with 0=no pain and 10=worst pain daily during the optional continuation phase (Cycle 2).
The Incidence of Using Alternative Analgesics in the Continuation Phase Day 1 to Day 7 in the Continuation Phase Patients were asked if they have taken any medications for pain over the past 24 hours, if yes, to record the name, strength and when they have taken the pain medications daily during the optional continuation phase (Cycle 2).
Trial Locations
- Locations (348)
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸Longmont, Colorado, United States
Illinois CancerCare - Canton
🇺🇸Canton, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸Wausau, Wisconsin, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸Seattle, Washington, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
🇺🇸Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Southeast
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Research Foundation NCORP
🇺🇸Las Vegas, Nevada, United States
Cancer Therapy and Integrative Medicine
🇺🇸Las Vegas, Nevada, United States
21st Century Oncology-Vegas Tenaya
🇺🇸Las Vegas, Nevada, United States
Cancer and Blood Specialists-Shadow
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Northwest
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
🇺🇸Las Vegas, Nevada, United States
21st Century Oncology-Fort Apache
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸Las Vegas, Nevada, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Cancer Center of Kansas - Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas - Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas - Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Southwest Oncology PC
🇺🇸Durango, Colorado, United States
Hematology and Oncology Associates-Oakland
🇺🇸Oakland, California, United States
Epic Care-Dublin
🇺🇸Dublin, California, United States
Rocky Mountain Cancer Centers-Greenwood Village
🇺🇸Greenwood Village, Colorado, United States
Anchorage Radiation Therapy Center
🇺🇸Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Alaska Regional Hospital
🇺🇸Anchorage, Alaska, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Epic Care Partners in Cancer Care
🇺🇸Emeryville, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Contra Costa Regional Medical Center
🇺🇸Martinez, California, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Mercy Medical Center
🇺🇸Durango, Colorado, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Mountain Blue Cancer Care Center
🇺🇸Golden, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Middlesex Hospital
🇺🇸Middletown, Connecticut, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Morton Plant Hospital
🇺🇸Clearwater, Florida, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸Thornton, Colorado, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
🇺🇸Hollywood, Florida, United States
Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Memorial Hospital West
🇺🇸Pembroke Pines, Florida, United States
Illinois CancerCare - Bloomington
🇺🇸Bloomington, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
OSF Saint Anthony Medical Center
🇺🇸Rockford, Illinois, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Sanford Clinic North-Bemidji
🇺🇸Bemidji, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Parkland Health Center-Bonne Terre
🇺🇸Bonne Terre, Missouri, United States
Central Care Center - Carrie J. Babb Cancer Center
🇺🇸Bolivar, Missouri, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Capital Region Medical Center-Goldschmidt Cancer Center
🇺🇸Jefferson City, Missouri, United States
Cancer and Blood Specialists-Henderson
🇺🇸Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Central
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson
🇺🇸Henderson, Nevada, United States
Las Vegas Cancer Center-Henderson
🇺🇸Henderson, Nevada, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
HealthCare Partners Medical Group Oncology/Hematology-San Martin
🇺🇸Las Vegas, Nevada, United States
Phelps County Regional Medical Center
🇺🇸Rolla, Missouri, United States
Siteman Cancer Center-South County
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Comprehensive Cancer Centers of Nevada - Henderson
🇺🇸Henderson, Nevada, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Cox Health South Hospital
🇺🇸Springfield, Missouri, United States
Cancer and Blood Specialists-Tenaya
🇺🇸Las Vegas, Nevada, United States
21st Century Oncology-Henderson
🇺🇸Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Summerlin
🇺🇸Las Vegas, Nevada, United States
Las Vegas Cancer Center-Medical Center
🇺🇸Las Vegas, Nevada, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Southern Oncology Specialists-Charlotte
🇺🇸Charlotte, North Carolina, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸Clinton, North Carolina, United States
CaroMont Regional Medical Center
🇺🇸Gastonia, North Carolina, United States
Oncology Specialists of Charlotte
🇺🇸Charlotte, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Randolph Hospital
🇺🇸Asheboro, North Carolina, United States
Veterans Affairs Western New York Health Care System-Buffalo
🇺🇸Buffalo, New York, United States
North Shore-LIJ Health System/Center for Advanced Medicine
🇺🇸New Hyde Park, New York, United States
Novant Health Oncology Specialists-Davidson County
🇺🇸Lexington, North Carolina, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Lake Norman Hematology Oncology Specialists-Huntersville
🇺🇸Huntersville, North Carolina, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
Hendersonville Hematology and Oncology at Pardee
🇺🇸Hendersonville, North Carolina, United States
Southern Oncology Specialists-Huntersville
🇺🇸Huntersville, North Carolina, United States
Novant Health Cancer Specialists-Matthews
🇺🇸Matthews, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸Reidsville, North Carolina, United States
Novant Health Oncology Specialists-Kernersville
🇺🇸Kernersville, North Carolina, United States
Carolina Oncology Associates PA
🇺🇸Salisbury, North Carolina, United States
Sanford Medical Center-Fargo
🇺🇸Fargo, North Dakota, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
FirstHealth of the Carolinas-Moore Regional Hospital
🇺🇸Pinehurst, North Carolina, United States
Novant Health Oncology Specialists-Wilkesboro
🇺🇸Wilkesboro, North Carolina, United States
Sanford Clinic North-Fargo
🇺🇸Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Southeastern Medical Oncology Center-Wilson
🇺🇸Wilson, North Carolina, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
Novant Health Oncology Specialists-Statesville
🇺🇸Statesville, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Providence Oncology and Hematology Care Southeast
🇺🇸Clackamas, Oregon, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Greenville Health System Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸Seneca, South Carolina, United States
Lewistown Hospital
🇺🇸Lewistown, Pennsylvania, United States
Geisinger Medical Oncology-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Greenville Health System Cancer Institute-Easley
🇺🇸Easley, South Carolina, United States
Martha Jefferson Hospital
🇺🇸Charlottesville, Virginia, United States
WellSpan Health-York Hospital
🇺🇸York, Pennsylvania, United States
Gibbs Cancer Center-Gaffney
🇺🇸Gaffney, South Carolina, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸Greenville, South Carolina, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
Swedish Cancer Institute-Eastside Oncology Hematology
🇺🇸Bellevue, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
Swedish Medical Center-Edmonds
🇺🇸Edmonds, Washington, United States
Group Health Cooperative-Seattle
🇺🇸Seattle, Washington, United States
Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸Yelm, Washington, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Rockwood Clinic Cancer Treatment Center-Valley
🇺🇸Spokane Valley, Washington, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Saint Joseph's Hospital
🇺🇸Marshfield, Wisconsin, United States
Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Saint Nicholas Hospital
🇺🇸Sheboygan, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Marshfield Clinic at Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Door County Cancer Center
🇺🇸Sturgeon Bay, Wisconsin, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
Diagnostic and Treatment Center
🇺🇸Weston, Wisconsin, United States
Saint Clare's Hospital
🇺🇸Weston, Wisconsin, United States
Porter Adventist Hospital
🇺🇸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-Midtown
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Saint Louis Cancer and Breast Institute - South City
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Saint Joseph's Hospital/Children's Hospital-Tampa
🇺🇸Tampa, Florida, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸Lakewood, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Rocky Mountain Cancer Centers-Parker
🇺🇸Parker, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Rocky Mountain Cancer Centers - Pueblo
🇺🇸Pueblo, Colorado, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Comprehensive Cancer Care and Research Institute of Colorado LLC
🇺🇸Englewood, California, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Central Illinois Hematology Oncology Center
🇺🇸Springfield, Illinois, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Lakeland Community Hospital
🇺🇸Niles, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
William Beaumont Hospital - Royal Oak
🇺🇸Royal Oak, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Lakeland Hospital
🇺🇸Saint Joseph, Michigan, United States
William Beaumont Hospital - Troy
🇺🇸Troy, Michigan, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸Jacksonville, North Carolina, United States
Matthews Radiation Oncology Center
🇺🇸Matthews, North Carolina, United States
Lake Norman Hematology Oncology Specialists-Mooresville
🇺🇸Mooresville, North Carolina, United States
Novant Health Oncology Specialists-Mount Airy
🇺🇸Mount Airy, North Carolina, United States
Geisinger Medical Center-Cancer Center Hazelton
🇺🇸Hazleton, Pennsylvania, United States
Providence Regional Cancer System-Aberdeen
🇺🇸Aberdeen, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Swedish Medical Center - Issaquah
🇺🇸Issaquah, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸Shelton, Washington, United States
Evergreen Hematology and Oncology PS
🇺🇸Spokane, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
Marshfield Clinic-Chippewa Center
🇺🇸Chippewa Falls, Wisconsin, United States
Sacred Heart Hospital
🇺🇸Eau Claire, Wisconsin, United States
Mayo Clinic Health System-Franciscan Healthcare
🇺🇸La Crosse, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Westfields Hospital/Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Marshfield Clinic at James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸Weston, Wisconsin, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Novant Health Forsyth Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Winston-Salem Health Care
🇺🇸Winston-Salem, North Carolina, United States
Novant Health Oncology Specialists
🇺🇸Winston-Salem, North Carolina, United States
Bay Area Tumor Institute CCOP
🇺🇸Oakland, California, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Carolina Surgical Clinic of Charlotte PA
🇺🇸Charlotte, North Carolina, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸Spartanburg, South Carolina, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Veterans Affairs Medical Center - Washington, DC
🇺🇸Washington, District of Columbia, United States
Heartland Cancer Research NCORP
🇺🇸Decatur, Illinois, United States
Cancer Care Specialists of Central Illinois
🇺🇸Decatur, Illinois, United States
Illinois CancerCare - Eureka
🇺🇸Eureka, Illinois, United States
Illinois CancerCare - Galesburg
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare - Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Illinois CancerCare - Macomb
🇺🇸Macomb, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Radiation Oncology of Northern Illinois
🇺🇸Ottawa, Illinois, United States
Illinois CancerCare- Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
OSF Saint Francis Medical Center Radiation Oncology Service at the Central Illinois Comprehensive CC
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
OSF St. Francis Medical Center
🇺🇸Peoria, Illinois, United States
Cancer Care Specialists of Illinois-Swansea
🇺🇸Swansea, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Memorial Regional Cancer Center Day Road
🇺🇸Mishawaka, Indiana, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Barnes-Jewish West County Hospital
🇺🇸Saint Louis, Missouri, United States
Cancer and Blood Specialists-Fort Apache
🇺🇸Las Vegas, Nevada, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Saint John Medical Center
🇺🇸Longview, 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
Marshfield Clinic-Rice Lake Center
🇺🇸Rice Lake, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Saint Luke's Mountain States Tumor Institute - Nampa
🇺🇸Nampa, Idaho, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Saint Luke's Mountain States Tumor Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Mountain States Tumor Institute-Twin Falls
🇺🇸Twin Falls, Idaho, United States
Maine Medical Center - Bramhall Campus
🇺🇸Portland, Maine, United States
21st Century Oncology
🇺🇸Las Vegas, Nevada, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Beaufort Memorial Hospital
🇺🇸Beaufort, South Carolina, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Greer
🇺🇸Greer, South Carolina, United States
Avera Saint Luke's Hospital and Cancer Center
🇺🇸Aberdeen, South Dakota, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Greenville Health System Cancer Institute-Faris
🇺🇸Greenville, South Carolina, United States
Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Rockwood Cancer Treatment Center-DHEC-Downtown
🇺🇸Spokane, Washington, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Saint Luke's Mountain States Tumor Institute - Meridian
🇺🇸Meridian, Idaho, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Oakwood Hospital and Medical Center
🇺🇸Dearborn, Michigan, United States