Methylphenidate in Treating Patients With Fatigue Caused by Cancer

Phase 3

Completed

Conditions: Fatigue
Unspecified Adult Solid Tumor, Protocol Specific

Interventions: Other: placebo
Drug: methylphenidate hydrochloride

Registration Number: NCT00376675

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: RATIONALE: Methylphenidate may help relieve fatigue caused by cancer. It is not yet known whether methylphenidate is more effective than a placebo in relieving fatigue and improving quality of life in patients with cancer.

PURPOSE: This randomized phase III trial is studying methylphenidate to see how well it works in treating patients with fatigue caused by cancer.

Detailed Description: OBJECTIVES:

Primary

* Test the efficacy of long-acting methylphenidate in patients with cancer-related fatigue as measured using an item of the Brief Fatigue Inventory.

Secondary

* Evaluate the tolerability and adverse events associated with this drug in these patients.

* Study the effect of this drug on quality of life (QOL)-related variables (vitality, sleep quality, overall QOL, QOL domains, other fatigue measures, and perceived treatment efficacy) in these patients.

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to disease stage (0, I, or II vs III or IV), level of fatigue at baseline (4-7 vs 8-10), concurrent biological therapy (yes vs no), concurrent chemotherapy (yes vs no), and concurrent radiotherapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients receive oral methylphenidate daily on days 1-28.

* Arm II: Patients receive oral placebo daily on days 1-28.

Patients in both arms complete questionnaires to assess their symptoms of fatigue, overall mood, quality of life, sleep quality, and adverse effects from treatment at baseline and once weekly for 4 weeks. Patients also complete a Symptom Experience Diary.

McNeil Consumer \& Specialty Pharmaceuticals provided medication support for NCCTG N05C7.

PROJECTED ACCRUAL: A total of 140 patients will be accrued for this study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 148

Inclusion Criteria

≥ 18 years of age
Men or women with a history of cancer-related fatigue as defined by a score ≥ 4 on a fatigue numerical analogue scale (0 - 10)
Fatigue for ≥ 1 month prior to registration
ECOG Performance Score (PS) 0, 1, or 2
Life expectancy ≥ 6 months
Histologic or cytologic proven cancer other than brain cancer or CNS lymphoma
Laboratory values obtained ≤ 30 days prior to registration:
- Hgb ≥ 10 g/dL
Willing and able to provide informed consent
Negative pregnancy test (urine or serum) done ≤ 7 days prior to registration, for women of childbearing potential only
Ability to complete questionnaire(s) by themselves or with assistance
Biological therapy (i.e. immunotherapy, biotherapy), chemotherapy or radiation therapy will be allowed
Use of a stable dose of anti-depressants (except tricyclic anti-depressants) will be allowed
Erythropoietic agents to treat anemia, and steroids as a part of cancer treatment and for symptom management (except for fatigue) will be allowed

Exclusion Criteria

Hypersensitivity to methylphenidate
Any prior use of methylphenidate
Concomitant (≤ 2 weeks) use of prescription stimulants (pemoline, modafinil, amphetamines); other medications, herbal products or dietary supplements for fatigue
Uncontrolled hypertension [defined as systolic blood pressure (BP) ≥ 160 mmHg and/or diastolic BP ≥ 100 mmHg on 2 separate visits ≤ 2 months prior to randomization]; or a resting heart rate > 100
Moderate or severe pain as defined by an average daily score ≥ 4 on a pain analog scale (0 - 10)
Known brain metastasis or primary CNS malignancy
Clinically significant acute or chronic progressive or unstable neurologic (dementia, delirium, or seizure disorder), hepatic, renal, cardiovascular, thyroid, or respiratory disease that would limit participation in the study per MD discretion or judgment
Psychiatric disorder such as manic depression, anxiety disorder, bipolar disorder, obsessive compulsive disorder, or schizophrenia
Major surgery < 4 weeks prior to registration. (Note: Insertion of central venous catheter is not considered major surgery.)
Using a drug contraindicated when taken concurrently with methylphenidate: coumarin anticoagulants, anticonvulsants, tricyclic antidepressants, antipsychotics, monoamine oxidase inhibitors, clonidine, theophylline, and pseudoephedrine

Note: use of Compazine prescribed as an antiemetic is permitted for use while participating in this study.
Additional medical conditions where use of methylphenidate is contraindicated:

glaucoma, motor tics, family history or diagnosis of Tourette's syndrome, history of drug or alcohol abuse or intestinal obstruction.
Pregnant women or nursing women. Women of childbearing potential who are unwilling to employ adequate contraception. This study involves an investigational agent whose genotoxic, mutagenic, and teratogenic effects on the developing fetus and newborn are unknown.
Untreated hypothyroidism (TSH ≥ 5)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm II	placebo	Patients receive oral placebo daily on days 1-28.
Arm I	methylphenidate hydrochloride	Patients receive oral methylphenidate hydrochloride daily on days 1-28.

Primary Outcome Measures

Name	Time	Method
Prorated AUC of Total Fatigue as Measured by the Brief Fatigue Inventory (BFI) at Baseline and at Weeks 1-4	Baseline to week 4	The prorated area under the curve (AUC) for the usual fatigue question of the BFI at baseline and at weeks 1-4 after being translated onto a 0 (poor quality of life (QOL) or bad symptoms) to 100 (best QOL or no symptoms) point scale was calculated as the following: 1. For those completed 4 weeks item: AUC/4; 2. For those completed up to week 3 item: (AUC \* 4) / 3; 3. For those completed up to week 2 item: AUC \* 2; 4. For those completed up to week 1 item: AUC \* 4; The prorated AUC scores were then transformed onto 0 to 100 point scale with 0 (poor QOL or bad symptoms) and 100 (best QOL or no symptoms) for analysis.

Secondary Outcome Measures

Name	Time	Method
AUC of Sleep Quality as Measured by the Pittsburgh Sleep Quality Index at Baseline and at Weeks 1-4	Baseline to Week 4	Pittsburgh Sleep Quality Index (PSQI) consists of 19 items and 7 scales. The AUC for the overall PSQI at baseline and at weeks 1-4 after being translated onto a 0 to 100 point scale was calculated. Higher scores are better.
Severity of Adverse Events as Measured by the Symptom Experience Diary Based on Mean Changes From Baseline to Week 4	Baseline and Week 4	The Symptom Experience Diary (SED) consists of 12 items. All scores were translated onto a 0-100 point scale, with 0 represent poor quality of life (QOL) or bad symptom and 100 is best QOL or no symptoms.The change in severity of adverse events was calculated as subtracting the item scores at baseline from the scores at week 4.
AUC of Overall Quality of Life (QOL) and QOL Domains as Measured by the Linear Analogue Self Assessment at Baseline and at Weeks 1-4	Baseline to Week 4	Linear Analogue Self Assessment (LASA) consists of 6 single-item numeric analogue scales. The AUC for the six-items at baseline and at weeks 1-4 after being translated onto a 0 to 100 point scale was calculated. Higher scores are better.
AUC of Other Fatigue Scores as Measured by Items of the Brief Fatigue Inventory (BFI) at Baseline and at Weeks 1-4	Baseline to Week 4	Area under the curve (AUC) for the other fatigue items of the BFI at baseline and at weeks 1-4 after being translated onto a 0 to 100 point scale was calculated. Higher scores are better.
Anchor-based Minimally Important Difference in SGIC Overall Quality of Life Based on Mean Changes From Baseline to Week 4 on BFI Usual Fatigue	Baseline and Week 4	Perceived treatment efficacy was measured by the Subject Global Impression of Change (SGIC). The SGIC is a 3-point item in which the patient rates the change in the overall status since beginning the study drug (ranging from very much better, moderately better, a little better, about the same, a little worse, moderately worse, to very much worse). The average change in patient fatigue scores for those participants who express a perceived change of "a little better" via the SGIC scores were calculated. BFI usual fatigue item score was translated into 0 to 100 point scale for the analysis, with 0 (poor QOL or bad symptoms) and 100 (best QOL or no symptoms).
AUC of Vitality as Measured by the Short Form-36 Vitality Subscale at Baseline and at Weeks 1-4	Baseline to Week 4	The SF-36 is a 36-item short form to measure health status in various populations. The vitality subscale is comprised of 4 items and is a measure of energy level as well as fatigue. The AUC for the vitality subscale at baseline and at weeks 1-4 after being translated onto a 0 to 100 point scale was calculated. Higher scores are better.
Anchor-based Minimally Important Difference in SGIC Emotional State Based on Mean Changes From Baseline to Week 4 on BFI Usual Fatigue	Baseline and Week 4	Perceived treatment efficacy was measured by the Subject Global Impression of Change (SGIC). The SGIC is a 3-point item in which the patient rates the change in the overall status since beginning the study drug (ranging from very much better, moderately better, a little better, about the same, a little worse, moderately worse, to very much worse). The average change in patient fatigue scores for those participants who express a perceived change of "a little better" via the SGIC scores were calculated. BFI usual fatigue item score was translated into 0 to 100 point scale for the analysis, with 0 (poor QOL or bad symptoms) and 100 (best QOL or no symptoms).
Anchor-based Minimally Important Difference in SGIC Physical Condition Based on Mean Changes From Baseline to Week 4 on BFI Usual Fatigue	Baseline and Week 4	Perceived treatment efficacy was measured by the Subject Global Impression of Change (SGIC). The SGIC is a 3-point item in which the patient rates the change in the overall status since beginning the study drug (ranging from very much better, moderately better, a little better, about the same, a little worse, moderately worse, to very much worse). The average change in patient fatigue scores for those participants who express a perceived change of "a little better" via the SGIC scores were calculated. BFI usual fatigue item score was translated into 0 to 100 point scale for the analysis, with 0 (poor QOL or bad symptoms) and 100 (best QOL or no symptoms).

Trial Locations

Locations (235): Riverside Methodist Hospital Cancer Care
🇺🇸
Columbus, Ohio, United States
Grant Medical Center Cancer Care
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health - West Hospital
🇺🇸
Columbus, Ohio, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose Cancer Center at Penrose Hospital
🇺🇸
Colorado Springs, Colorado, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF St. Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
🇺🇸
Ottawa, Illinois, United States
Eureka Community Hospital
🇺🇸
Eureka, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
CCOP - Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Community Cancer Center
🇺🇸
Normal, Illinois, United States
Cedar Rapids Oncology Associates
🇺🇸
Cedar Rapids, Iowa, United States
McDonough District Hospital
🇺🇸
Macomb, Illinois, United States
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
🇺🇸
Moline, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
McFarland Clinic, PC
🇺🇸
Ames, Iowa, United States
Joliet Oncology-Hematology Associates, Limited - West
🇺🇸
Joliet, Illinois, United States
St. Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
BroMenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Community Hospital of Ottawa
🇺🇸
Ottawa, Illinois, United States
St. Francis Hospital and Health Centers - Beech Grove Campus
🇺🇸
Beech Grove, Indiana, United States
Carle Cancer Center at Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Galesburg Clinic, PC
🇺🇸
Galesburg, Illinois, United States
Southwest Medical Center
🇺🇸
Liberal, Kansas, United States
Cancer Treatment Center at Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Saint Anthony Memorial Health Centers
🇺🇸
Michigan City, Indiana, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸
Sioux City, Iowa, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
Wesley Medical Center
🇺🇸
Wichita, Kansas, United States
St. Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸
Escanaba, Michigan, United States
Illinois Valley Community Hospital
🇺🇸
Peru, Illinois, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
Saint Joseph Regional Medical Center
🇺🇸
South Bend, Indiana, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
Foote Memorial Hospital
🇺🇸
Jackson, Michigan, United States
St. Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Lakeland Regional Cancer Care Center - St. Joseph
🇺🇸
St. Joseph, Michigan, United States
Sparrow Regional Cancer Center
🇺🇸
Lansing, Michigan, United States
Mercy Medical Center - Sioux City
🇺🇸
Sioux City, Iowa, United States
CCOP - Columbus
🇺🇸
Columbus, Ohio, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Mercy Regional Cancer Center at Mercy Hospital
🇺🇸
Port Huron, Michigan, United States
Immanuel St. Joseph's
🇺🇸
Mankato, Minnesota, United States
Haematology-Oncology Associates of Ohio and Michigan, PC
🇺🇸
Lambertville, Michigan, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
Miller - Dwan Medical Center
🇺🇸
Duluth, Minnesota, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
CCOP - Duluth
🇺🇸
Duluth, Minnesota, United States
MeritCare Bemidji
🇺🇸
Bemidji, Minnesota, United States
CCOP - MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸
Robbinsdale, Minnesota, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Medcenter One Hospital Cancer Care Center
🇺🇸
Bismarck, North Dakota, United States
St. Alexius Medical Center Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
MeritCare Broadway
🇺🇸
Fargo, North Dakota, United States
Altru Cancer Center at Altru Hospital
🇺🇸
Grand Forks, North Dakota, United States
Samaritan North Cancer Care Center
🇺🇸
Dayton, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
CCOP - Metro-Minnesota
🇺🇸
Saint Louis Park, Minnesota, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Community Hospital of Springfield and Clark County
🇺🇸
Springfield, Ohio, United States
Providence Milwaukie Hospital
🇺🇸
Milwaukie, Oregon, United States
CCOP - Upstate Carolina
🇺🇸
Spartanburg, South Carolina, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Geisinger Cancer Institute at Geisinger Health
🇺🇸
Danville, Pennsylvania, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Toledo Clinic - Oregon
🇺🇸
Oregon, Ohio, United States
Geisinger Hazleton Cancer Center
🇺🇸
Hazleton, Pennsylvania, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
CCOP - Toledo Community Hospital
🇺🇸
Toledo, Ohio, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Mercy Hospital at Wilkes-Barre
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Mount Carmel St. Ann's Cancer Center
🇺🇸
Westerville, Ohio, United States
Olympic Medical Center
🇺🇸
Port Angeles, Washington, United States
Mercy Medical Center
🇺🇸
Springfield, Ohio, United States
Strecker Cancer Center at Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸
Sandusky, Ohio, United States
Genesis - Good Samaritan Hospital
🇺🇸
Zanesville, Ohio, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
Legacy Meridian Park Hospital
🇺🇸
Tualatin, Oregon, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Medical X-Ray Center, PC
🇺🇸
Sioux Falls, South Dakota, United States
Franciscan Skemp Healthcare - La Crosse Campus
🇺🇸
La Crosse, Wisconsin, United States
Southlake Clinic
🇺🇸
Renton, Washington, United States
CCOP - Virginia Mason Research Center
🇺🇸
Seattle, Washington, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Welch Cancer Center at Sheridan Memorial Hospital
🇺🇸
Sheridan, Wyoming, United States
Graham Hospital
🇺🇸
Canton, Illinois, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Billings Clinic - Downtown
🇺🇸
Billings, Montana, United States
Glacier Oncology, PLLC
🇺🇸
Kalispell, Montana, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸
Billings, Montana, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, Montana, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸
Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Great Falls Clinic - Main Facility
🇺🇸
Great Falls, Montana, United States
Big Sky Oncology
🇺🇸
Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology at KRMC
🇺🇸
Kalispell, Montana, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
CentraCare Clinic - River Campus
🇺🇸
Saint Cloud, Minnesota, United States
Coborn Cancer Center
🇺🇸
Saint Cloud, Minnesota, United States
Minnesota Oncology Hematology, PA - Maplewood
🇺🇸
Maplewood, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Minnesota Oncology Hematology, PA - Woodbury
🇺🇸
Woodbury, Minnesota, United States
Mayo Clinic Scottsdale
🇺🇸
Scottsdale, Arizona, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
🇺🇸
Grand Junction, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Hope Cancer Care Center at Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Mayo Clinic - Jacksonville
🇺🇸
Jacksonville, Florida, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
St. Mary - Corwin Regional Medical Center
🇺🇸
Pueblo, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
MBCCOP - Medical College of Georgia Cancer Center
🇺🇸
Augusta, Georgia, United States
St. Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Rush-Copley Cancer Care Center
🇺🇸
Aurora, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Hopedale Medical Complex
🇺🇸
Hopedale, Illinois, United States
CCOP - Illinois Oncology Research Association
🇺🇸
Peoria, Illinois, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
CCOP - Northern Indiana CR Consortium
🇺🇸
South Bend, Indiana, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Dickinson County Healthcare System
🇺🇸
Iron Mountain, Michigan, United States
Mercy Memorial Hospital - Monroe
🇺🇸
Monroe, Michigan, United States
St. Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Seton Cancer Institute at Saint Mary's - Saginaw
🇺🇸
Saginaw, Michigan, United States
Duluth Clinic Cancer Center - Duluth
🇺🇸
Duluth, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
St. John Macomb Hospital
🇺🇸
Warren, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Mid Dakota Clinic, PC
🇺🇸
Bismarck, North Dakota, United States
Doctors Hospital at Ohio Health
🇺🇸
Columbus, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸
Maumee, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
St. Luke's Hospital
🇺🇸
Maumee, Ohio, United States
St. Charles Mercy Hospital
🇺🇸
Oregon, Ohio, United States
Flower Hospital Cancer Center
🇺🇸
Sylvania, Ohio, United States
Toledo Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸
Toledo, Ohio, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸
Tulsa, Oklahoma, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Geisinger Medical Group - Scenery Park
🇺🇸
State College, Pennsylvania, United States
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Cascade Cancer Center at Evergreen Hospital Medical Center
🇺🇸
Kirkland, Washington, United States
Fredericksburg Oncology, Incorporated
🇺🇸
Fredericksburg, Virginia, United States
Southwest Washington Medical Center Cancer Center
🇺🇸
Vancouver, Washington, United States
Sanford Cancer Center at Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Central Wisconsin Cancer Program at Agnesian HealthCare
🇺🇸
Fond du Lac, Wisconsin, United States
St. Mary's Hospital Medical Center - Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Aurora Presbyterian Hospital
🇺🇸
Aurora, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
CCOP - Colorado Cancer Research Program
🇺🇸
Denver, Colorado, United States
St. Anthony Central Hospital
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - St. Luke's Medical Center
🇺🇸
Denver, Colorado, United States
St. Joseph Hospital
🇺🇸
Denver, Colorado, United States
Saint Joseph Mercy Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
CCOP - Michigan Cancer Research Consortium
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegant Health Cancer Center at Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Legacy Good Samaritan Hospital & Comprehensive Cancer Center
🇺🇸
Portland, Oregon, United States
Providence Cancer Center at Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Adventist Medical Center
🇺🇸
Portland, Oregon, United States
CCOP - Columbia River Oncology Program
🇺🇸
Portland, Oregon, United States
Providence St. Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center and Children's Hospital
🇺🇸
Portland, Oregon, United States
Cancer Resource Center - Lincoln
🇺🇸
Lincoln, Nebraska, United States
AnMed Cancer Center
🇺🇸
Anderson, South Carolina, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Mercy Capitol Hospital
🇺🇸
Des Moines, Iowa, United States
CCOP - Iowa Oncology Research Association
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at Mercy Cancer Center
🇺🇸
Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
St. Peter's Hospital
🇺🇸
Helena, Montana, United States
Howard Community Hospital
🇺🇸
Kokomo, Indiana, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸
La Porte, Indiana, United States