Testing Diet Intervention Versus Non-Diet Intervention for Management of Bowel Symptoms in Rectal Cancer Survivors

Phase 2

Completed

Conditions: Rectal Carcinoma
Rectosigmoid Carcinoma

Interventions: Other: Best Practice
Dietary Supplement: Dietary Intervention
Other: Message
Other: Quality-of-Life Assessment
Other: Questionnaire Administration

Registration Number: NCT04205955

Lead Sponsor: SWOG Cancer Research Network

Brief Summary: This phase II trial studies how a diet intervention works in improving bowel dysfunction symptoms related in colon or rectal cancer survivors. Changing a diet may be helpful in reducing the severity of bowel symptoms, including diarrhea and constipation, and improve quality of life in colon or rectal cancer survivors and help doctors learn how to help patients better in the future.

Detailed Description: PRIMARY OBJECTIVES:

I. To compare total bowel function score, as measured by the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (BFI), at 18 weeks post-randomization between the intervention and attention control arms.

EXPLORATORY OBJECTIVES:

I. To compare total bowel function score at 26 weeks post-randomization between the intervention and attention control arms.

II. To compare bowel function subscale scores (dietary, urgency, frequency), as measured by the BFI at both 18- and 26- weeks post-randomization between the intervention and attention control arms.

III. To compare lower anterior resection syndrome (LARS) scores (for anastomosis participants only), quality of life, and dietary quality at both 18- and 26- weeks post-randomization between the intervention and attention control arms.

IV. To compare motivation, self-efficacy, and positive/negative affect at both 18- and 26- weeks post-randomization between the intervention and attention control arms.

V. To assess study feasibility, adherence, retention, and acceptability at both 18 and 26 weeks post-randomization.

VI. To explore variation in primary and exploratory study outcomes according to sex, and to investigate whether intervention effects on the primary outcome differ across subgroups defined by sex.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive diet modification coaching via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.

ARM II: Patients receive general healthy living education via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.

After completion of study, patients are followed up at 26 weeks.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 95

Inclusion Criteria

PRIOR TO STEP 1 REGISTRATION:
Patients must have prior history of rectosigmoid colon cancer or rectal cancer
Patients must have a post-surgical permanent ostomy or anastomosis
Patient's last date of treatment for rectal cancer (any surgery, chemotherapy, radiation therapy) must be at least 6 months prior to registration and not more than 24 months prior to registration
Anastomosis patients must have low anterior resection syndrome (LARS) score of 21-42 (minor to major symptoms) within 5 calendar days prior to registration
Patient must have completed all baseline questionnaires within 5 days prior to registration
Patients must be able to read, write and speak English. Study materials and telephone calls are only available in English
Patients with a prior malignancy or concurrent malignancy that is currently not being treated, whose natural history or treatment (in the opinion of the treating physician) does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
Patients who are currently undergoing treatment for another cancer will have a different symptom profile than what this study is targeting and are not eligible
Patients who have been diagnosed with inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn's disease, are not eligible
PRIOR TO STEP 2 REGISTRATION:
Patient must meet all eligibility criteria for step 1
Patient must have successfully completed ("pass") the run-in period, as per email notification from the University of Arizona
Patient must be registered to step 2 no more than 40 days after step 1 registration. If day 40 falls on a weekend or holiday, the limit may be extended to the next working day
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 Oncology Patient Enrollment Network (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: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (diet modification coaching, motivational messages)	Questionnaire Administration	Patients receive diet modification coaching via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm I (diet modification coaching, motivational messages)	Quality-of-Life Assessment	Patients receive diet modification coaching via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm II (standard of care, motivational messages)	Best Practice	Patients receive general healthy living education via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm II (standard of care, motivational messages)	Message	Patients receive general healthy living education via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm I (diet modification coaching, motivational messages)	Dietary Intervention	Patients receive diet modification coaching via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm II (standard of care, motivational messages)	Questionnaire Administration	Patients receive general healthy living education via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm II (standard of care, motivational messages)	Quality-of-Life Assessment	Patients receive general healthy living education via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.
Arm I (diet modification coaching, motivational messages)	Message	Patients receive diet modification coaching via telephone for 10 sessions over 30-60 minutes over 17 weeks. Patients also receive 3 motivational messages per week via email and/or text message beginning after session 6.

Primary Outcome Measures

Name	Time	Method
Bowel Function	At 18 weeks after randomization	Will be measured by the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (BFI) total score. Score range 18-90. Higher scores indicate better bowel function. Will be conducted according to a modified intention-to-treat principle. Study arm differences in BFI at 18 weeks will be assessed by a linear regression model as a function of randomization assignment, BFI baseline value, and stratification factors.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (226): UC Irvine Health Cancer Center-Newport
🇺🇸
Costa Mesa, California, United States
Mount Carmel East Hospital
🇺🇸
Columbus, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
City of Hope Comprehensive Cancer Center
🇺🇸
Duarte, California, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Mount Sinai Medical Center
🇺🇸
Miami Beach, Florida, United States
Queen's Cancer Center - Pearlridge
🇺🇸
'Aiea, Hawaii, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸
Orange, California, United States
John Fitzgerald Kennedy Medical Center
🇺🇸
Atlantis, Florida, United States
Mount Sinai Comprehensive Cancer Center at Aventura
🇺🇸
Aventura, Florida, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸
East China Township, Michigan, United States
Carle on Vermilion
🇺🇸
Danville, Illinois, United States
McLaren Cancer Institute-Clarkston
🇺🇸
Clarkston, Michigan, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸
Brighton, Michigan, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸
Dixon, Illinois, United States
McLaren Cancer Institute-Bay City
🇺🇸
Bay City, Michigan, United States
McFarland Clinic PC - Ames
🇺🇸
Ames, Iowa, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Saint Joseph Mercy Canton
🇺🇸
Canton, Michigan, United States
Lafayette Family Cancer Center-EMMC
🇺🇸
Brewer, Maine, United States
MMP Surgical Care Casco Bay
🇺🇸
Portland, Maine, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Parkland Health Center - Farmington
🇺🇸
Farmington, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
McLaren-Port Huron
🇺🇸
Port Huron, Michigan, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸
Ypsilanti, Michigan, United States
Las Vegas Urology - Green Valley
🇺🇸
Henderson, Nevada, United States
Urology Specialists of Nevada - Green Valley
🇺🇸
Henderson, Nevada, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
University of Kansas Cancer Center at North Kansas City Hospital
🇺🇸
North Kansas City, Missouri, United States
Asplundh Cancer Pavilion
🇺🇸
Willow Grove, Pennsylvania, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸
Lawton, Oklahoma, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸
West Chester, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
FHP Health Center-Guam
🇬🇺
Tamuning, Guam
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
VCU Community Memorial Health Center
🇺🇸
South Hill, Virginia, United States
Valley Health / Winchester Medical Center
🇺🇸
Winchester, Virginia, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Virginia Mason Medical Center
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸
Seattle, Washington, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Mary Greeley Medical Center
🇺🇸
Ames, Iowa, United States
McFarland Clinic PC-Boone
🇺🇸
Boone, Iowa, United States
Maine Medical Partners Surgical Care
🇺🇸
Portland, Maine, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸
Canton, Michigan, United States
Mid-Michigan Medical Center - Midland
🇺🇸
Midland, Michigan, United States
William Beaumont Hospital-Royal Oak
🇺🇸
Royal Oak, Michigan, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Comprehensive Cancer Centers of Nevada - Henderson
🇺🇸
Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson
🇺🇸
Henderson, Nevada, United States
Lovelace Medical Center-Saint Joseph Square
🇺🇸
Albuquerque, New Mexico, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸
Grove City, Ohio, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Shenandoah Oncology PC
🇺🇸
Winchester, Virginia, United States
Fred Hutchinson Cancer Research Center
🇺🇸
Seattle, Washington, United States
Seattle Cancer Care Alliance
🇺🇸
Seattle, Washington, United States
Olympic Medical Cancer Care Center
🇺🇸
Sequim, Washington, United States
Langlade Hospital and Cancer Center
🇺🇸
Antigo, Wisconsin, United States
Wenatchee Valley Hospital and Clinics
🇺🇸
Wenatchee, Washington, United States
Marshfield Clinic-Chippewa Center
🇺🇸
Chippewa Falls, Wisconsin, United States
Marshfield Clinic - Ladysmith Center
🇺🇸
Ladysmith, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Aspirus Medford Hospital
🇺🇸
Medford, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Marshfield Clinic Stevens Point Center
🇺🇸
Stevens Point, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸
Weston, Wisconsin, United States
Aspirus Regional Cancer Center
🇺🇸
Wausau, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸
Wausau, Wisconsin, United States
Las Vegas Urology - Pecos
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Charleston
🇺🇸
Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Central
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Central
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Sunset
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Southwest
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Cathedral Rock
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Smoke Ranch
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley
🇺🇸
Las Vegas, Nevada, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸
Cincinnati, Ohio, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
University of Texas Health Science Center at San Antonio
🇺🇸
San Antonio, Texas, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
Olathe Health Cancer Center
🇺🇸
Olathe, Kansas, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Hawaii Cancer Care - Savio
🇺🇸
'Aiea, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
HaysMed University of Kansas Health System
🇺🇸
Hays, Kansas, United States
University of Kansas Cancer Center-Overland Park
🇺🇸
Overland Park, Kansas, United States
University of Kansas Cancer Center-West
🇺🇸
Kansas City, Kansas, United States
University of Kansas Hospital-Indian Creek Campus
🇺🇸
Overland Park, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸
Westwood, Kansas, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Beebe South Coastal Health Campus
🇺🇸
Frankford, Delaware, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
McFarland Clinic PC-Trinity Cancer Center
🇺🇸
Fort Dodge, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
McFarland Clinic PC-Marshalltown
🇺🇸
Marshalltown, Iowa, United States
Skagit Valley Hospital Regional Cancer Care Center
🇺🇸
Mount Vernon, Washington, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Ascension Saint John Hospital
🇺🇸
Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Banner University Medical Center - Tucson
🇺🇸
Tucson, Arizona, United States
University of Arizona Cancer Center-North Campus
🇺🇸
Tucson, Arizona, United States
McFarland Clinic PC-Jefferson
🇺🇸
Jefferson, Iowa, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Beaumont Hospital - Farmington Hills
🇺🇸
Farmington Hills, Michigan, United States
McLaren Cancer Institute-Central Michigan
🇺🇸
Mount Pleasant, Michigan, United States
Truman Medical Centers
🇺🇸
Kansas City, Missouri, United States
University of Kansas Cancer Center - North
🇺🇸
Kansas City, Missouri, United States
Virginia Cancer Institute
🇺🇸
Richmond, Virginia, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸
Macomb, Michigan, United States
Comprehensive Cancer Centers of Nevada-Summerlin
🇺🇸
Las Vegas, Nevada, United States
Singh and Arora Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
AnMed Health Cancer Center
🇺🇸
Anderson, South Carolina, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸
Grosse Pointe Woods, Michigan, United States
Las Vegas Urology - Pebble
🇺🇸
Henderson, Nevada, United States
McLaren-Greater Lansing
🇺🇸
Lansing, Michigan, United States
Weisberg Cancer Treatment Center
🇺🇸
Farmington Hills, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸
Warren, Michigan, United States
Saint Joseph Regional Medical Center
🇺🇸
Lewiston, Idaho, United States
Saint Joseph Mercy Chelsea
🇺🇸
Chelsea, Michigan, United States
Academic Hematology Oncology Specialists
🇺🇸
Grosse Pointe Woods, Michigan, United States
Huron Gastroenterology PC
🇺🇸
Ypsilanti, Michigan, United States
Great Lakes Cancer Management Specialists-Rochester Hills
🇺🇸
Rochester Hills, Michigan, United States
Hope Cancer Care of Nevada
🇺🇸
Las Vegas, Nevada, United States
McLaren Cancer Institute-Flint
🇺🇸
Flint, Michigan, United States
Mid-Michigan Physicians-Lansing
🇺🇸
Lansing, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Beaumont Hospital - Dearborn
🇺🇸
Dearborn, Michigan, United States
William Beaumont Hospital - Troy
🇺🇸
Troy, Michigan, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
OptumCare Cancer Care at MountainView
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Seven Hills
🇺🇸
Henderson, Nevada, United States
Saint Joseph Mercy Brighton
🇺🇸
Brighton, Michigan, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸
Chelsea, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
McLaren Cancer Institute-Lapeer Region
🇺🇸
Lapeer, Michigan, United States
McLaren Cancer Institute-Northern Michigan
🇺🇸
Petoskey, Michigan, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸
Wisconsin Rapids, Wisconsin, United States
VCU Massey Cancer Center at Stony Point
🇺🇸
Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Presbyterian Intercommunity Hospital
🇺🇸
Whittier, California, United States