Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer
- Conditions
- Stage I Ovarian Cancer AJCC v6 and v7Stage IA Fallopian Tube Cancer AJCC v6 and v7Stage IC Fallopian Tube Cancer AJCC v6 and v7Stage IB Fallopian Tube Cancer AJCC v6 and v7Stage IIIC Fallopian Tube Cancer AJCC v7Stage IIB Fallopian Tube Cancer AJCC v6 and v7Stage III Primary Peritoneal Cancer AJCC v7Stage IIIA Fallopian Tube Cancer AJCC v7Stage IV Fallopian Tube Cancer AJCC v6 and v7Stage IIA Fallopian Tube Cancer AJCC v6 and v7
- Interventions
- Procedure: Assessment of Therapy ComplicationsBiological: FilgrastimOther: Pharmacological StudyOther: Quality-of-Life AssessmentOther: Questionnaire Administration
- Registration Number
- NCT01366183
- Lead Sponsor
- Gynecologic Oncology Group
- Brief Summary
This trial studies the chemotherapy toxicity on quality of life in older patients with stage I, stage II, stage III, or stage IV ovarian epithelial, primary peritoneal cavity, or fallopian tube cancer. Learning about the side effects of chemotherapy in older patients may help doctors plan better ways to treat cancer.
- Detailed Description
PRIMARY OBJECTIVES:
l. To determine whether the score on Instrumental Activities of Daily Living (IADL) obtained prior to treatment is associated with the ability of patients to complete four cycles of chemotherapy without dose reduction or a more than 7-day delay.
II. To estimate by regimen the percentage of patients who are able to complete four cycles of chemotherapy regardless of dose reductions and delays.
III. To compare actual and calculated carboplatin area under the curve (AUC) in this patient population.
SECONDARY OBJECTIVES:
I. To describe the percentage of patients who are entered after primary surgery versus those entered to receive primary or neoadjuvant chemotherapy, the percentage of patients who are treated with each allowed regimen, and the percentage of patients who eventually receive surgery in the primary chemotherapy group.
II. To determine whether the need for assistance with IADLs at time of registration is associated with choice of chemotherapy regimen (in both primary chemotherapy and primary surgery patients).
III. To explore whether age, baseline scores on the geriatric measures (functional status, nutritional status, or co-morbidity) and quality-of-life (QOL) are correlated with likelihood of completing four courses of chemotherapy without dose reduction or a more than 7-day delay.
IV. To explore reasons for and timing of dose reductions and delays. V. To describe toxicities, pre-/post-chemotherapy QOL, and pre-/post-chemotherapy scores on geriatric measures in this patient population.
TERTIARY OBJECTIVES:
I. To explore potential relationships of carboplatin AUC, paclitaxel clearance, and paclitaxel time above a plasma concentration of 0.05 mcM to nadir neutrophil and platelet counts during course 1 of treatment.
II. To explore the association between baseline IADL and survival. III. To explore the association between IADL and the functional well-being (FWB) subscale in the Functional Assessment of Cancer Therapy ? Ovary (FACT-O).
OUTLINE:
Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies.
Patients' quality of life is assessed by the FACT-O, the Functional Assessment of Cancer Treatment ? Neurotoxicity (FACT-Ntx subscale), the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 290
- Eligible patients must have a histologically or cytologically confirmed diagnosis of adenocarcinoma of the ovary, peritoneum, or fallopian tube either by surgery, biopsy, fine-needle aspiration (FNA), paracentesis, or thoracentesis; a diagnosis of a mucinous cancer must be made by biopsy only
- International Federation of Gynecology and Obstetrics (FIGO) stage I, II, III, and IV are eligible
- Patients must have received no previous treatment for this malignancy other than surgery
- Patients must be entered within eight weeks of confirmation of disease diagnosis by surgery, biopsy, FNA, paracentesis or thoracentesis if there is no primary surgery, and within twelve weeks of primary or staging surgery if patient received primary surgery
- Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl
- Platelets greater than or equal to 100,000/mcl
- Bilirubin less than or equal upper limit of normal (ULN)
- Creatinine less than or equal to 1.5 x ULN
- Patients must have a Gynecologic Oncology Group (GOG) performance status of 0, 1, 2 or 3
- Effective XX/XX/2014, only patients 75 years of age or older are eligible for enrollment; (04/23/2012) (08/12/2013)
- Patients must have recovered from the effects of recent surgery
- Patients must be free of active infection requiring antibiotics
- Patients must have signed an approved informed consent and Health Insurance Portability and Accountability Act (HIPAA)
- Patient and physician agree that they plan to conduct treatment according to Regimen 3
- Patient can read and understand sufficient English to be able to respond to questions posed by the study instruments
- Patients who have received previous treatment for this malignancy other than surgery
- Patients with other invasive malignancies whose previous cancer treatment contraindicates this protocol therapy
- ?Borderline tumors? (tumors of low malignant potential) by surgery or biopsy are excluded
- Patients with medical conditions that in the opinion of the investigator render treatment on this protocol unsafe should be excluded
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Observational (quality of life questionnaire) Filgrastim Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Pharmacological Study Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Assessment of Therapy Complications Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Quality-of-Life Assessment Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Questionnaire Administration Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Carboplatin Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed. Observational (quality of life questionnaire) Paclitaxel Patients receive chemotherapy comprising carboplatin, paclitaxel, and filgrastim (regimen 1) or carboplatin alone (regimen 2) every 21 days for 4 courses according to their physicians and/or patients' choice. Patients may undergo surgery and/or further chemotherapy at the discretion of treating physician. Patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies. Patients' quality of life is assessed by the FACT-O, the FACT-Ntx subscale, the IADL, and the Ability to Complete Social Activity questionnaires at baseline, prior to courses 1 and 3, and then 3-6 weeks after completion of course 4. Nutritional status, such as body mass index and weight loss, and comorbidity and hearing impairment are also assessed.
- Primary Outcome Measures
Name Time Method Tolerance to study treatment, defined as completing four cycles of study treatment, without dose reductions or treatment delays of over seven days Up to 5 years Will be modeled with logistic regression using baseline IADL scores as a covariate. Exploratory analysis will evaluate baseline IADL scores adjusting for covariates such as: Charlson scale, nutritional status, or age.
Percent of women, who are 70 years or older, able to complete at least 4 cycles of treatment regardless of dose reduction and delays Up to 5 years While this percentage will be estimated for each study regimen separately, the targeted sample size will limit the width of the 95%-confidence interval for the marginal percentage so that it is no larger than 0.15.
- Secondary Outcome Measures
Name Time Method Changes in quality-of-life measured by FACT-O, FACT/GOG-Ntx-4 subscale, IADL, and ADL Baseline to up to 6 weeks after completion of course 4 The changes in FACT-O, FACT/GOG-Ntx-4 subscale, IADL, and ADL will be summarized descriptively as the differences of scores between pre and post chemotherapy. Assuming 80% of patients complete the assessment at the completion of chemotherapy, then a sample of 148 patients will provide 90% power to detect 5 unit changes in FACT-O, 0.5 unit change in FACT/GOG-Ntx subscale score, 1 unit change in IADL or ADL score using paired t-test at significant level of 0.05.
Changes in comorbidity index measured by the Charlson scale Baseline to up to 6 weeks after completion of course 4 Changes in nutritional status measured by weight Baseline to up to 6 weeks after completion of course 4 The changes in weight will be summarized descriptively as the differences of scores between pre and post chemotherapy. The change of nutritional status after completing chemotherapy will be examined using McNemar?s test.
Clinical response of elderly patients with ovarian, primary peritoneal cavity, or fallopian tube cancer Up to 5 years Percent of patients reporting adverse events as assessed by the National Cancer Institute's Common Terminology Criteria for Adverse Events Up to 6 weeks after course 4 The probability of an adverse event will be estimated as the percent of patients reporting an adverse event out of all patients beginning treatment.
Trial Locations
- Locations (354)
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Temple University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Oncology Hematology Care Inc-Anderson
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Blue Ash
🇺🇸Cincinnati, Ohio, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸Mountain View, California, United States
John Muir Medical Center-Concord Campus
🇺🇸Concord, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸Palo Alto, California, United States
Olive View-University of California Los Angeles Medical Center
🇺🇸Sylmar, California, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Danbury Hospital
🇺🇸Danbury, Connecticut, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Stamford Hospital/Bennett Cancer Center
🇺🇸Stamford, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Middlesex Hospital
🇺🇸Middletown, Connecticut, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸Newark, Delaware, United States
Weiss Memorial Hospital
🇺🇸Chicago, Illinois, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Providence Medical Center
🇺🇸Kansas City, Kansas, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Menorah Medical Center
🇺🇸Overland Park, Kansas, United States
Woman's Hospital
🇺🇸Baton Rouge, Louisiana, United States
Oncology Hematology Care Inc-Crestview
🇺🇸Crestview Hills, Kentucky, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Ascension Providence Hospitals - Southfield
🇺🇸Southfield, Michigan, United States
William Beaumont Hospital - Troy
🇺🇸Troy, Michigan, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
University of Minnesota/Masonic Cancer Center
🇺🇸Minneapolis, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Park Nicollet Frauenshuh Cancer Center
🇺🇸Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Saint Luke's East - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Saint Joseph Oncology Inc
🇺🇸Saint Joseph, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸Billings, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Northern Montana Hospital
🇺🇸Havre, Montana, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
CHI Health Good Samaritan
🇺🇸Kearney, Nebraska, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
Rutgers New Jersey Medical School
🇺🇸Newark, New Jersey, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Virtua Voorhees
🇺🇸Voorhees, New Jersey, United States
Women's Cancer Care Associates LLC
🇺🇸Albany, New York, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
North Shore University Hospital
🇺🇸Manhasset, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Atrium Health Cabarrus/LCI-Concord
🇺🇸Concord, North Carolina, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸Cincinnati, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Mount Carmel East Hospital
🇺🇸Columbus, Ohio, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Oncology Hematology Care Inc-Healthplex
🇺🇸Fairfield, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Lancaster Radiation Oncology
🇺🇸Lancaster, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Chester County Hospital
🇺🇸West Chester, Pennsylvania, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
ProHealth D N Greenwald Center
🇺🇸Mukwonago, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Ascension Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
UCSF Medical Center-Mount Zion
🇺🇸San Francisco, California, United States
Beth Israel Deaconess Hospital-Plymouth
🇺🇸Plymouth, Massachusetts, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Rocky Mountain Gynecologic Oncology PC
🇺🇸Englewood, Colorado, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Sanford Clinic North-Fargo
🇺🇸Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Mayo Clinic Hospital in Arizona
🇺🇸Phoenix, Arizona, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Gynecologic Oncology Group of Arizona
🇺🇸Phoenix, Arizona, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Kalispell Medical Oncology
🇺🇸Kalispell, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Glens Falls Hospital
🇺🇸Glens Falls, New York, United States
Northwell Health/Center for Advanced Medicine
🇺🇸Lake Success, New York, United States
Saint Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Long Island Jewish Medical Center
🇺🇸New Hyde Park, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸Burlington, North Carolina, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Bethesda North Hospital
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Eden Park
🇺🇸Cincinnati, Ohio, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Dayton NCI Community Oncology Research Program
🇺🇸Dayton, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Monongalia Hospital
🇺🇸Morgantown, West Virginia, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸Sayre, Pennsylvania, United States
Scott and White Memorial Hospital
🇺🇸Temple, Texas, United States
WellSpan Health-York Hospital
🇺🇸York, Pennsylvania, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
University of Tennessee - Knoxville
🇺🇸Knoxville, Tennessee, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸Marshfield, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸Oconomowoc, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸Wausau, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸Weston, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸Rice Lake, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸Gainesville, Georgia, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸Wilmington, Delaware, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Jupiter Medical Center
🇺🇸Jupiter, Florida, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Kansas City NCI Community Oncology Research Program
🇺🇸Prairie Village, Kansas, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Manhattan
🇺🇸Manhattan, Kansas, United States
Saint Luke's South Hospital
🇺🇸Overland Park, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Saint Elizabeth Medical Center South
🇺🇸Edgewood, Kentucky, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cotton O'Neil Cancer Center / Stormont Vail Health
🇺🇸Topeka, Kansas, United States
Christiana Care - Union Hospital
🇺🇸Elkton, Maryland, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Liberty Radiation Oncology Center
🇺🇸Liberty, Missouri, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Natalie Warren Bryant Cancer Center at Saint Francis
🇺🇸Tulsa, Oklahoma, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Florida Gynecologic Oncology
🇺🇸Fort Myers, Florida, United States
Augusta University Medical Center
🇺🇸Augusta, Georgia, United States
Sarasota Memorial Hospital
🇺🇸Sarasota, Florida, United States
Dekalb Medical Center
🇺🇸Decatur, Georgia, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸Warrenville, Illinois, United States
West Suburban Medical Center
🇺🇸River Forest, Illinois, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Franciscan Health Indianapolis
🇺🇸Indianapolis, Indiana, United States
Cancer Care Partners LLC
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Duke Raleigh Hospital
🇺🇸Raleigh, North Carolina, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
Oncology Hematology Care Inc-Mercy West
🇺🇸Cincinnati, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸Cincinnati, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸Columbus, Ohio, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Carilion Clinic Gynecological Oncology
🇺🇸Roanoke, Virginia, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Mid Dakota Clinic
🇺🇸Bismarck, North Dakota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Warren Clinic Oncology-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Warren Clinic-Tulsa South
🇺🇸Tulsa, Oklahoma, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Mayo Clinic in Arizona
🇺🇸Scottsdale, Arizona, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Maine Medical Center-Bramhall Campus
🇺🇸Portland, Maine, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Christiana Gynecologic Oncology LLC
🇺🇸Newark, Delaware, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Beaumont Hospital - Dearborn
🇺🇸Dearborn, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
UMass Memorial Medical Center - Memorial Division
🇺🇸Worcester, Massachusetts, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Genesys Regional Medical Center
🇺🇸Grand Blanc, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Lake Huron Medical Center
🇺🇸Port Huron, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸Rhinelander, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Tulane University Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Norton Hospital Pavilion and Medical Campus
🇺🇸Louisville, Kentucky, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
North Kansas City Hospital
🇺🇸Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸Kansas City, Missouri, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸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
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸Beech Grove, Indiana, United States