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Vaginal DHEA for Vaginal Symptoms: A Phase III Randomized, Double Blind, Placebo- Controlled Trial


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Cancer

Thank you

Trial Information

Vaginal DHEA for Vaginal Symptoms: A Phase III Randomized, Double Blind, Placebo- Controlled Trial


OBJECTIVES:

Primary

- To determine the effectiveness of two doses of daily vaginal prasterone
(dehydroepiandrosterone [DHEA]) versus placebo for alleviation of the most bothersome
vaginal symptom (vaginal dryness or dyspareunia) over 12 weeks.

Secondary

- To evaluate any toxicities arising from DHEA in this patient population. (Exploratory)

- To evaluate the impact of vaginal DHEA on negative sexual thoughts, sexual function and
urologic symptoms. (Exploratory)

- To explore the role of psychologic (mood, stress), physical (demographics and treatment
variables) and situational factors (partner variables and fatigue) as predictors of
vaginal dryness and performance outcomes at baseline and at various endpoints
throughout the study. (Exploratory)

- To explore the characteristics of vaginal atrophy and the relationship between vaginal
atrophy and quality-of-life questionnaire responses and exposure to hormonal therapy
(tamoxifen, exemestane, anastrozole, or letrozole). (Exploratory)

- To examine the effects of the use of open-label vaginal DHEA gel over 8 weeks in women
completing the placebo gel arm of the randomized trial. (Exploratory)

- To evaluate the impact of vaginal DHEA on maturation index and pH (select
institutions). (Correlative)

- To evaluate the impact of vaginal DHEA on sex steroid concentrations (estradiol, free
testosterone, estrone, and DHEA-S) and markers of bone turnover (osteocalcin and bone
alkaline phosphatase). (Correlative)

- To bank blood products for future studies. (Correlative)

OUTLINE: This is a multicenter study. Patients are stratified according to current tamoxifen
therapy (yes vs no), concurrent aromatase inhibitor (anastrozole/letrozole vs exemestane vs
none), hysterectomy (yes vs no), and cigarette smoking (current vs past vs never). Patients
are randomized to 1 of 3 treatment arms.

- Arm I: Participants apply a low dose of vaginal prasterone (dehydroepiandrosterone
[DHEA]) gel once daily (QD), at bed time, for 12 weeks.

- Arm II: Participants apply a high dose of vaginal DHEA gel QD, at bed time, for 12
weeks.

- Arm III: Participants apply a vaginal placebo gel QD, at bed time, for 12 weeks.

- Optional Continuation Phase (for placebo arm only): Participants apply a high dose
of vaginal DHEA gel QD, at bed time, for 12 weeks.

Participants undergo blood sample collection at baseline and during weeks 11-12 for
estradiol, free testosterone, estrone, DHEA-sulfate, osteocalcin, and bone alkaline
phosphatase analysis. Some participants also undergo vaginal cells collection and vaginal pH
tests.

Participants may complete the Profile of Mood States (POMS), the Perceived Stress Scale
(PSS), the Fatigue: Vitality subscale of the SF-36, the Vaginal Symptom Quality
Questionnaire, the DHEA Side Effect Questionnaire, the Female Sexual Function Index (FSFI),
the Sexually Related Intrusive Thoughts - ITS, Impact of Treatment Scale, the Urogenital
Atrophy Questionnaire, and the Subject Global Impression of Change at baseline and
periodically during study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Postmenopausal women with a history of breast or gynecologic cancer (currently no
evidence of disease)

- Postmenopausal status determined by the following criteria:

- 12 months without a period or bilateral oophorectomy or complete chemical
ovarian suppression for the past 12 months with continued suppression
planned throughout the course of the study

- FSH and an estradiol value in the postmenopausal range (generally FSH >40
IU/L and estradiol < 10 pg/mL, depending on laboratory) if 9 months without
a period OR post hysterectomy with at least one ovary remaining and less
than 55 years old

- For age 55 or older, menopausal status does not need to be determined by
laboratory exams

- Significant vaginal complaints defined as persistent vaginal dryness and/or pain with
intercourse (dyspareunia) of sufficient severity to make a patient desire therapeutic
intervention

- Eligibility questionnaire response must be moderate or worse levels of severity on
one of the two symptoms, either dryness or dyspareunia

- Vaginal symptoms must have been present ≥ 2 months prior to randomization

PATIENT CHARACTERISTICS:

- Life expectancy > 12 months

- ECOG performance status 0 or 1

- Ability to complete questionnaires by themselves or with assistance

- Willing to return to NCCTG enrolling institution for follow-up

- Willing to provide blood samples for correlative research purposes

- Willing to undergo brief pelvic exam at baseline and week 11-12, if institution
participating in that portion of the study

- No current diagnosis of an active vaginal infection; if symptoms of vaginal infection
(i.e., foul discharge, fever) present, then infection must be ruled out

- No diagnosis of any of the following conditions within the past five years:

- Essential vulvodynia

- Vulvar vestibulitis

- Bartholin cyst/abscess

- History of Bartholin gland surgery

- Lichen sclerosis

- Lichen planus of the vulvovaginal region

- Desquamative vaginitis

- No history or current diagnosis of any of the following conditions (ever):

- Vulvar or vaginal dysplasia

- Vaginal prolapse

- No women of childbearing potential or premenopausal women

PRIOR CONCURRENT THERAPY:

- No initiation or discontinuation of tamoxifen or aromatase inhibitors ≤ 2 months
prior to randomization or plan to initiate or discontinue any of these medications
during the 12-week study

- No concurrent chemotherapy

- Long-term adjuvant trastuzumab, lapatinib, and/or bevacizumab is allowed

- Not planning to use any vaginal preparations during the study period (including any
over-the-counter or herbal preparations)

- Water-based lubricants, such as KY jelly, are allowed during sexual intercourse

- No use of any daily non-hormonal vaginal preparations ≤ 1 week prior to study entry

- Patients who stop agent may be enrolled after 1 week

- More then 4 weeks since prior and no concurrent use of any estrogen product or any
kind of hormonal vaginal product including bio-identical hormones, estriol, or any
androgen product

- No concurrent pharmacologic soy or phytoestrogen preparations (dietary intake of soy
[i.e., soy milk] is acceptable)

- Not on a placebo-controlled trial for endocrine therapy

- No prior or concurrent pelvic radiotherapy

- No prior radical pelvic surgery, specifically vaginectomy or pelvic exenteration

- Prior total abdominal hysterectomy (TAH) and/or bilateral salpingo-oophorectomy
(BSO) allowed

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Double-Blind, Primary Purpose: Supportive Care

Outcome Measure:

Alleviation of the most bothersome vaginal symptom (vaginal dryness or dyspareunia) over 12 weeks

Safety Issue:

No

Principal Investigator

Debra Barton, RN, PhD, AOCN, FAAN

Investigator Role:

Principal Investigator

Investigator Affiliation:

Mayo Clinic

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000702003

NCT ID:

NCT01376349

Start Date:

July 2011

Completion Date:

Related Keywords:

  • Cancer
  • depression
  • anxiety disorder
  • cognitive/functional effects
  • sexual dysfunction
  • cancer survivor
  • breast cancer
  • cervical cancer
  • fallopian tube cancer
  • uterine sarcoma
  • vaginal cancer
  • vulvar cancer
  • ovarian epithelial cancer
  • ovarian germ cell tumor
  • ovarian sarcoma
  • ovarian stromal cancer
  • primary peritoneal cavity cancer
  • endometrial cancer

Name

Location

Mayo Clinic ScottsdaleScottsdale, Arizona  85259
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Illinois Oncology Research AssociationPeoria, Illinois  61602
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
CCOP - Colorado Cancer Research ProgramDenver, Colorado  80224-2522
Porter Adventist HospitalDenver, Colorado  80210
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Rose Medical CenterDenver, Colorado  80220
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
St. Mary - Corwin Regional Medical CenterPueblo, Colorado  81004
North Suburban Medical CenterThornton, Colorado  80229
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
Cedar Rapids Oncology AssociatesCedar Rapids, Iowa  52403
Mercy Medical Center - Sioux CitySioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
St. Luke's Regional Medical CenterSioux City, Iowa  51104
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical CenterDearborn, Michigan  48123-2500
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
St. John Macomb HospitalWarren, Michigan  48093
MeritCare BemidjiBemidji, Minnesota  56601
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
CCOP - DuluthDuluth, Minnesota  55805
Miller - Dwan Medical CenterDuluth, Minnesota  55805
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Hutchinson Area Health CareHutchinson, Minnesota  55350
HealthEast Cancer Care at St. John's HospitalMaplewood, Minnesota  55109
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical CenterShakopee, Minnesota  55379
Park Nicollet Cancer CenterSt. Louis Park, Minnesota  55416
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
MeritCare BroadwayFargo, North Dakota  58122
CCOP - MeritCare HospitalFargo, North Dakota  58122
Geisinger Medical Group - Scenery ParkState College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical CenterWilkes-Barre, Pennsylvania  18711
Sanford Cancer Center at Sanford USD Medical CenterSioux Falls, South Dakota  57117-5039
Avera Cancer InstituteSioux Falls, South Dakota  57105
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
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CCOP - ColumbusColumbus, Ohio  43206
CCOP - DaytonKettering, Ohio  45429
Hinsdale, Illinois  60521
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Saint Joseph Regional Medical CenterSouth Bend, Indiana  46617
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
University of Florida Shands Cancer CenterGainesville, Florida  32610-0232
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Dickinson County Healthcare SystemIron Mountain, Michigan  49801
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54301-3526
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Bay Area Cancer Care Center at Bay Area Medical CenterMarinette, Wisconsin  54143
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Green Bay Oncology, Limited - Sturgeon BaySturgeon Bay, Wisconsin  54235
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McKee Medical CenterLoveland, Colorado  80539
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St. Peter's HospitalHelena, Montana  59601
Kalispell Regional Medical CenterKalispell, Montana  59901
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Doctors Hospital at Ohio HealthColumbus, Ohio  43228
Riverside Methodist Hospital Cancer CareColumbus, Ohio  43214
Grady Memorial HospitalDelaware, Ohio  43015
Fairfield Medical CenterLancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial HospitalMarietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial HospitalNewark, Ohio  43055
Community Hospital of Springfield and Clark CountySpringfield, Ohio  45505
Genesis - Good Samaritan HospitalZanesville, Ohio  43701
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
Dakota Cancer Institute at Dakota Clinic - South UniversityFargo, North Dakota  58103-4940
Geisinger Cancer Institute at Geisinger HealthDanville, Pennsylvania  17822-0001
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Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. JosephSt. Joseph, Michigan  49085
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Front Range Cancer SpecialistsFort Collins, Colorado  80528
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Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
St. Joseph Medical CenterBloomington, Illinois  61701
Eureka Community HospitalEureka, Illinois  61530
BroMenn Regional Medical CenterNormal, Illinois  61761
Community Cancer CenterNormal, Illinois  61761
Community Hospital of OttawaOttawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - OttawaOttawa, Illinois  61350
Cancer Treatment Center at Pekin HospitalPekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - PeoriaPeoria, Illinois  61615
OSF St. Francis Medical CenterPeoria, Illinois  61637
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
Bettendorf, Iowa  52722
Mercy Regional Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Medical Oncology and Hematology Associates at John Stoddard Cancer CenterDes Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer CenterDes Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des MoinesWest Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Community Cancer Center of MonroeMonroe, Michigan  48162
St. Joseph's Medical CenterBrainerd, Minnesota  56401
Coborn Cancer CenterSaint Cloud, Minnesota  56303
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Wood County Oncology CenterBowling Green, Ohio  43402
Samaritan North Cancer Care CenterDayton, Ohio  45415
Grandview HospitalDayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley HospitalDayton, Ohio  45409
Good Samaritan HospitalDayton, Ohio  45406
Blanchard Valley Medical AssociatesFindlay, Ohio  45840
Charles F. Kettering Memorial HospitalKettering, Ohio  45429
Lima Memorial HospitalLima, Ohio  45804
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Middletown Regional HospitalMiddletown, Ohio  45044
Toledo Clinic - OregonOregon, Ohio  43616
St. Charles Mercy HospitalOregon, Ohio  43616
Mercy Hospital of TiffinTiffin, Ohio  44883
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Fulton County Health CenterWauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Bon Secours St. Francis Health SystemGreenville, South Carolina  29601
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
Holy Family Memorial Medical Center Cancer Care CenterManitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial HospitalSheridan, Wyoming  82801
St. Anthony Central HospitalDenver, Colorado  80204-1335
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Cancer Resource Center - LincolnLincoln, Nebraska  68510
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Herbert D. Kerman Regional Oncology Center - Daytona BeachDaytona Beach, Florida  32114
Michiana Hematology-Oncology, PC - ElkhartElkhart, Indiana  46514
Elkhart Clinic, LLCElkhart, Indiana  46514-2098
Michiana Hematology Oncology PC - La PorteLa Porte, Indiana  46350
Michiana Hematology-Oncology, PC - South BendMishawaka, Indiana  46545-1470
Michiana Hematology Oncology PC - PlymouthPlymouth, Indiana  46563
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
Cancer Center of Kansas, PA - ChanuteChanute, Kansas  66720
Cancer Center of Kansas, PA - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Cancer Center of Kansas, PA - KingmanKingman, Kansas  67068
Lawrence Memorial HospitalLawrence, Kansas  66044
Cancer Center of Kansas, PA - LiberalLiberal, Kansas  67905
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
Cancer Center of Kansas, PA - WellingtonWellington, Kansas  67152
Cancer Center of Kansas, PA - WichitaWichita, Kansas  67214
Associates in Womens Health, PA - North ReviewWichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas, PA - WinfieldWinfield, Kansas  67156
Foote Memorial HospitalJackson, Michigan  49201
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial Hospital - MonroeMonroe, Michigan  48162
St. Joseph Mercy OaklandPontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
Lakeside Cancer Specialists, PLLCSaint Joseph, Michigan  49085
Willmar Cancer Center at Rice Memorial HospitalWillmar, Minnesota  56201
Billings Clinic - DowntownBillings, Montana  59107-7000
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
St. James Healthcare Cancer CareButte, Montana  59701
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Grant Medical Center Cancer CareColumbus, Ohio  43215
Hematology Oncology CenterElyria, Ohio  44035
Community Cancer CenterElyria, Ohio  44035
Wayne HospitalGreenville, Ohio  45331
Knox Community HospitalMount Vernon, Ohio  43050
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Mount Carmel St. Ann's Cancer CenterWesterville, Ohio  43081
Lehigh Valley Hospital - MuhlenbergBethlehem, Pennsylvania  18017
Geisinger Hazleton Cancer CenterHazleton, Pennsylvania  18201
Fredericksburg Oncology, IncorporatedFredericksburg, Virginia  22401
Rocky Mountain OncologyCasper, Wyoming  82609
Genesys Regional Medical CenterGrand Blanc, Michigan  48439-8066
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Rutherford HospitalRutherfordton, North Carolina  28139
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Galesburg Clinic, PCGalesburg, Illinois  61401
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
Hawaii Medical Center - EastHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - KuakiniHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - LusitanaHonolulu, Hawaii  96813
Maui Memorial Medical CenterWailuku, Hawaii  96793
Pacific Cancer Institute - MauiWailuku, Hawaii  96793
Illinois CancerCare - BloomingtonBloomington%, Illinois  61701
Illinois CancerCare - CantonCanton, Illinois  61520
Illinois CancerCare - CarthageCarthage, Illinois  62321
Illinois CancerCare - EurekaEureka, Illinois  61530
Illinois CancerCare - HavanaHavana, Illinois  62644
Illinois CancerCare - Kewanee ClinicKewanee, Illinois  61443
Illinois CancerCare - MacombMacomb, Illinois  61455
Trinity Cancer Center at Trinity Medical Center - 7th Street CampusMoline, Illinois  61265
OSF Holy Family Medical CenterMonmouth, Illinois  61462
Illinois CancerCare - MonmouthMonmouth, Illinois  61462
Illinois CancerCare - Community Cancer CenterNormal, Illinois  61761
Illinois CancerCare - PekinPekin, Illinois  61603
Illinois CancerCare - PeruPeru, Illinois  61354
Illinois CancerCare - PrincetonPrinceton, Illinois  61356
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United States Air Force Medical Center - Wright-PattersonWright-Patterson AFB, Ohio  45433-5529
AnMed Cancer CenterAnderson, South Carolina  29621
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Lovelace Medical Center - DowntownAlbuquerque, New Mexico  87102
Immanuel St. Joseph'sMankato, Minnesota  56002
Minnesota Oncology - MaplewoodMaplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Lakeview HospitalStillwater, Minnesota  55082
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Northwest Cancer Specialists at Vancouver Cancer CenterVancouver, Washington  98684
Castle Medical CenterKailua, Hawaii  96734
Kauai Medical ClinicLihue, Hawaii  96766
Lakeside HospitalOmaha, Nebraska  68130
Presbyterian Cancer Treatment Center at Presbyterian Kaseman HospitalAlbuquerque, New Mexico  87110
University of New Mexico Cancer Center - SouthLas Cruces, New Mexico  88011
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Providence Newberg Medical CenterNewberg, Oregon  97132
Willamette Falls HospitalOregon City, Oregon  97045
Littleton Adventist HospitalLittleton, Colorado  80122
Parker Adventist HospitalParker, Colorado  80138
New Ulm Medical CenterNew Ulm, Minnesota  56073
St. Nicholas HospitalSheboygan, Wisconsin  53081
Southern Ohio Medical Center Cancer CenterPortsmouth, Ohio  45662
Cancer Center of Kansas, PA - McPhersonMcPherson, Kansas  67460
Carolina Blood and Cancer Care Associates, PALancaster, South Carolina  29720
Carolina Blood and Cancer CareRock Hill, South Carolina  29732
St. Francis Hospital Cancer Care ServicesIndianapolis, Indiana  46237
Mercy Clinic Cancer and Hematology - RollaRolla, Missouri  65401
Idaho Urologic Institute, PAMeridian, Idaho  83642
Mercy Cancer Center - West LakesClive, Iowa  50325
Methodist West HospitalWest Des Moines, Iowa  50266-7700
Zangmeister CenterColumbus, Ohio  43219
Benefis Sletten Cancer InstituteGreat Falls, Montana  59405
Essentia Health - Duluth ClinicDuluth, Minnesota  55805-1983