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S0927: A Randomized Placebo-Controlled Trial of Omega-3-Fatty Acid for the Control of Aromatase Inhibitor-Induced Musculoskeletal Pain and Stiffness In Women With Early Stage Breast Cancer, Phase III


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Arthralgia, Breast Cancer, Pain

Thank you

Trial Information

S0927: A Randomized Placebo-Controlled Trial of Omega-3-Fatty Acid for the Control of Aromatase Inhibitor-Induced Musculoskeletal Pain and Stiffness In Women With Early Stage Breast Cancer, Phase III


OBJECTIVES:

Primary

- To assess whether omega-3-fatty acid as compared to placebo causes a reduction in worst
joint pain and/or stiffness at 12 weeks, as measured by the modified Brief Pain
Inventory (BPI), in women with early-stage breast cancer and aromatase inhibitor
(AI)-associated arthralgia.

Secondary

- To assess the proportion of patients who report improved versus deteriorated joint pain
with omega-3-fatty acid versus placebo.

- To assess the proportion of patients who report improved versus deteriorated joint
stiffness with omega-3-fatty acid versus placebo.

- To assess whether patients receiving omega-3-fatty acid compared to placebo have
decreased analgesic use and increased AI adherence.

- To assess whether patients receiving omega-3-fatty acid compared to placebo have
improved functioning, pain, and stiffness in the knees/hips (as measured by the Western
Ontario and McMaster Universities Osteoarthritis, WOMAC) score.

- To assess whether patients receiving omega-3-fatty acid have improved functioning,
pain, and stiffness in the hands (as measured by the Modified Score for the Assessment
and Quantification of Chronic Rheumatoid Affections of the Hands, M-SACRAH).

- To assess whether patients receiving omega-3-fatty acid compared to placebo have
improved functional quality of life as measured by the Functional Assessment of Cancer
Therapy-Endocrine Subscale (FACT-ES) Trial Outcome Index (TOI).

- To assess whether patients receiving omega-3-fatty acid report changes for the better
versus worse compared to placebo as measured by the Global Rating of Change Scale.

- To identify minimally important change in the WOMAC, M-SACRAH, and the FACT-ES Trial
Outcome Index (TOI) using "a little better" or "a little worse" responses on the
patient-reported global rating of change in joint pain and joint stiffness.

- To assess whether patients receiving omega-3-fatty acid compared to placebo have an
improved lipid profile as measured by triglycerides, HDL, and LDL.

- To assess the toxicity of omega-3-fatty acid compared to placebo in this setting.

- To assess whether there is a difference in serum-free and total estradiol levels before
and after treatment with omega-3-fatty acid compared to placebo.

- To explore whether CYP19A1 genotype correlates with severity of joint symptoms or
predicts response to omega-3-fatty acid. (exploratory)

- To explore changes in hormonal and inflammatory serum biomarkers, such as IL6, TNF-α,
and CRP.

- To assess whether there is a relationship between change in serum docosahexaenoic acid
(DHA) and EPA and resolution of joint symptoms.

- To establish a cohort of patients (placebo group) to better characterize the natural
history of the syndrome.

OUTLINE: This is a multicenter study. Patients are stratified according to prior
osteoarthritis (yes vs no) and prior taxane use (yes vs no). Patients are randomized to 1 of
2 treatment arms.

- Arm I: Patients receive oral omega-3-fatty acid twice daily (BID) or three times daily
(TID) for 24 weeks in the absence of disease progression or unacceptable toxicity.

- Arm II: Patients receive oral placebo BID or TID for 24 weeks in the absence of disease
progression or unacceptable toxicity.

Patients undergo blood sample collection at baseline and at 12 and 24 weeks for biomarker
and DNA analysis.

Patients complete the Brief Pain Inventory Short Form (BPI-SF), the Western Ontario and
McMaster Universities Osteoarthritis (WOMAC) Index, the Modified-Score for the Assessment
and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH), the FACT-ES
Trial Outcome Index, and the Omega-3-fatty acid Dietary Intake questionnaires at baseline
and at 6, 12, and 24 weeks.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed primary invasive adenocarcinoma of the breast

- Stage I, II, or IIIA disease

- No metastatic disease

- Must have undergone modified radical mastectomy or breast-sparing surgery and
recovered

- Estrogen-receptor positive (ER+) and/or progesterone-receptor positive (PR+)

- Currently taking a third-generation aromatase inhibitor (AI) [e.g., anastrozole
(Arimidex®), letrozole (Femara®), or exemestane (Aromasin®)] for ≥ 90 days prior to
registration with plans to continue for ≥ 180 days after registration

- Must have completed the S092 Brief Pain Inventory (BPI)-Short Form within the past 14
days, and must have a worst pain/stiffness of ≥ 5 on the BPI (item #2) that has
started or increased with AI therapy

PATIENT CHARACTERISTICS:

- Postmenopausal

- Zubrod performance status 0-2

- Willing to submit blood for serum-free estradiol, total estradiol, serum inflammatory
markers (IL6, TNF-α, CRP), DHA and EPA, lipid profile (LDL, HDL, triglycerides), and
DNA analysis (CYP19A1)

- Able to complete study questionnaires in English

- At least 5 years since other malignancy except adequately treated basal cell or
squamous cell skin cancer, in situ cervical cancer, ductal carcinoma in situ of the
breast or adequately treated stage I or II cancer from which the patient is currently
in complete remission

- Patients must not have a known allergy to soy, given that the placebo is suspended in
soybean oil

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- At least 3 months since prior omega-3 fatty acid supplements and must agree to
refrain from omega-3-fatty acid supplements from sources outside of this study

- More than 28 days since prior investigational agents

- No other medical therapy, alternative therapy, or physical therapy for joint
pain/stiffness within the past 30 days

- Patients must not be on anticoagulation medication (i.e., heparin/warfarin) because
of increased risk of bleeding within 28 days prior to registration

- Patients must not have a history of bone fracture or surgery of the afflicted knees
and/or hands within 6 months prior to registration

- Patients must not be on narcotics within 14 days of registration

- Patients may have received corticosteroid treatment; however, the following criteria
apply:

- Patients must not have received oral or intramuscular corticosteroids within the
28 days prior to registration

- Patients must not have received intra-articular steroids to the study, or any
other, joint within 28 days prior to registration

- Patients must not have received topical analgesics (e.g., capsaicin preparations) to
the study joint or any other analgesics (e.g., opiates, tramadol; with the exception
of nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen) within 14 days
prior to registration

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Supportive Care

Outcome Measure:

Reduction in worst joint pain and/or stiffness

Outcome Time Frame:

12 weeks

Safety Issue:

No

Principal Investigator

Dawn Hershman, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Herbert Irving Comprehensive Cancer Center

Authority:

United States: Federal Government

Study ID:

CDR0000686712

NCT ID:

NCT01385137

Start Date:

February 2012

Completion Date:

March 2014

Related Keywords:

  • Arthralgia
  • Breast Cancer
  • Pain
  • estrogen receptor-positive breast cancer
  • progesterone receptor-positive breast cancer
  • stage I breast cancer
  • stage II breast cancer
  • stage IIIA breast cancer
  • pain
  • arthralgia
  • Arthralgia
  • Breast Neoplasms

Name

Location

Fred Hutchinson Cancer Research CenterSeattle, Washington  98109
University of Michigan Comprehensive Cancer CenterAnn Arbor, Michigan  48109-0752
Cardinal Bernardin Cancer Center at Loyola University Medical CenterMaywood, Illinois  60153-5500
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
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
Kaiser Permanente Medical Center - Los AngelesLos Angeles, California  90027
CCOP - Bay Area Tumor InstituteOakland, California  94609-3305
CCOP - Cancer Research for the OzarksSpringfield, Missouri  65807
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
CCOP - ColumbusColumbus, Ohio  43206
CCOP - DaytonKettering, Ohio  45429
CCOP - GreenvilleGreenville, South Carolina  29615
LDS HospitalSalt Lake City, Utah  84143
CCOP - Grand RapidsGrand Rapids, Michigan  49503
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
MultiCare Regional Cancer Center at Tacoma General HospitalTacoma, Washington  98405
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
CCOP - St. Louis-Cape GirardeauSaint Louis, Missouri  63141
CCOP - Virginia Mason Research CenterSeattle, Washington  98101
CCOP - NorthwestTacoma, Washington  98405-0986
Sutter Cancer CenterSacramento, California  95816
Kaiser Permanente Medical Center - VallejoVallejo, California  94589
Utah Valley Regional Medical Center - ProvoProvo, Utah  84604
University of California Davis Cancer CenterSacramento, California  95817
Kaiser Permanente Medical Center - San Francisco Geary CampusSan Francisco, California  94115
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill CampusSeattle, Washington  98104
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
Winthrop University HospitalMineola, New York  11501
McDowell Cancer Center at Akron General Medical CenterAkron, Ohio  44307
Central Baptist HospitalLexington, Kentucky  40503
Kaiser Permanente Medical Center - OaklandSacramento, California  95825
Broward General Medical Center Cancer CenterFt. Lauderdale, Florida  33316
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Alvin and Lois Lapidus Cancer Institute at Sinai HospitalBaltimore, Maryland  21215
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Presbyterian Cancer Center at Presbyterian HospitalCharlotte, North Carolina  28233-3549
Lahey Clinic Medical Center - BurlingtonBurlington, Massachusetts  01805
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
Alaska Regional Hospital Cancer CenterAnchorage, Alaska  99508
Good Samaritan Regional Health CenterMt. Vernon, Illinois  62864
Battle Creek Health System Cancer Care CenterBattle Creek, Michigan  49017
Northern Michigan HospitalPetoskey, Michigan  49770
Munson Medical CenterTraverse City, Michigan  49684
David C. Pratt Cancer Center at St. John's MercySt. Louis, Missouri  63141
Hematology-Oncology Centers of the Northern Rockies - BillingsBillings, Montana  59101
St. Peter's HospitalHelena, Montana  59601
Kalispell Regional Medical CenterKalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences CenterMissoula, Montana  59802
Montana Cancer Specialists at Montana Cancer CenterMissoula, Montana  59802
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
Adena Regional Medical CenterChillicothe, Ohio  54601
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
American Fork HospitalAmerican Fork, Utah  84003
Logan Regional HospitalLogan, Utah  84321
Olympic Hematology and OncologyBremerton, Washington  98310
Skagit Valley Hospital Cancer Care CenterMt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical CenterSeattle, Washington  98195
Harborview Medical CenterSeattle, Washington  98104
Group Health Central HospitalSeattle, Washington  98104
North Puget Oncology at United General HospitalSedro-Wooley, Washington  98284
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Kaiser Permanente Medical Center - Santa Clara Kiely CampusSanta Clara, California  95051-5386
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
Butterworth Hospital at Spectrum HealthGrand Rapids, Michigan  49503-2560
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
Herbert Irving Comprehensive Cancer Center at Columbia University Medical CenterNew York, New York  10032
Legacy Emanuel Hospital and Health Center and Children's HospitalPortland, Oregon  97227
Kaiser Permanente Medical Center - SacramentoSacramento, California  95825
Kaiser Permanente Medical Center - Kaiser Foundation Hospital - San DiegoSan Diego, California  92120
Huntsman Cancer Institute at University of UtahSalt Lake City, Utah  84112
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Mount Carmel Health - West HospitalColumbus, Ohio  43222
Front Range Cancer SpecialistsFort Collins, Colorado  80528
Peninsula Medical CenterBurlingame, California  94010
Kaiser Permanente - FremontFremont, California  94538
Sutter Health - Western Division Cancer Research GroupGreenbrae, California  94904
Kaiser Permanente Medical Center - HaywardHayward, California  94545
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Kaiser Permanente Medical Center - Redwood CityRedwood City, California  94063
Kaiser Permanente Medical Center - RichmondRichmond, California  94801
Kaiser Permanente Medical Center - RosevilleRoseville, California  95661
Sutter Cancer Center at Roseville Medical CenterRoseville, California  95661
South Sacramento Kaiser-Permanente Medical CenterSacramento, California  95823
Kaiser Permanente Medical Office -Vandever Medical OfficeSan Diego, California  92120
California Pacific Medical Center - California CampusSan Francisco, California  94118
Kaiser Permanente Medical Center - Santa TeresaSan Jose, California  95119
Kaiser Foundation Hospital - San RafaelSan Rafael, California  94903
Kaiser Permanente Medical Center - Santa RosaSanta Rosa, California  95403
Kaiser Permanente Medical Center - South San FranciscoSouth San Francisco, California  94080
Kaiser Permanente Medical Facility - StocktonStockton, California  95210
Sutter Solano Medical CenterVallejo, California  94589
Kaiser Permanente Medical Center - Walnut CreekWalnut Creek, California  94596
Poudre Valley HospitalFort Collins, Colorado  80524
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
Edward Hospital Cancer CenterNaperville, Illinois  60540
St. Francis Hospital and Health Centers - Beech Grove CampusBeech Grove, Indiana  46107
Genesis Regional Cancer Center at Genesis Medical CenterDavenport, Iowa  52803
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Louisiana State University Health Sciences Center - MonroeMonroe, Louisiana  71210
Feist-Weiller Cancer Center at Louisiana State University Health SciencesShreveport, Louisiana  71130-3932
Bay Regional Medical CenterBay City, Michigan  48708
Mecosta County Medical CenterBig Rapids, Michigan  49307
Providence Cancer Institute at Providence Hospital - Southfield CampusSouthfield, Michigan  48075
Saint Francis Medical CenterCape Girardeau, Missouri  63701
Highland Hospital of RochesterRochester, New York  14620
Iredell Memorial HospitalStatesville, North Carolina  28677
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
Middletown Regional HospitalMiddletown, Ohio  45044
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Legacy Meridian Park HospitalTualatin, Oregon  97062
Bon Secours St. Francis Health SystemGreenville, South Carolina  29601
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Danville Regional Medical CenterDanville, Virginia  24541
Minor and James Medical, PLLCSeattle, Washington  98104
Polyclinic First HillSeattle, Washington  98122
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
North Star Lodge Cancer Center at Yakima Valley Memorial HospitalYakima, Washington  98902
Kaiser Permanente Medical GroupLos Angeles, California  90027
Fairbanks Cancer Treatment Center at Fairbanks Memorial HospitalFairbanks, Alaska  99701
St. Francis HospitalFederal Way, Washington  98003
Cascade Cancer Center at Evergreen Hospital Medical CenterKirkland, Washington  98034-3013
St. Clare HospitalLakewood, Washington  98499-0998
Providence St. Peter Hospital Regional Cancer CenterOlympia, Washington  98506
Good Samaritan Cancer CenterPuyallup, Washington  98371
Allenmore HospitalTacoma, Washington  98411-0414
Highland General HospitalOakland, California  94602
Northeast Georgia Medical CenterGainesville, Georgia  30501
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Randolph HospitalAsheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community HospitalGreensboro, North Carolina  27401
Kaiser Permanente - Deer ValleyAntioch, California  94531
Alta Bates Summit Comprehensive Cancer CenterBerkeley, California  94704
Kaiser Permanente - DenverDenver, Colorado  80205
Kaiser Permanente - Moanalua Medical Center and ClinicHonolulu, Hawaii  96819
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
Cancer Center of Kansas, PA - ChanuteChanute, Kansas  66720
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
Menorah Medical CenterOverland Park, Kansas  66209
Saint Luke's Hospital - SouthOverland Park, Kansas  66213
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
Cotton-O'Neil Cancer CenterTopeka, Kansas  66606
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
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
Heartland Hematology Oncology Associates, IncorporatedKansas City, Missouri  64118
North Kansas City HospitalKansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's HospitalKansas City, Missouri  64111
Research Medical CenterKansas City, Missouri  64132
Saint Luke's East - Lee's SummitLee's Summit, Missouri  64086
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Billings Clinic - DowntownBillings, Montana  59107-7000
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Sletten Cancer Institute at Benefis HealthcareGreat Falls, Montana  59405
Grant Medical Center Cancer CareColumbus, Ohio  43215
Wayne HospitalGreenville, Ohio  45331
Knox Community HospitalMount Vernon, Ohio  43050
Mount Carmel St. Ann's Cancer CenterWesterville, Ohio  43081
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
Salem Hospital Regional Cancer Care ServicesSalem, Oregon  97309-5014
Sandra L. Maxwell Cancer CenterCedar City, Utah  84720
Jon and Karen Huntsman Cancer Center at Intermountain Medical CenterMurray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital CenterOgden, Utah  84403
St. Joseph Cancer CenterBellingham, Washington  98225
Providence Centralia HospitalCentralia, Washington  98531-9027
Columbia Basin HematologyKennewick, Washington  99336
Harrison Poulsbo Hematology and OnocologyPoulsbo, Washington  98370
Evergreen Hematology and Oncology, PSSpokane, Washington  99218
Franciscan Cancer Center at St. Joseph Medical CenterTacoma, Washington  98405-3004
Legacy Salmon Creek Medical CenterVancouver, Washington  98686
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Rocky Mountain OncologyCasper, Wyoming  82609
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
Methodist HospitalHouston, Texas  77030
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Tucker Center for Cancer Care at Orange Regional Medical CenterMiddletown, New York  10940-4199
Pardee Memorial HospitalHendersonville, North Carolina  28791
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris RoadGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical OncologyGreer, South Carolina  29650
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
Kaiser Permanente Medical Center - Anaheim/Orange CountyAnaheim, California  92805
Kaiser Permanente Medical Center - Baldwin ParkBaldwin Park, California  91706
Kaiser Permanente Medical Center - BellflowerBellflower, California  90706
Kaiser Permanente Medical Center - FontanaFontana, California  92335
Kaiser Permanente Medical Center - Harbor CityHarbor City, California  90710
Kaiser Foundation Hospital - West Los AngelesLos Angeles, California  90034
Kaiser Permanente Medical Center - RiversideRiverside, California  92505
Kaiser Permanente Medical Cener - Woodland HillsWoodland Hills, California  91365-4084
Phelps County Regional Medical CenterRolla, Missouri  65401
McLeod Regional Medical CenterFlorence, South Carolina  29501
Highlands Oncology Group - SpringdaleSpringdale, Arkansas  72764
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
St. Charles Medical Center - BendBend, Oregon  97701
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
Parvin Radiation OncologyKansas City, Missouri  64116
Midwest Hematology Oncology Group, IncorporatedSaint Louis, Missouri  63109
Providence Cancer Center at Providence HospitalMobile, Alabama  36608
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Tibotec Therapeutics - Division of Ortho Biotech Products, LPMarysville, California  95901
El Camino Hospital Cancer CenterMountain View, California  94040
Valley Medical Oncology Consultants - PleasantonPleasanton, California  94588
Tahoe Forest Cancer CenterTruckee, California  96161
Mercy General Health PartnersMuskegon, Michigan  49443
United States Air Force Medical Center - Wright-PattersonWright-Patterson AFB, Ohio  45433-5529
AnMed Cancer CenterAnderson, South Carolina  29621
CaroMont Cancer Center at Gaston Memorial HospitalGastonia, North Carolina  28053
Lovelace Medical Center - DowntownAlbuquerque, New Mexico  87102
Self Regional Cancer Center at Self Regional Medical CenterGreenwood, South Carolina  29646
Falck Cancer Center at Arnot Ogden Medical CenterElmira, New York  14905
Baylor University Medical Center - DallasDallas, Texas  75246
CCOP - Kansas CityPrairie Village, Kansas  66208
Clemens Regional Medical CenterMount Clemens, Michigan  48043
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Providence Newberg Medical CenterNewberg, Oregon  97132
Willamette Falls HospitalOregon City, Oregon  97045
Island Hospital Cancer Care Center at Island HospitalAnacortes, Washington  98221
Highline Medical Center Cancer CenterBurien, Washington  98166
Pacific Medical CenterSeattle, Washington  98104
Saint Luke's Mountain States Tumor InstituteBoise, Idaho  83712
Highland ClinicShreveport, Louisiana  71105
Southern Ohio Medical Center Cancer CenterPortsmouth, Ohio  45662
McLaren Cancer InstituteFlint, Michigan  48532
Baylor Medical Center at IrvingIrving, Texas  75061
Saint Luke's Mountain States Tumor Institute - FruitlandFruitland, Idaho  83619
Mountain States Tumor Institute - MeridianMeridian, Idaho  83642
Mountain States Tumor Institute at St. Luke'sTwin Falls, Idaho  83301
Central Care Cancer Center at Carrie J. Babb Cancer CenterBolivar, Missouri  65613
Kaiser Permanente Health CareSan Marcos, California  92069
Spectrum Health Reed City HospitalReed City, Michigan  49677
Providence Regional Cancer PartnershipEverett, Washington  98201
Carolina Blood and Cancer Care Associates, PALancaster, South Carolina  29720
Carolina Blood and Cancer CareRock Hill, South Carolina  29732
Kaiser Permanente Medical Center - VacavilleVacaville, California  95688
St. Joseph Regional Medical CenterLewiston, Idaho  83501
Swedish Medical Center - Issaquah CampusIssaquah, Washington  98029
Kaiser Permanente - IrvineIrvine, California  92618
Kaiser Permanente Fresno Medical CenterFresno, California  93720
Epic Care - OaklandOakland, California  94612
Singh and Arora Hematology Oncology, PCFlint, Michigan  48532
Great Lakes Cancer Institute - Lapeer CampusLapeer, Michigan  48446
Mercy Cancer Center at Mercy Medical CenterMerced, California  95340
CHRISTUS Cabrini Cancer CenterAlexandria, Louisiana  71301
Sutter Pacific Medical FoundationSanta Rosa, California  95403