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NCT07283939NARecruitingAccepts Healthy Volunteers

Studying the PAGODA Algorithm for Chemotherapy Dose Changes to Prevent Unplanned Treatment Delays

Alliance for Clinical Trials in Oncology

Start Date

2/13/2026

Completion Date

5/2/2030

Summary

This study seeks to learn whether using the PAGODA algorithm to guide chemotherapy dosing will lower the chance of unplanned delays during chemotherapy for cancer in the gastrointestinal system compared to usual care.

Detailed Description

The primary and secondary objectives of the study: PRIMARY OBJECTIVE: I. To compare the proportion of chemotherapy cycles with unplanned delays in patients receiving FOLFOX chemotherapy under standardized usual care (control) versus (vs) according to the PAGODA dose modification algorithm (intervention). SECONDARY OBJECTIVES: I. To compare the mean number of health care contact days (time toxicity) for patients receiving FOLFOX chemotherapy according to assignment to the control vs intervention arms. II. To compare the incidence moderate-to-severe neutropenia (absolute neutrophil count less than 1000/mm3 in patients receiving FOLFOX chemotherapy according to assignment to the control vs intervention arms. III. To compare the relative dose-intensity of bolus 5-FU, oxaliplatin, and infusional 5-FU in patients receiving FOLFOX chemotherapy according to assignment to the control vs intervention arms, both overall and among the subgroup of participants treated with curative intent. OUTLINE: This is an interventional study. Patients are randomized to 1 of 2 arms. ARM A: Patients receive chemotherapy delays and dose modifications at the discretion of the treating clinician during cycles 2-7 of SOC FOLFOX chemotherapy on study. ARM B: Patients receive chemotherapy delays and dose modifications based on PAGODA algorithm followed by treating clinician decision during cycles 2-7 of SOC FOLFOX chemotherapy on study.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * \* REGISTRATION ELIGIBILITY CRITERIA (STEP 1) * Histologic confirmation of invasive cancer that is confirmed or suspected to arise from the gastrointestinal (GI) tract * Any stage for which FOLFOX-based chemotherapy is a clinically-indicated, standard-of-care treatment (adjuvant, neoadjuvant, or first-line chemotherapy) * Eligible primary tumor sites include the esophagus, gastroesophageal junction, stomach, small intestine, ampulla of Vater, appendix, colon, rectum, and cancers of unknown primary with suspected GI origin * Prior systemic therapy for GI cancer (other than cycle 1 of FOLFOX-based chemotherapy) is not allowed. Prior radiation-sensitizing chemotherapy is permitted * The planned duration of FOLFOX-based chemotherapy must be at least four cycles (1 cycle = 14 days) * Cycle 1, day 1 of FOLFOX-based chemotherapy must be completed 1 to 8 days prior to registration * Cycle 1, day 1 of FOLFOX-based chemotherapy must include minimum ordered doses of oxaliplatin (≥ 65 mg/m\^2) and infusional 5-FU (2400 mg/m\^2/46 hours). Use of the 5-FU bolus is at the discretion of the treating physician * Patients who require primary prophylactic white blood cell growth factor with cycle 1 of FOLFOX chemotherapy due to high risk for fever and neutropenia are not eligible * History of hypersensitivity reaction to oxaliplatin or other platinum-based drugs, to fluorouracil, or to leucovorin, and the excipients in their formulations are not eligible * Age ≥ 18 years * ECOG performance status ≤ 2 * Absolute neutrophil count (ANC) ≥ 1,000/mm\^3 * Platelet count ≥ 100,000/mm\^3 * Total bilirubin ≤ 3 x upper limit of normal (ULN) * AST (SGOT)/ALT (SGPT) ≤ 5 x upper limit of normal (ULN) * Calc. creatinine clearance ≥ 30 mL/min * Not pregnant and not nursing, because this study involves agents that have known genotoxic, mutagenic and teratogenic effects. Therefore, for women of childbearing potential only, a negative pregnancy test done ≤ 30 days prior to registration is required * Patients with treated brain metastases are eligible if follow-up brain imaging after CNS-directed therapy shows no evidence of progression * Patients with known HIV infection are eligible if receiving effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration * Patients with known chronic hepatitis B virus (HBV) infection are eligible if HBV DNA is undetectable when measured within 6 months prior to registration * Patients with a known history of hepatitis C virus (HCV) infection are eligible if HCV RNA is undetectable when measured at least 12 weeks after completion of antiviral therapy * Patients with known history or current symptoms of cardiac disease are eligible if the New York Heart Association Functional Classification is class I or II * Patients with a known history of congenital long QT syndrome are ineligible * Patients with known DPD deficiency are ineligible * \* NON-PATIENT (ONCOLOGY PHYSICIAN OR ONCOLOGY ADVANCED PRACTICE PROVIDER ELIGIBILITY: * The non-patient provider participant is a medical oncologist or oncology advanced practice provider with responsibility for signing and making necessary modifications to chemotherapy orders for a subject assigned to the intervention arm (Arm B). Non-patient participants may not be enrolled more than once over the course of the study * The non-patient participant must be proficient in the English language * The non-patient participant must be age 21 years or older

Interventions

OTHER

PAGODA algorithm

DRUG

Oxaliplatin

DRUG

Folinic Acid

DRUG

Fluorouracil

Interested in This Trial?

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Conditions

Ampulla of Vater CarcinomaAppendix CarcinomaCarcinoma of Unknown Primary With Gastrointestinal ProfileColon CarcinomaEsophageal CarcinomaGastric CarcinomaGastroesophageal Junction CarcinomaMalignant Digestive System NeoplasmRectal CarcinomaSmall Intestinal Carcinoma

Locations

Fairbanks Memorial Hospital

Fairbanks, Alaska 99701

United States

Cancer Center at Saint Joseph's

Phoenix, Arizona 85004

United States

Mercy Hospital Fort Smith

Fort Smith, Arkansas 72903

United States

NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro

Jonesboro, Arkansas 72401

United States

CARTI Cancer Center

Little Rock, Arkansas 72205

United States

Mission Hope Medical Oncology - Arroyo Grande

Arroyo Grande, California 93420

United States

Mercy Cancer Center - Carmichael

Carmichael, California 95608

United States

Mercy San Juan Medical Center

Carmichael, California 95608

United States

Mercy Cancer Center - Elk Grove

Elk Grove, California 95758

United States

Mercy Cancer Center

Merced, California 95340

United States

Mercy Cancer Center - Rocklin

Rocklin, California 95765

United States

Mercy Cancer Center - Sacramento

Sacramento, California 95816

United States

Pacific Central Coast Health Center-San Luis Obispo

San Luis Obispo, California 93401

United States

Mission Hope Medical Oncology - Santa Maria

Santa Maria, California 93444

United States

Saint Joseph's Medical Center

Stockton, California 95204

United States

Woodland Memorial Hospital

Woodland, California 95695

United States

Penrose-Saint Francis Healthcare

Colorado Springs, Colorado 80907

United States

Rocky Mountain Cancer Centers-Penrose

Colorado Springs, Colorado 80907

United States

Saint Francis Cancer Center

Colorado Springs, Colorado 80923

United States

CommonSpirit Cancer Center Mercy

Durango, Colorado 81301

United States

Mercy Medical Center

Durango, Colorado 81301

United States

CommonSpirit Saint Anthony Hospital Cancer Center

Lakewood, Colorado 80228

United States

Longmont United Hospital

Longmont, Colorado 80501

United States

Saint Mary Corwin Medical Center

Pueblo, Colorado 81004

United States

Saint Anthony North Hospital

Westminster, Colorado 80023

United States

Beebe Medical Center

Lewes, Delaware 19958

United States

Beebe South Coastal Health Campus

Millville, Delaware 19967

United States

Helen F Graham Cancer Center

Newark, Delaware 19713

United States

Medical Oncology Hematology Consultants PA

Newark, Delaware 19713

United States

Christiana Care Health System-Christiana Hospital

Newark, Delaware 19718

United States

Beebe Health Campus

Rehoboth Beach, Delaware 19971

United States

Christiana Care Health System-Wilmington Hospital

Wilmington, Delaware 19801

United States

Holy Cross Hospital

Fort Lauderdale, Florida 33308

United States

Northside Hospital

Atlanta, Georgia 30342

United States

Tift Regional Medical Center

Tifton, Georgia 31794

United States

Saint Alphonsus Cancer Care Center-Boise

Boise, Idaho 83706

United States

Saint Alphonsus Cancer Care Center-Caldwell

Caldwell, Idaho 83605

United States

Kootenai Health - Coeur d'Alene

Coeur d'Alene, Idaho 83814

United States

Idaho Urologic Institute-Meridian

Meridian, Idaho 83642

United States

Saint Alphonsus Cancer Care Center-Nampa

Nampa, Idaho 83687

United States

Kootenai Clinic Cancer Services - Post Falls

Post Falls, Idaho 83854

United States

Kootenai Clinic Cancer Services - Sandpoint

Sandpoint, Idaho 83864

United States

OSF Saint Anthony's Health Center

Alton, Illinois 62002

United States

Illinois CancerCare-Bloomington

Bloomington, Illinois 61704

United States

Illinois CancerCare-Canton

Canton, Illinois 61520

United States

Memorial Hospital of Carbondale

Carbondale, Illinois 62902

United States

SIH Cancer Institute

Carterville, Illinois 62918

United States

Illinois CancerCare-Carthage

Carthage, Illinois 62321

United States

Centralia Oncology Clinic

Centralia, Illinois 62801

United States

Saint Mary's Hospital

Centralia, Illinois 62801

United States

Carle at The Riverfront

Danville, Illinois 61832

United States

Cancer Care Specialists of Illinois - Decatur

Decatur, Illinois 62526

United States

Decatur Memorial Hospital

Decatur, Illinois 62526

United States

Illinois CancerCare-Dixon

Dixon, Illinois 61021

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Crossroads Cancer Center

Effingham, Illinois 62401

United States

Illinois CancerCare-Eureka

Eureka, Illinois 61530

United States

Illinois CancerCare-Galesburg

Galesburg, Illinois 61401

United States

Illinois CancerCare-Kewanee Clinic

Kewanee, Illinois 61443

United States

Illinois CancerCare-Macomb

Macomb, Illinois 61455

United States

Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois 61938

United States

SSM Health Good Samaritan

Mount Vernon, Illinois 62864

United States

Carle BroMenn Medical Center

Normal, Illinois 61761

United States

Carle Cancer Institute Normal

Normal, Illinois 61761

United States

Cancer Care Center of O'Fallon

O'Fallon, Illinois 62269

United States

HSHS Saint Elizabeth's Hospital

O'Fallon, Illinois 62269

United States

Illinois CancerCare-Ottawa Clinic

Ottawa, Illinois 61350

United States

Illinois CancerCare-Pekin

Pekin, Illinois 61554

United States

Illinois CancerCare-Peoria

Peoria, Illinois 61615

United States

Illinois CancerCare-Peru

Peru, Illinois 61354

United States

Valley Radiation Oncology

Peru, Illinois 61354

United States

Illinois CancerCare-Princeton

Princeton, Illinois 61356

United States

Southern Illinois University School of Medicine

Springfield, Illinois 62702

United States

Springfield Clinic

Springfield, Illinois 62702

United States

Springfield Memorial Hospital

Springfield, Illinois 62781

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

Illinois CancerCare - Washington

Washington, Illinois 61571

United States

Northwest Cancer Center - Crown Point

Crown Point, Indiana 46307

United States

Northwest Oncology LLC

Dyer, Indiana 46311

United States

Northwest Cancer Center - Hobart

Hobart, Indiana 46342

United States

Saint Mary Medical Center

Hobart, Indiana 46342

United States

Saint Catherine Hospital

Indianapolis, Indiana 46312

United States

The Community Hospital

Munster, Indiana 46321

United States

Women's Diagnostic Center - Munster

Munster, Indiana 46321

United States

Northwest Cancer Center - Valparaiso

Valparaiso, Indiana 46383

United States

Mary Greeley Medical Center

Ames, Iowa 50010

United States

McFarland Clinic - Ames

Ames, Iowa 50010

United States

UI Health Care Mission Cancer and Blood - Ankeny Clinic

Ankeny, Iowa 50023

United States

McFarland Clinic - Boone

Boone, Iowa 50036

United States

Mercy Hospital

Cedar Rapids, Iowa 52403

United States

Oncology Associates at Mercy Medical Center

Cedar Rapids, Iowa 52403

United States

Mercy Cancer Center-West Lakes

Clive, Iowa 50325

United States

Greater Regional Medical Center

Creston, Iowa 50801

United States

Iowa Methodist Medical Center

Des Moines, Iowa 50309

United States

UI Health Care Mission Cancer and Blood - Des Moines Clinic

Des Moines, Iowa 50309

United States

Broadlawns Medical Center

Des Moines, Iowa 50314

United States

Mercy Medical Center - Des Moines

Des Moines, Iowa 50314

United States

UI Health Care Mission Cancer and Blood - Laurel Clinic

Des Moines, Iowa 50314

United States

McFarland Clinic - Trinity Cancer Center

Fort Dodge, Iowa 50501

United States

McFarland Clinic - Jefferson

Jefferson, Iowa 50129

United States

McFarland Clinic - Marshalltown

Marshalltown, Iowa 50158

United States

UI Health Care Mission Cancer and Blood - Waukee Clinic

Waukee, Iowa 50263

United States

Mercy Medical Center-West Lakes

West Des Moines, Iowa 50266

United States

Central Care Cancer Center - Garden City

Garden City, Kansas 67846

United States

Central Care Cancer Center - Great Bend

Great Bend, Kansas 67530

United States

University of Kansas Cancer Center-Overland Park

Overland Park, Kansas 66210

United States

Mercy Hospital Pittsburg

Pittsburg, Kansas 66762

United States

CommonSpirit Saint Joseph Hospital - Bardstown

Bardstown, Kentucky 40004

United States

Commonwealth Cancer Center-Corbin

Corbin, Kentucky 40701

United States

CommonSpirit Saint Joseph Hospital - Lexington

Lexington, Kentucky 40504

United States

Saint Joseph Radiation Oncology Resource Center

Lexington, Kentucky 40504

United States

CommonSpirit Saint Joseph Medical Center - East Lexington

Lexington, Kentucky 40509

United States

CommonSpirit Saint Joseph Hospital London

London, Kentucky 40741

United States

CommonSpirit Saint Joseph Hospital Mount Sterling

Mount Sterling, Kentucky 40353

United States

MaineHealth Cancer Care and IV Therapy - Brunswick

Brunswick, Maine 04011

United States

MaineHealth Cancer Care Center of York County

Sanford, Maine 04073

United States

MaineHealth Maine Medical Center- Scarborough

Scarborough, Maine 04074

United States

MaineHealth Cancer Care and IV Therapy - South Portland

South Portland, Maine 04106

United States

Christiana Care - Union Hospital

Elkton, Maryland 21921

United States

MyMichigan Medical Center Gratiot

Alma, Michigan 48801

United States

MyMichigan Medical Center Alpena

Alpena, Michigan 49707

United States

Trinity Health IHA - Obstetrics and Gynecology West Arbor

Ann Arbor, Michigan 48103

United States

Trinity Health Saint Joseph Mercy Hospital Ann Arbor

Ann Arbor, Michigan 48106

United States

Bronson Battle Creek

Battle Creek, Michigan 49017

United States

Trinity Health IHA Medical Group Hematology Oncology - Brighton

Brighton, Michigan 48114

United States

Trinity Health Medical Center - Brighton

Brighton, Michigan 48114

United States

Trinity Health IHA Medical Group Hematology Oncology - Canton

Canton, Michigan 48188

United States

Trinity Health Medical Center - Canton

Canton, Michigan 48188

United States

Chelsea Hospital

Chelsea, Michigan 48118

United States

Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital

Chelsea, Michigan 48118

United States

Hematology Oncology Consultants-Clarkston

Clarkston, Michigan 48346

United States

Newland Medical Associates-Clarkston

Clarkston, Michigan 48346

United States

Henry Ford Health Saint John Hospital

Detroit, Michigan 48236

United States

Henry Ford River District Hospital

East China Township, Michigan 48054

United States

OSF Saint Francis Hospital and Medical Group

Escanaba, Michigan 49829

United States

Cancer Hematology Centers - Flint

Flint, Michigan 48503

United States

Genesee Hematology Oncology PC

Flint, Michigan 48503

United States

Genesys Hurley Cancer Institute

Flint, Michigan 48503

United States

Hurley Medical Center

Flint, Michigan 48503

United States

MyMichigan Medical Center Gladwin

Gladwin, Michigan 48624

United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital

Grand Rapids, Michigan 49503

United States

Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

Grand Rapids, Michigan 49503

United States

Trinity Health Grand Rapids Hospital

Grand Rapids, Michigan 49503

United States

Henry Ford Saint John Hospital - Academic

Grosse Pointe Woods, Michigan 48236

United States

Henry Ford Saint John Hospital - Breast

Grosse Pointe Woods, Michigan 48236

United States

Henry Ford Saint John Hospital - Van Elslander

Grosse Pointe Woods, Michigan 48236

United States

Bronson Methodist Hospital

Kalamazoo, Michigan 49007

United States

West Michigan Cancer Center

Kalamazoo, Michigan 49007

United States

Beacon Kalamazoo Cancer Center

Kalamazoo, Michigan 49009

United States

Beacon Kalamazoo

Kalamazoo, Michigan 49048

United States

University of Michigan Health - Sparrow Lansing

Lansing, Michigan 48912

United States

Trinity Health Saint Mary Mercy Livonia Hospital

Livonia, Michigan 48154

United States

Henry Ford Saint John Hospital - Macomb Medical

Macomb, Michigan 48044

United States

Henry Ford Warren Hospital - Breast Macomb

Macomb, Michigan 48044

United States

Schoolcraft Memorial Hospital

Manistique, Michigan 49854

United States

MyMichigan Medical Center Midland

Midland, Michigan 48670

United States

MyMichigan Medical Center Mount Pleasant

Mount Pleasant, Michigan 48858

United States

Trinity Health Muskegon Hospital

Muskegon, Michigan 49444

United States

Corewell Health Lakeland Hospitals - Niles Hospital

Niles, Michigan 49120

United States

Cancer and Hematology Centers of Western Michigan - Norton Shores

Norton Shores, Michigan 49444

United States

Hope Cancer Center

Pontiac, Michigan 48341

United States

Michigan Healthcare Professionals Pontiac

Pontiac, Michigan 48341

United States

Newland Medical Associates-Pontiac

Pontiac, Michigan 48341

United States

Trinity Health Saint Joseph Mercy Oakland Hospital

Pontiac, Michigan 48341

United States

Corewell Health Reed City Hospital

Reed City, Michigan 49677

United States

MyMichigan Medical Center Saginaw

Saginaw, Michigan 48601

United States

Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

Saint Joseph, Michigan 49085

United States

Corewell Health Lakeland Hospitals - Saint Joseph Hospital

Saint Joseph, Michigan 49085

United States

MyMichigan Medical Center Tawas

Tawas City, Michigan 48764

United States

Munson Medical Center

Traverse City, Michigan 49684

United States

Henry Ford Health Warren Hospital

Warren, Michigan 48093

United States

Henry Ford Madison Heights Hospital - Breast

Warren, Michigan 48093

United States

Henry Ford Warren Hospital - GLCMS

Warren, Michigan 48093

United States

University of Michigan Health - West

Wyoming, Michigan 49519

United States

Huron Gastroenterology PC

Ypsilanti, Michigan 48106

United States

Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus

Ypsilanti, Michigan 48197

United States

Riverwood Healthcare Center

Aitkin, Minnesota 56431

United States

Essentia Health - Baxter Clinic

Baxter, Minnesota 56425

United States

Sanford Joe Lueken Cancer Center

Bemidji, Minnesota 56601

United States

Essentia Health Saint Joseph's Medical Center

Brainerd, Minnesota 56401

United States

Minnesota Oncology - Burnsville

Burnsville, Minnesota 55337

United States

Minnesota Oncology Hematology PA-Chaska

Chaska, Minnesota 55318

United States

Mercy Hospital

Coon Rapids, Minnesota 55433

United States

Minnesota Oncology - Coon Rapids

Coon Rapids, Minnesota 55433

United States

Essentia Health - Saint Joseph's Crosslake Clinic

Crosslake, Minnesota 56442

United States

Essentia Health - Deer River Clinic

Deer River, Minnesota 56636

United States

Essentia Health Saint Mary's - Detroit Lakes Clinic

Detroit Lakes, Minnesota 56501

United States

Essentia Health Cancer Center

Duluth, Minnesota 55805

United States

Essentia Health Saint Mary's Medical Center

Duluth, Minnesota 55805

United States

Miller-Dwan Hospital

Duluth, Minnesota 55805

United States

Fairview Southdale Hospital

Edina, Minnesota 55435

United States

Minnesota Oncology - Edina

Edina, Minnesota 55435

United States

Essentia Health - Ely Clinic

Ely, Minnesota 55731

United States

Essentia Health - Fosston

Fosston, Minnesota 56542

United States

Essentia Health Hibbing Clinic

Hibbing, Minnesota 55746

United States

Essentia Health - International Falls Clinic

International Falls, Minnesota 56649

United States

Fairview Clinics and Surgery Center Maple Grove

Maple Grove, Minnesota 55369

United States

Minnesota Oncology - Maple Grove

Maple Grove, Minnesota 55369

United States

Minnesota Oncology Hematology PA-Maplewood

Maplewood, Minnesota 55109

United States

Saint John's Hospital - Healtheast

Maplewood, Minnesota 55109

United States

Abbott-Northwestern Hospital

Minneapolis, Minnesota 55407

United States

Hennepin County Medical Center

Minneapolis, Minnesota 55415

United States

Essentia Health - Moose Lake Clinic

Moose Lake, Minnesota 55767

United States

New Ulm Medical Center

New Ulm, Minnesota 56073

United States

Essentia Health - Park Rapids

Park Rapids, Minnesota 56470

United States

Essentia Health - Saint Joseph's Pequot Lakes Clinic

Pequot Lakes, Minnesota 56472

United States

Essentia Health - Saint Joseph's Pine River Clinic

Pine River, Minnesota 56474

United States

Fairview Northland Medical Center

Princeton, Minnesota 55371

United States

North Memorial Medical Health Center

Robbinsdale, Minnesota 55422

United States

Park Nicollet Clinic - Saint Louis Park

Saint Louis Park, Minnesota 55416

United States

Regions Hospital

Saint Paul, Minnesota 55101

United States

United Hospital

Saint Paul, Minnesota 55102

United States

Essentia Health Sandstone

Sandstone, Minnesota 55072

United States

Saint Francis Regional Medical Center

Shakopee, Minnesota 55379

United States

Essentia Health - Saint Joseph's Staples Clinic

Staples, Minnesota 56479

United States

Lakeview Hospital

Stillwater, Minnesota 55082

United States

Sanford Thief River Falls Medical Center

Thief River Falls, Minnesota 56701

United States

Essentia Health Virginia Clinic

Virginia, Minnesota 55792

United States

Ridgeview Medical Center

Waconia, Minnesota 55387

United States

Rice Memorial Hospital

Willmar, Minnesota 56201

United States

Minnesota Oncology Hematology PA-Woodbury

Woodbury, Minnesota 55125

United States

Sanford Cancer Center Worthington

Worthington, Minnesota 56187

United States

Fairview Lakes Medical Center

Wyoming, Minnesota 55092

United States

Baptist Memorial Hospital and Cancer Center-Golden Triangle

Columbus, Mississippi 39705

United States

Baptist Cancer Center-Grenada

Grenada, Mississippi 38901

United States

Baptist Memorial Hospital and Cancer Center-Union County

New Albany, Mississippi 38652

United States

Baptist Memorial Hospital and Cancer Center-Oxford

Oxford, Mississippi 38655

United States

Baptist Memorial Hospital and Cancer Center-Desoto

Southhaven, Mississippi 38671

United States

Mercy Oncology and Hematology - Clayton-Clarkson

Ballwin, Missouri 63011

United States

Central Care Cancer Center - Bolivar

Bolivar, Missouri 65613

United States

Cox Cancer Center Branson

Branson, Missouri 65616

United States

Mercy Cancer Center - Cape Girardeau

Cape Girardeau, Missouri 63703

United States

Saint Francis Medical Center

Cape Girardeau, Missouri 63703

United States

Parkland Health Center - Farmington

Farmington, Missouri 63640

United States

Freeman Health System

Joplin, Missouri 64804

United States

Mercy Hospital Joplin

Joplin, Missouri 64804

United States

Lake Regional Hospital

Osage Beach, Missouri 65065

United States

Mercy Clinic-Rolla-Cancer and Hematology

Rolla, Missouri 65401

United States

Phelps Health Delbert Day Cancer Institute

Rolla, Missouri 65401

United States

Heartland Regional Medical Center

Saint Joseph, Missouri 64506

United States

Sainte Genevieve County Memorial Hospital

Sainte Genevieve, Missouri 63670

United States

Mercy Hospital Springfield

Springfield, Missouri 65804

United States

CoxHealth South Hospital

Springfield, Missouri 65807

United States

Mercy Infusion Center - Chippewa

St Louis, Missouri 63109

United States

Mercy Hospital South

St Louis, Missouri 63128

United States

Missouri Baptist Medical Center

St Louis, Missouri 63131

United States

Mercy Hospital Saint Louis

St Louis, Missouri 63141

United States

Missouri Baptist Sullivan Hospital

Sullivan, Missouri 63080

United States

BJC Outpatient Center at Sunset Hills

Sunset Hills, Missouri 63127

United States

Mercy Hospital Washington

Washington, Missouri 63090

United States

Community Hospital of Anaconda

Anaconda, Montana 59711

United States

Billings Clinic Cancer Center

Billings, Montana 59101

United States

Bozeman Health Deaconess Hospital

Bozeman, Montana 59715

United States

Benefis Sletten Cancer Institute

Great Falls, Montana 59405

United States

Great Falls Clinic

Great Falls, Montana 59405

United States

Hi-Line Sletten Cancer Center

Havre, Montana 59501

United States

Benefis Helena Specialty Center

Helena, Montana 59601

United States

Logan Health Medical Center

Kalispell, Montana 59901

United States

Community Medical Center

Missoula, Montana 59804

United States

CHI Health Saint Francis

Grand Island, Nebraska 68803

United States

CHI Health Good Samaritan

Kearney, Nebraska 68847

United States

Alegent Health Immanuel Medical Center

Omaha, Nebraska 68122

United States

Alegent Health Bergan Mercy Medical Center

Omaha, Nebraska 68124

United States

Alegent Health Lakeside Hospital

Omaha, Nebraska 68130

United States

University of New Mexico Cancer Center

Albuquerque, New Mexico 87106

United States

James J Peters VA Medical Center

The Bronx, New York 10468

United States

FirstHealth of the Carolinas-Moore Regional Hospital

Pinehurst, North Carolina 28374

United States

Sanford Bismarck Medical Center

Bismarck, North Dakota 58501

United States

Essentia Health Cancer Center-South University Clinic

Fargo, North Dakota 58103

United States

Sanford South University Medical Center

Fargo, North Dakota 58103

United States

Southpointe-Sanford Medical Center Fargo

Fargo, North Dakota 58103

United States

Sanford Medical Center Fargo

Fargo, North Dakota 58104

United States

Sanford Broadway Medical Center

Fargo, North Dakota 58122

United States

Sanford Roger Maris Cancer Center

Fargo, North Dakota 58122

United States

Essentia Health - Jamestown Clinic

Jamestown, North Dakota 58401

United States

Good Samaritan Hospital - Cincinnati

Cincinnati, Ohio 45220

United States

Bethesda North Hospital

Cincinnati, Ohio 45242

United States

TriHealth Cancer Institute-Westside

Cincinnati, Ohio 45247

United States

TriHealth Cancer Institute-Anderson

Cincinnati, Ohio 45255

United States

Mercy Hospital Oklahoma City

Oklahoma City, Oklahoma 73120

United States

Saint Alphonsus Cancer Care Center-Baker City

Baker City, Oregon 97814

United States

Saint Alphonsus Cancer Care Center-Ontario

Ontario, Oregon 97914

United States

Lehigh Valley Hospital-Cedar Crest

Allentown, Pennsylvania 18103

United States

Lehigh Valley Hospital - Muhlenberg

Bethlehem, Pennsylvania 18017

United States

Christiana Care Health System-Concord Health Center

Chadds Ford, Pennsylvania 19317

United States

Pocono Medical Center

East Stroudsburg, Pennsylvania 18301

United States

Lehigh Valley Hospital-Hazleton

Hazleton, Pennsylvania 18201

United States

Prisma Health Cancer Institute - Spartanburg

Boiling Springs, South Carolina 29316

United States

Prisma Health Cancer Institute - Easley

Easley, South Carolina 29640

United States

Prisma Health Cancer Institute - Butternut

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Faris

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Eastside

Greenville, South Carolina 29615

United States

Prisma Health Cancer Institute - Greer

Greer, South Carolina 29650

United States

Prisma Health Cancer Institute - Seneca

Seneca, South Carolina 29672

United States

Sanford Cancer Center Oncology Clinic

Sioux Falls, South Dakota 57104

United States

Sanford USD Medical Center - Sioux Falls

Sioux Falls, South Dakota 57117-5134

United States

Baptist Memorial Hospital and Cancer Center-Collierville

Collierville, Tennessee 38017

United States

Baptist Memorial Hospital and Cancer Center-Memphis

Memphis, Tennessee 38120

United States

VCU Massey Comprehensive Cancer Center

Richmond, Virginia 23298

United States

VCU Community Memorial Health Center

South Hill, Virginia 23970

United States

VCU Health Tappahannock Hospital

Tappahannock, Virginia 22560

United States

Saint Joseph Medical Center Hematology and Oncology - Silverdale

Silverdale, Washington 98383

United States

Aspirus Cancer Care-Antigo-Volm Cancer Center

Antigo, Wisconsin 54409

United States

Ascension Northeast Wisconsin-Saint Elizabeth Cancer Center-Appleton

Appleton, Wisconsin 54915

United States

Duluth Clinic Ashland

Ashland, Wisconsin 54806

United States

Northwest Wisconsin Cancer Center

Ashland, Wisconsin 54806

United States

Ascension Southeast Wisconsin Hospital-Elmbrook Campus-Brookfield

Brookfield, Wisconsin 53045

United States

Ascension Calumet Hospital-Chilton

Chilton, Wisconsin 53014

United States

Ascension Southeast Wisconsin Hospital - Franklin

Franklin, Wisconsin 53132

United States

Reiman Cancer Center-Ascension Wisconsin Health Center-Rawson

Franklin, Wisconsin 53132

United States

Saint Vincent Hospital Cancer Center Green Bay

Green Bay, Wisconsin 54301

United States

Saint Vincent Hospital Cancer Center at Saint Mary's

Green Bay, Wisconsin 54303

United States

Essentia Health-Hayward Clinic

Hayward, Wisconsin 54843

United States

Tamarack Health Hayward Medical Center

Hayward, Wisconsin 54843

United States

Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

United States

Aspirus Medford Hospital

Medford, Wisconsin 54451

United States

Ascension Columbia Saint Mary's Hospital-Ozaukee Campus-Mequon

Mequon, Wisconsin 53097

United States

Ascension Southeast Wisconsin Hospital-Saint Joseph-Milwaukee

Milwaukee, Wisconsin 53210

United States

Ascension Columbia Saint Mary's Hospital-Milwaukee Campus

Milwaukee, Wisconsin 53211

United States

Ascension Saint Francis Hospital-Milwaukee

Milwaukee, Wisconsin 53215

United States

Cancer Center of Western Wisconsin

New Richmond, Wisconsin 54017

United States

Saint Vincent Hospital Cancer Center at Oconto Falls

Oconto Falls, Wisconsin 54154

United States

Ascension Northeast Wisconsin-Mercy Hospital-Oshkosh

Oshkosh, Wisconsin 54904

United States

Ascension All Saints Hospital-Spring Street-Racine

Racine, Wisconsin 53405

United States

Aspirus Cancer Care-Rhinelander-James Beck Cancer Center

Rhinelander, Wisconsin 54501

United States

Saint Vincent Hospital Cancer Center at Sheboygan

Sheboygan, Wisconsin 53081

United States

Sheboygan Physicians Group

Sheboygan, Wisconsin 53081

United States

Essentia Health-Spooner Clinic

Spooner, Wisconsin 54801

United States

Aspirus Cancer Care - Stevens Point

Stevens Point, Wisconsin 54481

United States

Saint Vincent Hospital Cancer Center at Sturgeon Bay

Sturgeon Bay, Wisconsin 54235-1495

United States

Essentia Health Saint Mary's Hospital - Superior

Superior, Wisconsin 54880

United States

Aspirus Cancer Care-Wausau

Wausau, Wisconsin 54401

United States

Ascension Southeast Wisconsin Hospital-Mayfair Road-Wauwatosa

Wauwatosa, Wisconsin 53226

United States

Aspirus Cancer Care - Wisconsin Rapids

Wisconsin Rapids, Wisconsin 54494

United States

Memorial Hospital of Laramie County

Cheyenne, Wyoming 82001

United States

Billings Clinic-Cody

Cody, Wyoming 82414

United States

FHP Health Center-Guam

Tamuning, 96913

Guam

Cancer Center-Metro Medical Center Bayamon

Bayamón, 00959-5060

Puerto Rico

Puerto Rico Hematology Oncology Group

Bayamón, 00961

Puerto Rico

Doctors Cancer Center

Manati, 00674

Puerto Rico

San Juan Community Oncology Group

San Juan, 00917

Puerto Rico

Centro Comprensivo de Cancer de UPR

San Juan, 00927

Puerto Rico

PROncology

San Juan, 00927

Puerto Rico

San Juan City Hospital

San Juan, 00936

Puerto Rico