The Use of American Ginseng (Panax Quinquefolius) to Improve Cancer-Related Fatigue: A Randomized, Double-Blind, Placebo-Controlled Phase III Study
Phase 3
18 Years
N/A
18 Years
N/A
Open (Enrolling)
Both
Chronic Myeloproliferative Disorders, Fatigue, Leukemia, Lymphoma, Lymphoproliferative Disorder, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Neoplasms, Precancerous Condition, Unspecified Adult Solid Tumor, Protocol Specific
Both
Chronic Myeloproliferative Disorders, Fatigue, Leukemia, Lymphoma, Lymphoproliferative Disorder, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Neoplasms, Precancerous Condition, Unspecified Adult Solid Tumor, Protocol Specific
Trial Information
The Use of American Ginseng (Panax Quinquefolius) to Improve Cancer-Related Fatigue: A Randomized, Double-Blind, Placebo-Controlled Phase III Study
OBJECTIVES:
Primary
- To evaluate the efficacy of American ginseng (Panax quinquefolius) as therapy for
cancer-related fatigue as measured by the general subscale of the Multidimensional
Fatigue Symptom Inventory-Short Form (MFSI-SF).
Secondary
- To evaluate toxicities and tolerability of American ginseng when used for
cancer-related fatigue.
- To examine stress as a mediating variable on the effects of American ginseng on
cancer-related fatigue.
- To explore the impact of American ginseng on various dimensions of fatigue as measured
by the other subscales of the MFSI-SF, functional interference as measured by the Brief
Fatigue Inventory (BFI), stress as measured by the Perceived Stress Scale, and well
being as measured by the Profile of Mood States (POMS), as well as the single measure
of fatigue.
- To determine clinically significant changes in fatigue scores using the global
impression of change.
- To evaluate whether there are differences in the efficacy of American ginseng for
fatigue based on minority populations.
Tertiary
- To describe cortisol and cytokine values in fatigued cancer survivors and to evaluate
the relationship of cortisol and cytokines to fatigue severity as well as to patterns
of alterations previously documented in fatigued breast cancer survivors.
- To evaluate whether Wisconsin Ginseng impacts the expression of cortisol and cytokine
in fatigued cancer survivors.
- To evaluate the role of cortisol and cytokine changes as the mechanism by which
Wisconsin Ginseng can ameliorate cancer related fatigue.
- To evaluate the relationships between cytokine and cortisol levels with secondary
outcomes such as mood and stress.
OUTLINE: This is a multicenter study. Patients are stratified according to baseline fatigue
score (4-7 vs 8-10), disease status of current cancer (initial diagnosis vs recurrent
disease), current treatment (chemotherapy, radiation, endocrine therapy [i.e., tamoxifen or
aromatase inhibitors], or other targeted therapy) ( yes vs no), duration of all prior cancer
treatment in patient's lifetime (none vs ≤ 180 days vs > 180 days), and current tumor type
(hematologic vs solid tumor malignancy). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive oral American ginseng twice daily for 14 days. Treatment
repeats every 2 weeks for 4 courses until disease progression or unacceptable toxicity.
- Arm II: Patients receive oral placebo twice daily for 14 days. Treatment repeats every
2 weeks for 4 courses.
Patients are instructed to complete the Ginseng Symptom Experience Diary and the Linear
Analogue Scale weekly. Patients also complete the Multidimensional Fatigue Symptom
Inventory-Short Form (MFSI-SF), the Profile of Mood States (POMS), and the Brief Fatigue
Inventory (BFI) questionnaires at baseline and periodically during study therapy.
Patients who are not actively receiving chemotherapy or radiation therapy undergo blood and
saliva sample collection at baseline and periodically during study therapy for correlative
studies.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Diagnosis of histologically or cytologically proven cancer within the past 2 years
- Currently undergoing curative intent therapy (including anti-hormonal therapies
such as tamoxifen or leuprolide) or completed curative intent therapy
- Must have completed > 1 course of chemotherapy or targeted therapy or > 1 week
of radiation therapy
- Not planning to start new or complete cancer therapy during study
- If not currently receiving treatment, no chemotherapy agents ≤ 21 days
prior to randomization
- Combination treatment regimens that have components ending at different
times are allowed, as long as any part of the initially started treatment
continues through the double blind portion of the study
- History of cancer-related fatigue as defined by an average score of ≥ 4 over the past
30 days on the numeric analogue scale (1 - 10)
- Experiencing fatigue for ≥ 1 month
- No known brain metastasis or primary CNS malignancy
PATIENT CHARACTERISTICS:
- ECOG performance score 0-2
- Hemoglobin ≥ 11 g/dL
- Creatinine ≤ 1.2 times upper limit of normal (ULN)
- AST/ALT ≤ 1.5 times ULN
- No uncontrolled hypertension (diastolic blood pressure > 100 mm Hg and systolic blood
pressure > 160 mm Hg) on more than one occasion within the past 90 days
- No pain requiring opioid pain medication
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Able to complete patient questionnaires alone or with assistance
- No insomnia ≤ 4 as measure by the Linear Analogue Scale
- No uncontrolled thyroid disorder
- No hypersensitivity to ginseng
- No diabetes type I or II (defined as being on oral hypoglycemics or insulin)
- No psychiatric disorder such as severe depression, manic depressive disorder,
obsessive-compulsive disorder, or schizophrenia
- No malnutrition, active infection, significant pulmonary disease, or cardiovascular
disease
- No uncontrolled nausea or vomiting, or any symptom that would preclude the patient's
ability to comply with daily oral ginseng/placebo treatment
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- More than 4 weeks since prior major surgery including any procedure that requires
general anesthetic
- Concurrent erythropoietin agents for anemia allowed
- No prior use of ginseng capsules for fatigue
- Prior teas or beverages containing ginseng are allowed
- No concurrent over-the-counter herbal/dietary supplement marketed for fatigue or
energy (e.g., products containing any type of ginseng, rhodiola rosea, high doses of
caffeine, guarana, or anything called an "adaptogen")
- No concurrent pharmacologic agent or nonpharmacologic interventions that specifically
treats fatigue including, but not limited to, psychostimulants, antidepressants, or
acupuncture except antidepressants to treat conditions other than fatigue (e.g., hot
flashes) provided patient has been on a stable dose for ≥ 1 month and plans to
continue for ≥ 1 month
- Exercise is allowed
- No concurrent chronic systemic steroids (including as part of cyclophosphamide,
doxorubicin hydrochloride, vincristine, and prednisolone [CHOP] therapy or any
regular cancer treatment) except as prophylaxis for nausea and vomiting
- Low-dose dexamethasone allowed to prevent rash with Alimta
- No concurrent full dose anticoagulant therapy
- 1 mg/day of coumadin for preventing catheter clots allowed
- No concurrent monoamine oxidase inhibitors
- No concurrent single agent on a blinded placebo controlled treatment trial
Type of Study:
Interventional
Study Design:
Allocation: Randomized, Masking: Double-Blind, Primary Purpose: Supportive Care
Outcome Measure:
Duration of response as measured by the general subscale MFSI-SF
Safety Issue:
No
Principal Investigator
Debra Barton, RN, PhD, AOCN, FAAN
Investigator Role:
Study Chair
Investigator Affiliation:
Mayo Clinic
Authority:
United States: Federal Government
Study ID:
CDR0000597665
NCT ID:
NCT00719563
Start Date:
October 2008
Completion Date:
Related Keywords:
- Chronic Myeloproliferative Disorders
- Fatigue
- Leukemia
- Lymphoma
- Lymphoproliferative Disorder
- Multiple Myeloma and Plasma Cell Neoplasm
- Myelodysplastic Syndromes
- Myelodysplastic/Myeloproliferative Neoplasms
- Precancerous Condition
- Unspecified Adult Solid Tumor, Protocol Specific
- fatigue
- unspecified adult solid tumor, protocol specific
- accelerated phase chronic myelogenous leukemia
- acute undifferentiated leukemia
- adult acute lymphoblastic leukemia in remission
- adult acute myeloid leukemia in remission
- adult acute myeloid leukemia with 11q23 (MLL) abnormalities
- adult acute myeloid leukemia with inv(16)(p13;q22)
- adult acute myeloid leukemia with t(15;17)(q22;q12)
- adult acute myeloid leukemia with t(16;16)(p13;q22)
- adult acute myeloid leukemia with t(8;21)(q22;q22)
- atypical chronic myeloid leukemia, BCR-ABL1 negative
- blastic phase chronic myelogenous leukemia
- chronic myelomonocytic leukemia
- chronic phase chronic myelogenous leukemia
- mast cell leukemia
- progressive hairy cell leukemia, initial treatment
- prolymphocytic leukemia
- recurrent adult acute lymphoblastic leukemia
- recurrent adult acute myeloid leukemia
- recurrent adult T-cell leukemia/lymphoma
- refractory chronic lymphocytic leukemia
- refractory hairy cell leukemia
- relapsing chronic myelogenous leukemia
- secondary acute myeloid leukemia
- stage 0 chronic lymphocytic leukemia
- stage I adult T-cell leukemia/lymphoma
- stage I chronic lymphocytic leukemia
- stage II adult T-cell leukemia/lymphoma
- stage II chronic lymphocytic leukemia
- stage III adult T-cell leukemia/lymphoma
- stage III chronic lymphocytic leukemia
- stage IV adult T-cell leukemia/lymphoma
- stage IV chronic lymphocytic leukemia
- T-cell large granular lymphocyte leukemia
- untreated adult acute lymphoblastic leukemia
- recurrent adult Hodgkin lymphoma
- stage I adult Hodgkin lymphoma
- stage II adult Hodgkin lymphoma
- stage III adult Hodgkin lymphoma
- stage IV adult Hodgkin lymphoma
- anaplastic large cell lymphoma
- angioimmunoblastic T-cell lymphoma
- cutaneous B-cell non-Hodgkin lymphoma
- recurrent cutaneous T-cell non-Hodgkin lymphoma
- stage I cutaneous T-cell non-Hodgkin lymphoma
- stage II cutaneous T-cell non-Hodgkin lymphoma
- stage III cutaneous T-cell non-Hodgkin lymphoma
- stage IV cutaneous T-cell non-Hodgkin lymphoma
- recurrent mycosis fungoides/Sezary syndrome
- stage I mycosis fungoides/Sezary syndrome
- stage II mycosis fungoides/Sezary syndrome
- stage III mycosis fungoides/Sezary syndrome
- stage IV mycosis fungoides/Sezary syndrome
- adult grade III lymphomatoid granulomatosis
- adult nasal type extranodal NK/T-cell lymphoma
- Waldenstrom macroglobulinemia
- extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
- nodal marginal zone B-cell lymphoma
- splenic marginal zone lymphoma
- contiguous stage II adult Burkitt lymphoma
- contiguous stage II adult diffuse large cell lymphoma
- contiguous stage II adult diffuse mixed cell lymphoma
- contiguous stage II adult diffuse small cleaved cell lymphoma
- contiguous stage II adult immunoblastic large cell lymphoma
- contiguous stage II adult lymphoblastic lymphoma
- contiguous stage II grade 1 follicular lymphoma
- contiguous stage II grade 2 follicular lymphoma
- contiguous stage II grade 3 follicular lymphoma
- contiguous stage II mantle cell lymphoma
- contiguous stage II marginal zone lymphoma
- contiguous stage II small lymphocytic lymphoma
- stage I adult Burkitt lymphoma
- stage I adult diffuse large cell lymphoma
- stage I adult diffuse mixed cell lymphoma
- stage I adult diffuse small cleaved cell lymphoma
- stage I adult immunoblastic large cell lymphoma
- stage I adult lymphoblastic lymphoma
- stage I grade 1 follicular lymphoma
- stage I grade 2 follicular lymphoma
- stage I grade 3 follicular lymphoma
- stage I mantle cell lymphoma
- stage I marginal zone lymphoma
- stage I small lymphocytic lymphoma
- noncontiguous stage II adult Burkitt lymphoma
- noncontiguous stage II adult diffuse large cell lymphoma
- noncontiguous stage II adult diffuse mixed cell lymphoma
- noncontiguous stage II adult diffuse small cleaved cell lymphoma
- noncontiguous stage II adult immunoblastic large cell lymphoma
- noncontiguous stage II adult lymphoblastic lymphoma
- noncontiguous stage II grade 1 follicular lymphoma
- noncontiguous stage II grade 2 follicular lymphoma
- noncontiguous stage II grade 3 follicular lymphoma
- noncontiguous stage II mantle cell lymphoma
- noncontiguous stage II marginal zone lymphoma
- noncontiguous stage II small lymphocytic lymphoma
- stage III adult Burkitt lymphoma
- stage III adult diffuse large cell lymphoma
- stage III adult diffuse mixed cell lymphoma
- stage III adult diffuse small cleaved cell lymphoma
- stage III adult immunoblastic large cell lymphoma
- stage III adult lymphoblastic lymphoma
- stage III grade 1 follicular lymphoma
- stage III grade 2 follicular lymphoma
- stage III grade 3 follicular lymphoma
- stage III mantle cell lymphoma
- stage III marginal zone lymphoma
- stage III small lymphocytic lymphoma
- stage IV adult Burkitt lymphoma
- stage IV adult diffuse large cell lymphoma
- stage IV adult diffuse mixed cell lymphoma
- stage IV adult diffuse small cleaved cell lymphoma
- stage IV adult immunoblastic large cell lymphoma
- stage IV adult lymphoblastic lymphoma
- stage IV grade 1 follicular lymphoma
- stage IV grade 2 follicular lymphoma
- stage IV grade 3 follicular lymphoma
- stage IV mantle cell lymphoma
- stage IV marginal zone lymphoma
- stage IV small lymphocytic lymphoma
- recurrent adult Burkitt lymphoma
- recurrent adult diffuse large cell lymphoma
- recurrent adult diffuse mixed cell lymphoma
- recurrent adult diffuse small cleaved cell lymphoma
- recurrent adult grade III lymphomatoid granulomatosis
- recurrent adult immunoblastic large cell lymphoma
- recurrent adult lymphoblastic lymphoma
- recurrent grade 1 follicular lymphoma
- recurrent grade 2 follicular lymphoma
- recurrent grade 3 follicular lymphoma
- recurrent mantle cell lymphoma
- recurrent marginal zone lymphoma
- recurrent small lymphocytic lymphoma
- intraocular lymphoma
- post-transplant lymphoproliferative disorder
- chronic eosinophilic leukemia
- chronic neutrophilic leukemia
- primary myelofibrosis
- essential thrombocythemia
- polycythemia vera
- extramedullary plasmacytoma
- isolated plasmacytoma of bone
- monoclonal gammopathy of undetermined significance
- stage I multiple myeloma
- stage II multiple myeloma
- stage III multiple myeloma
- primary systemic amyloidosis
- refractory multiple myeloma
- de novo myelodysplastic syndromes
- previously treated myelodysplastic syndromes
- secondary myelodysplastic syndromes
- myelodysplastic/myeloproliferative neoplasm, unclassifiable
- Neoplasms
- Fatigue
- Leukemia
- Lymphoma
- Lymphoma, Non-Hodgkin
- Lymphoproliferative Disorders
- Multiple Myeloma
- Neoplasms, Plasma Cell
- Plasmacytoma
- Myelodysplastic Syndromes
- Preleukemia
- Myeloproliferative Disorders
- Precancerous Conditions
- Lymphoma, Large-Cell, Immunoblastic
- Myelodysplastic-Myeloproliferative Diseases
Name | Location |
|---|---|
| Mayo Clinic Scottsdale | Scottsdale, Arizona 85259 |
| Mayo Clinic - Jacksonville | Jacksonville, Florida 32224 |
| Mayo Clinic Cancer Center | Rochester, Minnesota 55905 |
| MBCCOP - Hawaii | Honolulu, Hawaii 96813 |
| CCOP - Upstate Carolina | Spartanburg, South Carolina 29303 |
| Tripler Army Medical Center | Honolulu, Hawaii 96859-5000 |
| CCOP - Wichita | Wichita, Kansas 67214-3882 |
| Hurley Medical Center | Flint, Michigan 48503 |
| CCOP - Missouri Valley Cancer Consortium | Omaha, Nebraska 68131 |
| CCOP - Illinois Oncology Research Association | Peoria, Illinois 61602 |
| CCOP - Carle Cancer Center | Urbana, Illinois 61801 |
| CCOP - Iowa Oncology Research Association | Des Moines, Iowa 50309-1016 |
| CCOP - Metro-Minnesota | Saint Louis Park, Minnesota 55416 |
| Aurora Presbyterian Hospital | Aurora, Colorado 80012 |
| Boulder Community Hospital | Boulder, Colorado 80301-9019 |
| Penrose Cancer Center at Penrose Hospital | Colorado Springs, Colorado 80933 |
| CCOP - Colorado Cancer Research Program | Denver, Colorado 80224-2522 |
| Porter Adventist Hospital | Denver, Colorado 80210 |
| Presbyterian - St. Luke's Medical Center | Denver, Colorado 80218 |
| St. Joseph Hospital | Denver, Colorado 80218 |
| Rose Medical Center | Denver, Colorado 80220 |
| Swedish Medical Center | Englewood, Colorado 80110 |
| St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center | Grand Junction, Colorado 81502 |
| Sky Ridge Medical Center | Lone Tree, Colorado 80124 |
| Hope Cancer Care Center at Longmont United Hospital | Longmont, Colorado 80502 |
| St. Mary - Corwin Regional Medical Center | Pueblo, Colorado 81004 |
| North Suburban Medical Center | Thornton, Colorado 80229 |
| Rush-Copley Cancer Care Center | Aurora, Illinois 60507 |
| Cedar Rapids Oncology Associates | Cedar Rapids, Iowa 52403 |
| Mercy Medical Center - Sioux City | Sioux City, Iowa 51104 |
| Siouxland Hematology-Oncology Associates, LLP | Sioux City, Iowa 51101 |
| St. Luke's Regional Medical Center | Sioux City, Iowa 51104 |
| CCOP - Michigan Cancer Research Consortium | Ann Arbor, Michigan 48106 |
| Saint Joseph Mercy Cancer Center | Ann Arbor, Michigan 48106-0995 |
| Oakwood Cancer Center at Oakwood Hospital and Medical Center | Dearborn, Michigan 48123-2500 |
| Genesys Hurley Cancer Institute | Flint, Michigan 48503 |
| Van Elslander Cancer Center at St. John Hospital and Medical Center | Grosse Pointe Woods, Michigan 48236 |
| Sparrow Regional Cancer Center | Lansing, Michigan 48912-1811 |
| St. John Macomb Hospital | Warren, Michigan 48093 |
| MeritCare Bemidji | Bemidji, Minnesota 56601 |
| Fairview Ridges Hospital | Burnsville, Minnesota 55337 |
| Mercy and Unity Cancer Center at Mercy Hospital | Coon Rapids, Minnesota 55433 |
| Duluth Clinic Cancer Center - Duluth | Duluth, Minnesota 55805-1983 |
| CCOP - Duluth | Duluth, Minnesota 55805 |
| Miller - Dwan Medical Center | Duluth, Minnesota 55805 |
| Fairview Southdale Hospital | Edina, Minnesota 55435 |
| Mercy and Unity Cancer Center at Unity Hospital | Fridley, Minnesota 55432 |
| Hutchinson Area Health Care | Hutchinson, Minnesota 55350 |
| Minnesota Oncology Hematology, PA - Maplewood | Maplewood, Minnesota 55109 |
| HealthEast Cancer Care at St. John's Hospital | Maplewood, Minnesota 55109 |
| Hennepin County Medical Center - Minneapolis | Minneapolis, Minnesota 55415 |
| Virginia Piper Cancer Institute at Abbott - Northwestern Hospital | Minneapolis, Minnesota 55407 |
| Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center | Robbinsdale, Minnesota 55422-2900 |
| St. Francis Cancer Center at St. Francis Medical Center | Shakopee, Minnesota 55379 |
| Park Nicollet Cancer Center | St. Louis Park, Minnesota 55416 |
| Regions Hospital Cancer Care Center | St. Paul, Minnesota 55101 |
| United Hospital | St. Paul, Minnesota 55102 |
| Ridgeview Medical Center | Waconia, Minnesota 55387 |
| Minnesota Oncology Hematology, PA - Woodbury | Woodbury, Minnesota 55125 |
| MeritCare Broadway | Fargo, North Dakota 58122 |
| CCOP - MeritCare Hospital | Fargo, North Dakota 58122 |
| Natalie Warren Bryant Cancer Center at St. Francis Hospital | Tulsa, Oklahoma 74136 |
| Geisinger Medical Group - Scenery Park | State College, Pennsylvania 16801 |
| Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center | Wilkes-Barre, Pennsylvania 18711 |
| Avera Cancer Institute | Sioux Falls, South Dakota 57105 |
| Marshfield Clinic - Marshfield Center | Marshfield, Wisconsin 54449 |
| Marshfield Clinic - Indianhead Center | Rice Lake, Wisconsin 54868 |
| CCOP - Ochsner | New Orleans, Louisiana 70121 |
| Rapid City Regional Hospital | Rapid City, South Dakota 57709 |
| Methodist Medical Center of Illinois | Peoria, Illinois 61636 |
| Memorial Hospital of South Bend | South Bend, Indiana 46601 |
| CCOP - Cancer Research for the Ozarks | Springfield, Missouri 65807 |
| CCOP - Montana Cancer Consortium | Billings, Montana 59101 |
| CCOP - Columbus | Columbus, Ohio 43206 |
| CCOP - Dayton | Kettering, Ohio 45429 |
| Hinsdale, Illinois 60521 | |
| CCOP - Northern Indiana CR Consortium | South Bend, Indiana 46601 |
| Saint Joseph Regional Medical Center | South Bend, Indiana 46617 |
| CCOP - Grand Rapids | Grand Rapids, Michigan 49503 |
| CCOP - Columbia River Oncology Program | Portland, Oregon 97225 |
| Cancer Research Center of Hawaii | Honolulu, Hawaii 96813 |
| CCOP - Virginia Mason Research Center | Seattle, Washington 98101 |
| Wesley Medical Center | Wichita, Kansas 67214 |
| John Stoddard Cancer Center at Iowa Methodist Medical Center | Des Moines, Iowa 50309 |
| St. Vincent Mercy Medical Center | Toledo, Ohio 43608 |
| Hulston Cancer Center at Cox Medical Center South | Springfield, Missouri 65807 |
| St. John's Regional Health Center | Springfield, Missouri 65804 |
| CCOP - Toledo Community Hospital | Toledo, Ohio 43623-3456 |
| University of Florida Shands Cancer Center | Gainesville, Florida 32610-0232 |
| Via Christi Cancer Center at Via Christi Regional Medical Center | Wichita, Kansas 67214 |
| Ochsner Cancer Institute at Ochsner Clinic Foundation | New Orleans, Louisiana 70121 |
| Medical University of Ohio Cancer Center | Toledo, Ohio 43614 |
| Toledo Hospital | Toledo, Ohio 43606 |
| Edwards Comprehensive Cancer Center at Cabell Huntington Hospital | Huntington, West Virginia 25701 |
| St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54307-3508 |
| McCreery Cancer Center at Ottumwa Regional | Ottumwa, Iowa 52501 |
| Green Bay Oncology, Limited - Escanaba | Escanaba, Michigan 49431 |
| Dickinson County Healthcare System | Iron Mountain, Michigan 49801 |
| St. Mary's Hospital Medical Center - Green Bay | Green Bay, Wisconsin 54303 |
| Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54301-3526 |
| Green Bay Oncology, Limited at St. Mary's Hospital | Green Bay, Wisconsin 54303 |
| Bay Area Cancer Care Center at Bay Area Medical Center | Marinette, Wisconsin 54143 |
| Green Bay Oncology, Limited - Oconto Falls | Oconto Falls, Wisconsin 54154 |
| Green Bay Oncology, Limited - Sturgeon Bay | Sturgeon Bay, Wisconsin 54235 |
| Battle Creek Health System Cancer Care Center | Battle Creek, Michigan 49017 |
| Munson Medical Center | Traverse City, Michigan 49684 |
| Northern Rockies Radiation Oncology Center | Billings, Montana 59101 |
| Hematology-Oncology Centers of the Northern Rockies - Billings | Billings, Montana 59101 |
| Big Sky Oncology | Great Falls, Montana 59405 |
| St. Peter's Hospital | Helena, Montana 59601 |
| Kalispell Regional Medical Center | Kalispell, Montana 59901 |
| Glacier Oncology, PLLC | Kalispell, Montana 59901 |
| Montana Cancer Center at St. Patrick Hospital and Health Sciences Center | Missoula, Montana 59802 |
| Montana Cancer Specialists at Montana Cancer Center | Missoula, Montana 59802 |
| Adena Regional Medical Center | Chillicothe, Ohio 54601 |
| Doctors Hospital at Ohio Health | Columbus, Ohio 43228 |
| Riverside Methodist Hospital Cancer Care | Columbus, Ohio 43214 |
| Grady Memorial Hospital | Delaware, Ohio 43015 |
| Fairfield Medical Center | Lancaster, Ohio 43130 |
| Strecker Cancer Center at Marietta Memorial Hospital | Marietta, Ohio 45750 |
| Licking Memorial Cancer Care Program at Licking Memorial Hospital | Newark, Ohio 43055 |
| Community Hospital of Springfield and Clark County | Springfield, Ohio 45505 |
| Genesis - Good Samaritan Hospital | Zanesville, Ohio 43701 |
| MBCCOP - Medical College of Georgia Cancer Center | Augusta, Georgia 30912-3730 |
| Butterworth Hospital at Spectrum Health | Grand Rapids, Michigan 49503-2560 |
| University of New Mexico Cancer Center | Albuquerque, New Mexico 87131-5636 |
| Geisinger Cancer Institute at Geisinger Health | Danville, Pennsylvania 17822-0001 |
| Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center | Hartford, Connecticut 06105 |
| Elkhart General Hospital | Elkhart, Indiana 46515 |
| Howard Community Hospital | Kokomo, Indiana 46904 |
| South Bend Clinic | South Bend, Indiana 46617 |
| Lakeland Regional Cancer Care Center - St. Joseph | St. Joseph, Michigan 49085 |
| Mount Carmel Health - West Hospital | Columbus, Ohio 43222 |
| Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest | Allentown, Pennsylvania 18105 |
| Front Range Cancer Specialists | Fort Collins, Colorado 80528 |
| Poudre Valley Hospital | Fort Collins, Colorado 80524 |
| St. Joseph Medical Center | Bloomington, Illinois 61701 |
| Graham Hospital | Canton, Illinois 61520 |
| Memorial Hospital | Carthage, Illinois 62321 |
| Eureka Community Hospital | Eureka, Illinois 61530 |
| Galesburg Cottage Hospital | Galesburg, Illinois 61401 |
| Mason District Hospital | Havana, Illinois 62644 |
| McDonough District Hospital | Macomb, Illinois 61455 |
| BroMenn Regional Medical Center | Normal, Illinois 61761 |
| Community Cancer Center | Normal, Illinois 61761 |
| Community Hospital of Ottawa | Ottawa, Illinois 61350 |
| Oncology Hematology Associates of Central Illinois, PC - Ottawa | Ottawa, Illinois 61350 |
| Cancer Treatment Center at Pekin Hospital | Pekin, Illinois 61554 |
| Oncology Hematology Associates of Central Illinois, PC - Peoria | Peoria, Illinois 61615 |
| OSF St. Francis Medical Center | Peoria, Illinois 61637 |
| Proctor Hospital | Peoria, Illinois 61614 |
| Illinois Valley Community Hospital | Peru, Illinois 61354 |
| Perry Memorial Hospital | Princeton, Illinois 61356 |
| St. Francis Hospital and Health Centers - Beech Grove Campus | Beech Grove, Indiana 46107 |
| Center for Cancer Therapy at LaPorte Hospital and Health Services | La Porte, Indiana 46350 |
| Bettendorf, Iowa 52722 | |
| Mercy Regional Cancer Center at Mercy Medical Center | Cedar Rapids, Iowa 52403 |
| John Stoddard Cancer Center at Iowa Lutheran Hospital | Des Moines, Iowa 50316-2301 |
| Medical Oncology and Hematology Associates at John Stoddard Cancer Center | Des Moines, Iowa 50309 |
| Medical Oncology and Hematology Associates at Mercy Cancer Center | Des Moines, Iowa 50314 |
| Mercy Cancer Center at Mercy Medical Center - Des Moines | Des Moines, Iowa 50314 |
| Medical Oncology and Hematology Associates - West Des Moines | West Des Moines, Iowa 50266 |
| Cancer Center of Kansas, PA - Dodge City | Dodge City, Kansas 67801 |
| Hickman Cancer Center at Bixby Medical Center | Adrian, Michigan 49221 |
| Mecosta County Medical Center | Big Rapids, Michigan 49307 |
| Community Cancer Center of Monroe | Monroe, Michigan 48162 |
| Alexandria, Minnesota 56308 | |
| St. Joseph's Medical Center | Brainerd, Minnesota 56401 |
| Coborn Cancer Center | Saint Cloud, Minnesota 56303 |
| CentraCare Clinic - River Campus | St. Cloud, Minnesota 56303 |
| Immanuel Medical Center | Omaha, Nebraska 68122 |
| Creighton University Medical Center | Omaha, Nebraska 68131-2197 |
| Bismarck Cancer Center | Bismarck, North Dakota 58501 |
| Wood County Oncology Center | Bowling Green, Ohio 43402 |
| Samaritan North Cancer Care Center | Dayton, Ohio 45415 |
| Grandview Hospital | Dayton, Ohio 45405 |
| David L. Rike Cancer Center at Miami Valley Hospital | Dayton, Ohio 45409 |
| Good Samaritan Hospital | Dayton, Ohio 45406 |
| Blanchard Valley Medical Associates | Findlay, Ohio 45840 |
| Charles F. Kettering Memorial Hospital | Kettering, Ohio 45429 |
| Lima Memorial Hospital | Lima, Ohio 45804 |
| St. Luke's Hospital | Maumee, Ohio 43537 |
| Northwest Ohio Oncology Center | Maumee, Ohio 43537 |
| Middletown Regional Hospital | Middletown, Ohio 45044 |
| Toledo Clinic - Oregon | Oregon, Ohio 43616 |
| St. Charles Mercy Hospital | Oregon, Ohio 43616 |
| North Coast Cancer Care, Incorporated | Sandusky, Ohio 44870 |
| Mercy Hospital of Tiffin | Tiffin, Ohio 44883 |
| Toledo Clinic, Incorporated - Main Clinic | Toledo, Ohio 43623 |
| UVMC Cancer Care Center at Upper Valley Medical Center | Troy, Ohio 45373-1300 |
| Fulton County Health Center | Wauseon, Ohio 43567 |
| Ruth G. McMillan Cancer Center at Greene Memorial Hospital | Xenia, Ohio 45385 |
| Providence Milwaukie Hospital | Milwaukie, Oregon 97222 |
| Providence Cancer Center at Providence Portland Medical Center | Portland, Oregon 97213-2967 |
| Providence St. Vincent Medical Center | Portland, Oregon 97225 |
| Southwest Washington Medical Center Cancer Center | Vancouver, Washington 98668 |
| Holy Family Memorial Medical Center Cancer Care Center | Manitowoc, Wisconsin 54221-1450 |
| Welch Cancer Center at Sheridan Memorial Hospital | Sheridan, Wyoming 82801 |
| St. Anthony Central Hospital | Denver, Colorado 80204-1335 |
| Cascade Cancer Center at Evergreen Hospital Medical Center | Kirkland, Washington 98034-3013 |
| Valley Medical Center | Renton, Washington 98055 |
| Missouri Baptist Cancer Center | St. Louis, Missouri 63131 |
| Cancer Resource Center - Lincoln | Lincoln, Nebraska 68510 |
| Altru Cancer Center at Altru Hospital | Grand Forks, North Dakota 58201 |
| Midelfort Clinic - Luther | Eau Claire, Wisconsin 54702 |
| Michiana Hematology-Oncology, PC - Elkhart | Elkhart, Indiana 46514 |
| Elkhart Clinic, LLC | Elkhart, Indiana 46514-2098 |
| Michiana Hematology Oncology PC - La Porte | La Porte, Indiana 46350 |
| Michiana Hematology-Oncology, PC - South Bend | Mishawaka, Indiana 46545-1470 |
| Michiana Hematology Oncology PC - Plymouth | Plymouth, Indiana 46563 |
| Reid Hospital & Health Care Services | Richmond, Indiana 47374 |
| McFarland Clinic, PC | Ames, Iowa 50010 |
| Hospital District Sixth of Harper County | Anthony, Kansas 67003 |
| Cancer Center of Kansas, PA - Chanute | Chanute, Kansas 66720 |
| Cancer Center of Kansas, PA - El Dorado | El Dorado, Kansas 67042 |
| Cancer Center of Kansas - Fort Scott | Fort Scott, Kansas 66701 |
| Cancer Center of Kansas-Independence | Independence, Kansas 67301 |
| Cancer Center of Kansas, PA - Kingman | Kingman, Kansas 67068 |
| Lawrence Memorial Hospital | Lawrence, Kansas 66044 |
| Cancer Center of Kansas, PA - Liberal | Liberal, Kansas 67905 |
| Cancer Center of Kansas, PA - Newton | Newton, Kansas 67114 |
| Cancer Center of Kansas, PA - Parsons | Parsons, Kansas 67357 |
| Cancer Center of Kansas, PA - Pratt | Pratt, Kansas 67124 |
| Cancer Center of Kansas, PA - Salina | Salina, Kansas 67401 |
| Cancer Center of Kansas, PA - Wellington | Wellington, Kansas 67152 |
| Cancer Center of Kansas, PA - Wichita | Wichita, Kansas 67214 |
| Associates in Womens Health, PA - North Review | Wichita, Kansas 67208 |
| Cancer Center of Kansas, PA - Medical Arts Tower | Wichita, Kansas 67208 |
| Cancer Center of Kansas, PA - Winfield | Winfield, Kansas 67156 |
| Ochsner Health Center - Bluebonnet | Baton Rouge, Louisiana 70809 |
| Foote Memorial Hospital | Jackson, Michigan 49201 |
| St. Mary Mercy Hospital | Livonia, Michigan 48154 |
| Mercy Memorial Hospital - Monroe | Monroe, Michigan 48162 |
| Michiana Hematology Oncology PC - Niles | Niles, Michigan 49120 |
| St. Joseph Mercy Oakland | Pontiac, Michigan 48341-2985 |
| Mercy Regional Cancer Center at Mercy Hospital | Port Huron, Michigan 48060 |
| Seton Cancer Institute at Saint Mary's - Saginaw | Saginaw, Michigan 48601 |
| Lakeside Cancer Specialists, PLLC | Saint Joseph, Michigan 49085 |
| Fergus Falls Medical Group, PA | Fergus Falls, Minnesota 56537 |
| Willmar Cancer Center at Rice Memorial Hospital | Willmar, Minnesota 56201 |
| Billings Clinic - Downtown | Billings, Montana 59107-7000 |
| Bozeman Deaconess Cancer Center | Bozeman, Montana 59715 |
| St. James Healthcare Cancer Care | Butte, Montana 59701 |
| Great Falls Clinic - Main Facility | Great Falls, Montana 59405 |
| Sletten Cancer Institute at Benefis Healthcare | Great Falls, Montana 59405 |
| Northern Montana Hospital | Havre, Montana 59501 |
| Kalispell Medical Oncology at KRMC | Kalispell, Montana 59901 |
| Alegant Health Cancer Center at Bergan Mercy Medical Center | Omaha, Nebraska 68124 |
| Mary Rutan Hospital | Bellefontaine, Ohio 43311 |
| North Coast Cancer Care - Clyde | Clyde, Ohio 43410 |
| Grant Medical Center Cancer Care | Columbus, Ohio 43215 |
| Hematology Oncology Center | Elyria, Ohio 44035 |
| Community Cancer Center | Elyria, Ohio 44035 |
| Wayne Hospital | Greenville, Ohio 45331 |
| Knox Community Hospital | Mount Vernon, Ohio 43050 |
| Fisher-Titus Medical Center | Norwalk, Ohio 44857 |
| Flower Hospital Cancer Center | Sylvania, Ohio 43560 |
| St. Anne Mercy Hospital | Toledo, Ohio 43623 |
| Mount Carmel St. Ann's Cancer Center | Westerville, Ohio 43081 |
| Clinton Memorial Hospital | Wilmington, Ohio 45177 |
| Adventist Medical Center | Portland, Oregon 97216 |
| Geisinger Hazleton Cancer Center | Hazleton, Pennsylvania 18201 |
| Fredericksburg Oncology, Incorporated | Fredericksburg, Virginia 22401 |
| St. Joseph Cancer Center | Bellingham, Washington 98225 |
| Marshfield Clinic - Chippewa Center | Chippewa Falls, Wisconsin 54729 |
| Marshfield Clinic Cancer Care at Regional Cancer Center | Eau Claire, Wisconsin 54701 |
| Marshfield Clinic - Lakeland Center | Minocqua, Wisconsin 54548 |
| Ministry Medical Group at Saint Mary's Hospital | Rhinelander, Wisconsin 54501 |
| Marshfield Clinic at Saint Michael's Hospital | Stevens Point, Wisconsin 54481 |
| Marshfield Clinic - Weston Center | Weston, Wisconsin 54476 |
| Marshfield Clinic - Wisconsin Rapids Center | Wisconsin Rapids, Wisconsin 54494 |
| Rocky Mountain Oncology | Casper, Wyoming 82609 |
| Mid Dakota Clinic, PC | Bismarck, North Dakota 58501 |
| Queen's Cancer Institute at Queen's Medical Center | Honolulu, Hawaii 96813 |
| Rutherford Hospital | Rutherfordton, North Carolina 28139 |
| Gibbs Regional Cancer Center at Spartanburg Regional Medical Center | Spartanburg, South Carolina 29303 |
| Lacks Cancer Center at Saint Mary's Health Care | Grand Rapids, Michigan 49503 |
| Metro Health Hospital | Grand Rapids, Michigan 49506 |
| Galesburg Clinic, PC | Galesburg, Illinois 61401 |
| St. Vincent Healthcare Cancer Care Services | Billings, Montana 59101 |
| Kapiolani Medical Center at Pali Momi | Aiea, Hawaii 96701 |
| Kapiolani Medical Center for Women and Children | Honolulu, Hawaii 96826 |
| Straub Clinic and Hospital, Incorporated | Honolulu, Hawaii 96813 |
| Hawaii Medical Center - East | Honolulu, Hawaii 96817 |
| OnCare Hawaii, Incorporated - Kuakini | Honolulu, Hawaii 96817 |
| OnCare Hawaii, Incorporated - Lusitana | Honolulu, Hawaii 96813 |
| Maui Memorial Medical Center | Wailuku, Hawaii 96793 |
| Pacific Cancer Institute - Maui | Wailuku, Hawaii 96793 |
| Illinois CancerCare - Bloomington | Bloomington%, Illinois 61701 |
| Illinois CancerCare - Canton | Canton, Illinois 61520 |
| Illinois CancerCare - Carthage | Carthage, Illinois 62321 |
| Illinois CancerCare - Eureka | Eureka, Illinois 61530 |
| Illinois CancerCare - Galesburg | Galesburg, Illinois 61401 |
| Illinois CancerCare - Havana | Havana, Illinois 62644 |
| Illinois CancerCare - Kewanee Clinic | Kewanee, Illinois 61443 |
| Illinois CancerCare - Macomb | Macomb, Illinois 61455 |
| Trinity Cancer Center at Trinity Medical Center - 7th Street Campus | Moline, Illinois 61265 |
| OSF Holy Family Medical Center | Monmouth, Illinois 61462 |
| Illinois CancerCare - Monmouth | Monmouth, Illinois 61462 |
| Illinois CancerCare - Community Cancer Center | Normal, Illinois 61761 |
| Illinois CancerCare - Pekin | Pekin, Illinois 61603 |
| Illinois CancerCare - Peru | Peru, Illinois 61354 |
| Illinois CancerCare - Princeton | Princeton, Illinois 61356 |
| Illinois CancerCare - Spring Valley | Spring Valley, Illinois 61362 |
| Mercy General Health Partners | Muskegon, Michigan 49443 |
| United States Air Force Medical Center - Wright-Patterson | Wright-Patterson AFB, Ohio 45433-5529 |
| AnMed Cancer Center | Anderson, South Carolina 29621 |
| Franciscan Skemp Healthcare - La Crosse Campus | La Crosse, Wisconsin 54601 |
| Medcenter One Hospital Cancer Care Center | Bismarck, North Dakota 58501 |
| St. Alexius Medical Center Cancer Center | Bismarck, North Dakota 58502 |
| Lovelace Medical Center - Downtown | Albuquerque, New Mexico 87102 |
| Hematology Oncology Associates, PC | Albuquerque, New Mexico 87106 |
| Ochsner Health Center - Covington | Covington, Louisiana 70433 |
| Immanuel St. Joseph's | Mankato, Minnesota 56002 |
| Luther Midlelfort Hospital | Eau Claire, Wisconsin 54702 |
| Lakeview Hospital | Stillwater, Minnesota 55082 |
| Central Wisconsin Cancer Program at Agnesian HealthCare | Fond du Lac, Wisconsin 54935 |
| Kauai Medical Clinic | Lihue, Hawaii 96766 |
| Goldschmidt Cancer Center | Jefferson City, Missouri 65109 |
| Comprehensive Cancer Care, PC | Saint Louis, Missouri 63141 |
| Clackamas Radiation Oncology Center | Clackamas, Oregon 97015 |
| Providence Newberg Medical Center | Newberg, Oregon 97132 |
| Willamette Falls Hospital | Oregon City, Oregon 97045 |
| St. Nicholas Hospital | Sheboygan, Wisconsin 53081 |
| Pacific Medical Center | Seattle, Washington 98104 |
| Door County Cancer Center at Door County Memorial Hospital | Sturgeon Bay, Wisconsin 54235-1495 |
