Viewing Study NCT00892866


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Study NCT ID: NCT00892866
Status: ACTIVE_NOT_RECRUITING
Last Update Posted: 2024-05-03
First Post: 2009-05-02
Is NOT Gene Therapy: True
Has Adverse Events: False

Brief Title: CA-IX, p16, Proliferative Markers, and HPV in Diagnosing Cervical Lesions in Patients With Abnormal Cervical Cells
Sponsor:
Organization:

Raw JSON

{'hasResults': False, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D004714', 'term': 'Endometrial Hyperplasia'}, {'id': 'D030361', 'term': 'Papillomavirus Infections'}, {'id': 'D002578', 'term': 'Uterine Cervical Dysplasia'}], 'ancestors': [{'id': 'D014591', 'term': 'Uterine Diseases'}, {'id': 'D005831', 'term': 'Genital Diseases, Female'}, {'id': 'D052776', 'term': 'Female Urogenital Diseases'}, {'id': 'D005261', 'term': 'Female Urogenital Diseases and Pregnancy Complications'}, {'id': 'D000091642', 'term': 'Urogenital Diseases'}, {'id': 'D000091662', 'term': 'Genital Diseases'}, {'id': 'D015229', 'term': 'Sexually Transmitted Diseases, Viral'}, {'id': 'D012749', 'term': 'Sexually Transmitted Diseases'}, {'id': 'D003141', 'term': 'Communicable Diseases'}, {'id': 'D007239', 'term': 'Infections'}, {'id': 'D004266', 'term': 'DNA Virus Infections'}, {'id': 'D014777', 'term': 'Virus Diseases'}, {'id': 'D014412', 'term': 'Tumor Virus Infections'}, {'id': 'D020969', 'term': 'Disease Attributes'}, {'id': 'D010335', 'term': 'Pathologic Processes'}, {'id': 'D013568', 'term': 'Pathological Conditions, Signs and Symptoms'}, {'id': 'D011230', 'term': 'Precancerous Conditions'}, {'id': 'D009369', 'term': 'Neoplasms'}, {'id': 'D002577', 'term': 'Uterine Cervical Diseases'}]}}, 'protocolSection': {'designModule': {'phases': ['NA'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'NON_RANDOMIZED', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'OTHER', 'interventionModel': 'SINGLE_GROUP'}, 'enrollmentInfo': {'type': 'ESTIMATED', 'count': 877}}, 'statusModule': {'overallStatus': 'ACTIVE_NOT_RECRUITING', 'startDateStruct': {'date': '2009-04-13', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2024-05', 'completionDateStruct': {'date': '2025-05-31', 'type': 'ESTIMATED'}, 'lastUpdateSubmitDate': '2024-05-02', 'studyFirstSubmitDate': '2009-05-02', 'studyFirstSubmitQcDate': '2009-05-02', 'lastUpdatePostDateStruct': {'date': '2024-05-03', 'type': 'ACTUAL'}, 'studyFirstPostDateStruct': {'date': '2009-05-05', 'type': 'ESTIMATED'}, 'primaryCompletionDateStruct': {'date': '2025-05-31', 'type': 'ESTIMATED'}}, 'outcomesModule': {'otherOutcomes': [{'measure': 'Biomarker expression, loss of heterozygosity (LOH), chromosome gains, and chromosome losses in tissue from the highest grade or most abnormal lesions in women with AGC', 'timeFrame': 'Baseline', 'description': 'Exploratory analyses of genomic alterations, including LOH as well as chromosome gains and chromosome losses will be performed to identify genomic alterations associated with cervical dysplasia/neoplasia.'}, {'measure': 'CA-IX expression, combined p16 and Ki67 expression, and MCM2 expression in LBC specimens', 'timeFrame': 'Baseline', 'description': 'Will be used to see which subset of markers will provide the higher and sensitivity in the diagnosis of cervical AIS.'}], 'primaryOutcomes': [{'measure': 'Biomarker expression in patients from North America', 'timeFrame': 'Baseline', 'description': 'CA-IX, p16, Ki-67, and MCM2 expression in LBC specimens is measured via IHC. A logistic regression and receiver operating characteristic (ROC)-type analysis will be performed.'}, {'measure': 'Biomarker expression in patients from Japan', 'timeFrame': 'Baseline', 'description': 'CA-IX, p16, Ki-67, and MCM2 expression in LBC specimens is measured via IHC. A logistic regression and ROC-type analysis will be performed.'}, {'measure': 'Biomarker expression in patients from Korea', 'timeFrame': 'Baseline', 'description': 'CA-IX, p16, Ki-67, and MCM2 expression in LBC specimens is measured via IHC. A logistic regression and ROC-type analysis will be performed.'}], 'secondaryOutcomes': [{'measure': 'Effect of patient age on the accuracy of diagnosis based on CA-IX, HPV, p16, Ki-67, and/or MCM2 expression in the North American population', 'timeFrame': 'Baseline', 'description': 'Logistic regression analyses will be performed to assess the effect of age and country on sensitivity, specificity, false positive rate (FPR), and complement negative predictive value (NPVC.). For each country and at each age, an upper 95% confidence limit will be calculated for the NPVC.'}, {'measure': 'Effect of patient age on the accuracy of diagnosis based on CA-IX, HPV, p16, Ki-67, and/or MCM2 expression in the Korean and Japanese populations', 'timeFrame': 'Baseline', 'description': 'Logistic regression analyses will be performed to assess the effect of age and country on sensitivity, specificity, FPR, and NPVC. For each country and at each age, an upper 95% confidence limit will be calculated for the NPVC.'}]}, 'oversightModule': {'oversightHasDmc': True}, 'conditionsModule': {'conditions': ['Atypical Endometrial Hyperplasia', 'Human Papillomavirus Infection', 'Stage 0 Cervical Cancer AJCC v7']}, 'descriptionModule': {'briefSummary': 'This research trial studies carbonic anhydrase 9 (CA-IX), p16, proliferative markers, and human papilloma virus (HPV) in diagnosing cervical lesions in patients with abnormal cervical cells. Studying biomarkers in abnormal cervical cells may improve the ability to find cervical lesions and plan effective treatment.', 'detailedDescription': "PRIMARY OBJECTIVES:\n\nI. To examine CA-IX, p16, Ki-67, and mini-chromosome maintenance complex component 2 (MCM2) expression in liquid-based cytology (LBC) specimens to see which subset of markers can provide the optimal diagnosis of significant cervical lesions in women in North America with a cytologic diagnosis of atypical glandular cells (AGC) and a positive test for high risk human papillomavirus (HPV).\n\nII. To examine high risk HPV, CA-IX, p16, Ki-67, and MCM2 expression in LBC specimens to see which subset of markers can provide the optimal diagnosis of significant cervical lesions in women in Japan and Korea (with each country's cohort analyzed separately) with a cytologic diagnosis of AGC.\n\nSECONDARY OBJECTIVES:\n\nI. To determine whether the accuracy of diagnosis based on high risk HPV and expression of CA-IX, p16, Ki-67, and/or MCM2 varies with patient age at enrollment and country of enrollment.\n\nTERTIARY OBJECTIVES:\n\nI. To assess biomarker expression, loss of heterozygosity, and chromosome gains/losses in formalin-fixed, paraffin-embedded tissue from the highest grade or most abnormal lesion in women from North America, Japan, or Korea presenting with a cytologic diagnosis of AGC or with a cytologic/histologic diagnosis of adenocarcinoma in situ (AIS).\n\nII. To determine CA-IX, p16, Ki67, and MCM2 expression in LBC specimens to see which subset (or combination) of markers will provide higher sensitivity in the diagnosis of cervical adenocarcinoma in situ (AIS).\n\nOUTLINE:\n\nPatients undergo liquid-based cytology specimen sample collection for analysis of CA-IX, p16, Ki-67, and MCM2 expression via immunohistochemistry (IHC) and for the presence of high risk HPV deoxyribonucleic acid (DNA) and HPV genotyping."}, 'eligibilityModule': {'sex': 'FEMALE', 'stdAges': ['ADULT', 'OLDER_ADULT'], 'minimumAge': '18 Years', 'healthyVolunteers': False, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* Patients with a cytologic diagnosis of AGC (AGC, atypical endocervical cells \\[AEC\\], atypical endometrial cells \\[AEmC\\]) or a cytologic/histologic diagnosis of AIS documented within the last 6 months who can wait at least one week after the AGC or AIS diagnosis to have an LBC specimen (i.e., ThinPrep) collected and then receive any other intervention; acceptable time frame range is 4 days prior to registration to 7 days after registration\n* Patients with positive HPV results who are willing to undergo a complete histologic examination of the uterus and cervix, including the cervical transformation zone, within 6 months of the AGC or AIS diagnosis (histologic examination includes a loop electrosurgical excision procedure \\[LEEP\\], loop excision of the transformation zone \\[LETZ\\], excisional cone biopsy, or hysterectomy)\n* Patients must have signed an approved informed consent and authorization permitting release of personal health information\n\nExclusion Criteria:\n\n* Patients who have had a hysterectomy\n* History of endometrial hyperplasia or cancer of the endometrium, vagina, or cervix\n* Patients who have previously been treated, or are currently being treated with radiation therapy or chemotherapy for vaginal or cervical cancer\n* Patients who are known to be human immunodeficiency virus (HIV)-positive\n* Patients who are pregnant and thought to be at risk for excessive bleeding or preterm labor if a cone biopsy is performed'}, 'identificationModule': {'nctId': 'NCT00892866', 'briefTitle': 'CA-IX, p16, Proliferative Markers, and HPV in Diagnosing Cervical Lesions in Patients With Abnormal Cervical Cells', 'organization': {'class': 'NETWORK', 'fullName': 'GOG Foundation'}, 'officialTitle': 'Comparative Analysis of CA-IX, p16, Proliferative Markers, and Human Papilloma Virus (HPV) in the Diagnosis of Significant Cervical Lesions in Patients With a Cytologic Diagnosis of Atypical Glandular Cells (AGC)', 'orgStudyIdInfo': {'id': 'GOG-0237'}, 'secondaryIdInfos': [{'id': 'NCI-2009-01103', 'type': 'REGISTRY', 'domain': 'CTRP (Clinical Trial Reporting Program)'}, {'id': 'CDR0000632236'}, {'id': 'GOG-0237', 'type': 'OTHER', 'domain': 'Gynecologic Oncology Group'}, {'id': 'GOG-0237', 'type': 'OTHER', 'domain': 'DCP'}, {'id': 'GOG-0237', 'type': 'OTHER', 'domain': 'CTEP'}, {'id': 'N01CM62201', 'link': 'https://reporter.nih.gov/quickSearch/N01CM62201', 'type': 'NIH'}, {'id': 'U10CA101165', 'link': 'https://reporter.nih.gov/quickSearch/U10CA101165', 'type': 'NIH'}, {'id': 'UG1CA189867', 'link': 'https://reporter.nih.gov/quickSearch/UG1CA189867', 'type': 'NIH'}]}, 'armsInterventionsModule': {'armGroups': [{'type': 'OTHER', 'label': 'Ancillary-Correlative (biomarkers in cervical cancer)', 'description': 'Patients undergo liquid-based cytology specimen sample collection for analysis of CA-IX, p16, Ki-67, and MCM2 expression via IHC and for the presence of high risk HPV DNA and HPV genotyping.', 'interventionNames': ['Other: Cytology Specimen Collection Procedure', 'Other: Laboratory Biomarker Analysis']}], 'interventions': [{'name': 'Cytology Specimen Collection Procedure', 'type': 'OTHER', 'otherNames': ['Cytologic Sampling'], 'description': 'Correlative studies', 'armGroupLabels': ['Ancillary-Correlative (biomarkers in cervical cancer)']}, {'name': 'Laboratory Biomarker Analysis', 'type': 'OTHER', 'description': 'Correlative studies', 'armGroupLabels': ['Ancillary-Correlative (biomarkers in cervical cancer)']}]}, 'contactsLocationsModule': {'locations': [{'zip': '85719', 'city': 'Tucson', 'state': 'Arizona', 'country': 'United States', 'facility': 'Banner University Medical Center - Tucson', 'geoPoint': {'lat': 32.22174, 'lon': -110.92648}}, {'zip': '85719', 'city': 'Tucson', 'state': 'Arizona', 'country': 'United States', 'facility': 'University of Arizona Cancer Center-North Campus', 'geoPoint': {'lat': 32.22174, 'lon': -110.92648}}, {'zip': '92093', 'city': 'La Jolla', 'state': 'California', 'country': 'United States', 'facility': 'UC San Diego Moores Cancer Center', 'geoPoint': {'lat': 32.84727, 'lon': -117.2742}}, {'zip': '90027', 'city': 'Los Angeles', 'state': 'California', 'country': 'United States', 'facility': 'Kaiser Permanente Los Angeles Medical Center', 'geoPoint': {'lat': 34.05223, 'lon': -118.24368}}, {'zip': '90095', 'city': 'Los Angeles', 'state': 'California', 'country': 'United States', 'facility': 'UCLA / Jonsson Comprehensive Cancer Center', 'geoPoint': {'lat': 34.05223, 'lon': -118.24368}}, {'zip': '92868', 'city': 'Orange', 'state': 'California', 'country': 'United States', 'facility': 'Saint Joseph Hospital - Orange', 'geoPoint': {'lat': 33.78779, 'lon': -117.85311}}, {'zip': '92868', 'city': 'Orange', 'state': 'California', 'country': 'United States', 'facility': 'UC Irvine Health/Chao Family Comprehensive Cancer Center', 'geoPoint': {'lat': 33.78779, 'lon': -117.85311}}, {'zip': '91342', 'city': 'Sylmar', 'state': 'California', 'country': 'United States', 'facility': 'Olive View-University of California Los Angeles Medical Center', 'geoPoint': {'lat': 34.30778, 'lon': -118.44925}}, {'zip': '06102', 'city': 'Hartford', 'state': 'Connecticut', 'country': 'United States', 'facility': 'Hartford Hospital', 'geoPoint': {'lat': 41.76371, 'lon': -72.68509}}, {'zip': '06050', 'city': 'New Britain', 'state': 'Connecticut', 'country': 'United States', 'facility': 'The Hospital of Central Connecticut', 'geoPoint': {'lat': 41.66121, 'lon': -72.77954}}, {'zip': '83706', 'city': 'Boise', 'state': 'Idaho', 'country': 'United States', 'facility': 'Saint Alphonsus Cancer Care Center-Boise', 'geoPoint': {'lat': 43.6135, 'lon': -116.20345}}, {'zip': '83605', 'city': 'Caldwell', 'state': 'Idaho', 'country': 'United States', 'facility': 'Saint Alphonsus Cancer Care Center-Caldwell', 'geoPoint': {'lat': 43.66294, 'lon': -116.68736}}, {'zip': '83814', 'city': "Coeur d'Alene", 'state': 'Idaho', 'country': 'United States', 'facility': "Kootenai Health - Coeur d'Alene", 'geoPoint': {'lat': 47.67768, 'lon': -116.78047}}, {'zip': '83617', 'city': 'Emmett', 'state': 'Idaho', 'country': 'United States', 'facility': 'Walter Knox Memorial Hospital', 'geoPoint': {'lat': 43.8735, 'lon': -116.4993}}, {'zip': '83642', 'city': 'Meridian', 'state': 'Idaho', 'country': 'United States', 'facility': 'Idaho Urologic Institute-Meridian', 'geoPoint': {'lat': 43.61211, 'lon': -116.39151}}, {'zip': '83686', 'city': 'Nampa', 'state': 'Idaho', 'country': 'United States', 'facility': 'Saint Alphonsus Medical Center-Nampa', 'geoPoint': {'lat': 43.54072, 'lon': -116.56346}}, {'zip': '83854', 'city': 'Post Falls', 'state': 'Idaho', 'country': 'United States', 'facility': 'Kootenai Clinic Cancer Services - Post Falls', 'geoPoint': {'lat': 47.71796, 'lon': -116.95159}}, {'zip': '83864', 'city': 'Sandpoint', 'state': 'Idaho', 'country': 'United States', 'facility': 'Kootenai Cancer Clinic', 'geoPoint': {'lat': 48.27659, 'lon': -116.55325}}, {'zip': '60201', 'city': 'Evanston', 'state': 'Illinois', 'country': 'United States', 'facility': 'NorthShore University HealthSystem-Evanston Hospital', 'geoPoint': {'lat': 42.04114, 'lon': -87.69006}}, {'zip': '62864', 'city': 'Mount Vernon', 'state': 'Illinois', 'country': 'United States', 'facility': 'Good Samaritan Regional Health Center', 'geoPoint': {'lat': 38.31727, 'lon': -88.90312}}, {'zip': '46514-2098', 'city': 'Elkhart', 'state': 'Indiana', 'country': 'United States', 'facility': 'Elkhart Clinic', 'geoPoint': {'lat': 41.68199, 'lon': -85.97667}}, {'zip': '46514', 'city': 'Elkhart', 'state': 'Indiana', 'country': 'United States', 'facility': 'Michiana Hematology Oncology PC-Elkhart', 'geoPoint': {'lat': 41.68199, 'lon': -85.97667}}, {'zip': '46515', 'city': 'Elkhart', 'state': 'Indiana', 'country': 'United States', 'facility': 'Elkhart General Hospital', 'geoPoint': {'lat': 41.68199, 'lon': -85.97667}}, {'zip': '46904', 'city': 'Kokomo', 'state': 'Indiana', 'country': 'United States', 'facility': 'Community Howard Regional Health', 'geoPoint': {'lat': 40.48643, 'lon': -86.1336}}, {'zip': '46350', 'city': 'La Porte', 'state': 'Indiana', 'country': 'United States', 'facility': 'IU Health La Porte Hospital', 'geoPoint': {'lat': 41.60774, 'lon': -86.71389}}, {'zip': '46545', 'city': 'Mishawaka', 'state': 'Indiana', 'country': 'United States', 'facility': 'Michiana Hematology Oncology PC-Mishawaka', 'geoPoint': {'lat': 41.66199, 'lon': -86.15862}}, {'zip': '46545', 'city': 'Mishawaka', 'state': 'Indiana', 'country': 'United States', 'facility': 'Saint Joseph Regional Medical Center-Mishawaka', 'geoPoint': {'lat': 41.66199, 'lon': -86.15862}}, {'zip': '46563', 'city': 'Plymouth', 'state': 'Indiana', 'country': 'United States', 'facility': 'Michiana Hematology Oncology PC-Plymouth', 'geoPoint': {'lat': 41.34366, 'lon': -86.30973}}, {'zip': '46601', 'city': 'South Bend', 'state': 'Indiana', 'country': 'United States', 'facility': 'Memorial Hospital of South Bend', 'geoPoint': {'lat': 41.68338, 'lon': -86.25001}}, {'zip': '46601', 'city': 'South Bend', 'state': 'Indiana', 'country': 'United States', 'facility': 'Michiana Hematology Oncology PC-South Bend', 'geoPoint': {'lat': 41.68338, 'lon': -86.25001}}, {'zip': '46617', 'city': 'South Bend', 'state': 'Indiana', 'country': 'United States', 'facility': 'South Bend Clinic', 'geoPoint': {'lat': 41.68338, 'lon': -86.25001}}, {'zip': '46391', 'city': 'Westville', 'state': 'Indiana', 'country': 'United States', 'facility': 'Michiana Hematology Oncology PC-Westville', 'geoPoint': {'lat': 41.54143, 'lon': -86.90058}}, {'zip': '66112', 'city': 'Kansas City', 'state': 'Kansas', 'country': 'United States', 'facility': 'Providence Medical Center', 'geoPoint': {'lat': 39.11417, 'lon': -94.62746}}, {'zip': '66219', 'city': 'Lenexa', 'state': 'Kansas', 'country': 'United States', 'facility': 'Kansas Institute of Medicine Cancer and Blood Center', 'geoPoint': {'lat': 38.95362, 'lon': -94.73357}}, {'zip': '66219', 'city': 'Lenexa', 'state': 'Kansas', 'country': 'United States', 'facility': 'Minimally Invasive Surgery Hospital', 'geoPoint': {'lat': 38.95362, 'lon': -94.73357}}, {'zip': '66209', 'city': 'Overland Park', 'state': 'Kansas', 'country': 'United States', 'facility': 'Menorah Medical Center', 'geoPoint': {'lat': 38.98223, 'lon': -94.67079}}, {'zip': '66213', 'city': 'Overland Park', 'state': 'Kansas', 'country': 'United States', 'facility': "Saint Luke's South Hospital", 'geoPoint': {'lat': 38.98223, 'lon': -94.67079}}, {'zip': '66204', 'city': 'Shawnee Mission', 'state': 'Kansas', 'country': 'United States', 'facility': 'Advent Health - Shawnee Mission Medical Center', 'geoPoint': {'lat': 39.02, 'lon': -94.66583}}, {'zip': '70817', 'city': 'Baton Rouge', 'state': 'Louisiana', 'country': 'United States', 'facility': "Woman's Hospital", 'geoPoint': {'lat': 30.44332, 'lon': -91.18747}}, {'zip': '04102', 'city': 'Portland', 'state': 'Maine', 'country': 'United States', 'facility': 'Maine Medical Center-Bramhall Campus', 'geoPoint': {'lat': 43.65737, 'lon': -70.2589}}, {'zip': '04074', 'city': 'Scarborough', 'state': 'Maine', 'country': 'United States', 'facility': 'Maine Medical Center- Scarborough Campus', 'geoPoint': {'lat': 43.57814, 'lon': -70.32172}}, {'zip': '01199', 'city': 'Springfield', 'state': 'Massachusetts', 'country': 'United States', 'facility': 'Baystate Medical Center', 'geoPoint': {'lat': 42.10148, 'lon': -72.58981}}, {'zip': '49120', 'city': 'Niles', 'state': 'Michigan', 'country': 'United States', 'facility': 'Lakeland Hospital Niles', 'geoPoint': {'lat': 41.82977, 'lon': -86.25418}}, {'zip': '48073', 'city': 'Royal Oak', 'state': 'Michigan', 'country': 'United States', 'facility': 'William Beaumont Hospital-Royal Oak', 'geoPoint': {'lat': 42.48948, 'lon': -83.14465}}, {'zip': '49085', 'city': 'Saint Joseph', 'state': 'Michigan', 'country': 'United States', 'facility': 'Lakeland Medical Center Saint Joseph', 'geoPoint': {'lat': 42.10976, 'lon': -86.48002}}, {'zip': '49085', 'city': 'Saint Joseph', 'state': 'Michigan', 'country': 'United States', 'facility': 'Marie Yeager Cancer Center', 'geoPoint': {'lat': 42.10976, 'lon': -86.48002}}, {'zip': '55905', 'city': 'Rochester', 'state': 'Minnesota', 'country': 'United States', 'facility': 'Mayo Clinic in Rochester', 'geoPoint': {'lat': 44.02163, 'lon': -92.4699}}, {'zip': '64057', 'city': 'Independence', 'state': 'Missouri', 'country': 'United States', 'facility': 'Centerpoint Medical Center LLC', 'geoPoint': {'lat': 39.09112, 'lon': -94.41551}}, {'zip': '64108', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': 'Truman Medical Centers', 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64111', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': "Saint Luke's Hospital of Kansas City", 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64114', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': 'Saint Joseph Health Center', 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64116', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': 'North Kansas City Hospital', 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64118', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': 'Heartland Hematology and Oncology Associates Incorporated', 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64132', 'city': 'Kansas City', 'state': 'Missouri', 'country': 'United States', 'facility': 'Research Medical Center', 'geoPoint': {'lat': 39.09973, 'lon': -94.57857}}, {'zip': '64086', 'city': "Lee's Summit", 'state': 'Missouri', 'country': 'United States', 'facility': "Saint Luke's East - Lee's Summit", 'geoPoint': {'lat': 38.91084, 'lon': -94.38217}}, {'zip': '64068', 'city': 'Liberty', 'state': 'Missouri', 'country': 'United States', 'facility': 'Liberty Radiation Oncology Center', 'geoPoint': {'lat': 39.24611, 'lon': -94.41912}}, {'zip': '65401', 'city': 'Rolla', 'state': 'Missouri', 'country': 'United States', 'facility': 'Delbert Day Cancer Institute at PCRMC', 'geoPoint': {'lat': 37.95143, 'lon': -91.77127}}, {'zip': '65401', 'city': 'Rolla', 'state': 'Missouri', 'country': 'United States', 'facility': 'Mercy Clinic-Rolla-Cancer and Hematology', 'geoPoint': {'lat': 37.95143, 'lon': -91.77127}}, {'zip': '64506', 'city': 'Saint Joseph', 'state': 'Missouri', 'country': 'United States', 'facility': 'Heartland Regional Medical Center', 'geoPoint': {'lat': 39.76861, 'lon': -94.84663}}, {'zip': '64507', 'city': 'Saint Joseph', 'state': 'Missouri', 'country': 'United States', 'facility': 'Saint Joseph Oncology Inc', 'geoPoint': {'lat': 39.76861, 'lon': -94.84663}}, {'zip': '65804', 'city': 'Springfield', 'state': 'Missouri', 'country': 'United States', 'facility': 'Mercy Hospital Springfield', 'geoPoint': {'lat': 37.21533, 'lon': -93.29824}}, {'zip': '65807', 'city': 'Springfield', 'state': 'Missouri', 'country': 'United States', 'facility': 'CoxHealth South Hospital', 'geoPoint': {'lat': 37.21533, 'lon': -93.29824}}, {'zip': '63141', 'city': 'St Louis', 'state': 'Missouri', 'country': 'United States', 'facility': 'Mercy Hospital Saint Louis', 'geoPoint': {'lat': 38.62727, 'lon': -90.19789}}, {'zip': '59711', 'city': 'Anaconda', 'state': 'Montana', 'country': 'United States', 'facility': 'Community Hospital of Anaconda', 'geoPoint': {'lat': 46.12854, 'lon': -112.94226}}, {'zip': '59101', 'city': 'Billings', 'state': 'Montana', 'country': 'United States', 'facility': 'Billings Clinic Cancer Center', 'geoPoint': {'lat': 45.78329, 'lon': -108.50069}}, {'zip': '59101', 'city': 'Billings', 'state': 'Montana', 'country': 'United States', 'facility': 'Saint Vincent Healthcare', 'geoPoint': {'lat': 45.78329, 'lon': -108.50069}}, {'zip': '59715', 'city': 'Bozeman', 'state': 'Montana', 'country': 'United States', 'facility': 'Bozeman Deaconess Hospital', 'geoPoint': {'lat': 45.67965, 'lon': -111.03856}}, {'zip': '59701', 'city': 'Butte', 'state': 'Montana', 'country': 'United States', 'facility': 'Saint James Community Hospital and Cancer Treatment Center', 'geoPoint': {'lat': 46.00382, 'lon': -112.53474}}, {'zip': '59405', 'city': 'Great Falls', 'state': 'Montana', 'country': 'United States', 'facility': 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