Public Relations: Beef Up Clinical Trial Numbers
Increasingly, trials exist in a very competitive environment, where multiple trials are vying for a limited pool of potential participants. This is especially true of cancer and cardiology trials. It has become necessary for trial directors to view recruitment as a marketing effort, just as one would market a product or a service. They must focus on the positioning and messaging that differentiates the trial and the compound being studied from other compounds currently in testing or on the market.
Public relations has become an important part of the recruitment and enrollment effort for clinical trials. Unlike advertising's "paid" media, PR has the credibility of "earned" media. PR is also far less expensive than advertising. A broader and richer strategy featuring a range of tactics and channels that stretch beyond newspapers and magazines, public relations is able to not only educate patients but also alert them to the existence and benefits of trials. And the Internet, a valuable PR tool that has been growing in use and reach, provides a host of specialty sites that channel information and news regarding medical information to people interested in specific topics.
The Other Lung Cancer
Recently, a Manning, Selvage & Lee client, a large biotechnology company in Cambridge, needed to recruit patients with bronchioloalveolar cancer (BAC) for a Phase II clinical trial. BAC is a relatively rare subtype of non-small cell lung cancer (NSCLC); it makes up about 20 percent of the NSCLC patient population—or about 30,000 patients.
Unfortunately, in addition to being rare, BAC is also frequently misdiagnosed. It has a unique "masked" presentation, it frequently strikes non-smokers and other low-risk populations, and is often mistaken for pneumonia or other inflammatory conditions of the lung—at least until antibiotics and other treatments fail.
Taken together, these factors increased the difficulty of recruiting patients for the BAC trial.
This particular recruitment effort was focused on five larger markets—Boston, Seattle, New York, Chicago, and Atlanta—with principal investigators already in place, a presumably larger patient pool, and plenty of traditional media providing recruiting opportunities. Interestingly, as we developed the PR side of the recruiting effort, we found that the most effective and efficient way to reach our target audiences was online through a variety of Internet sites and channels—listservs, blogs, and chat rooms, as well as patient advocacy sites.
BAC on the Web
With the knowledge that much of our outreach was going to be conducted online, we developed an informational Web site to use in recruitment efforts. The site itself was rudimentary—a simple single page that contained the same information as the print flier for the trial. But, the benefit of the Web site was that we were able to change the information as needed. For example, when the protocol changed mid-trial, we were able to reflect those changes immediately, while the fliers that had already been distributed continued to contain the outdated information.
We found that many Web sites we were interested in—including local chapters of the American Cancer Society and Gilda's Club—were unwilling or unable to post direct links or direct information about one particular clinical trial. There were, however, some Web sites created explicitly for this purpose, including NexCura and the clinical trials pages of the National Cancer Institute. Most patient-focused Web sites were more than willing to link to these clearinghouse sites.
We also identified an assortment of groups that supported our target population. Most of these groups and organizations have physical locations. This helped since we were targeting specific cities and markets. To that end, once we had developed a strong support group in Gilda's Club, we used the Web page for the local Gilda's Club chapters as an information conduit. Often these pages listed content about lung cancer support groups, or posted news on the calendar about an event for lung cancer awareness, lung cancer support lunches, or fundraising. If we found a lung cancer program, we tracked down the organizer and asked if we could send fliers and information for distribution at their event. No one ever said no.
If nothing was available online, we used the piece of information that was always available—a phone number—and worked from there. We called and asked if there were any upcoming events, or resource rooms, libraries, or bulletin boards where patients would likely look for information. We sent a stack of fliers to at least three local organizations in each market to be distributed to potential candidates.
Our list of organizations included Gilda's Club, Cancer Care, The National Lung Cancer Partnership (formerly Women Against Lung Cancer), Wellness Center, and a variety of local organizations and support groups we found through various Internet searches. We also called local hospitals and asked them to name places and groups to which they referred patients.
Listservs have become an increasingly popular way for members of a patient population to communicate with one another. Because they offer access to targeted patient populations that have already chosen to play an active role in their medical treatment, they can provide an ideal cluster of audiences. However, it is important to approach these groups carefully and unobtrusively.
Every listserv has a list owner who serves as the moderator. The safest approach to sending information to groups is to e-mail the listserv owner, explain who you are, and ask him or her to pass along the trial information. For this particular trial, we identified a list that catered specifically to the small subset of lung cancer patients we were interested in, as well as a larger one with more members. It turned out the listserv owner was the same for both lists, and she happily passed the information along to both groups.
Another benefit of the listserv is that the messages are typically archived and posted online. Consequently, even people who aren't members can seek information simply by going online and reading past e-mails.
Harvesting Clinical Trial Web Sites
Another key strategy was to distribute information about the trial to the major clinical trial Web sites—clinicaltrials.gov, centerwatch.com, nih.gov—as well as cancer-focused Web sites, such as cancer.org, lungcancer.org, cancernews.com, cancercare.org, and medicineworld.org. These sites are critical channels for delivering information because they are regularly visited by cancer patients and their loved ones.
We also identified and enlisted lung- cancer groups on both a national and a local level to help deliver the BAC messages to their constituents. We reached potential patients through media vehicles, such as press releases, newswires, and repurposed press materials. We announced the trial in each market, explaining the purpose, condition, treatment, enrollment protocol, principal investigator, and background on BAC.
Each trial was led by a leading cancer researcher and associated with a major teaching hospital that included Rush University Medical Center, Massachusetts General Hospital, Swedish Cancer Institute, Sloan Kettering Memorial Cancer Center, and Emory University Hospital. These institutions enhanced the credibility of each trial.
More than 500 fliers and brochures were mailed to physicians, patients, and department support staff at sponsoring hospitals in the five markets. Information was distributed at events that targeted lung cancer patients and providers, such as the Lung Run in Chicago, Lung Cancer Awareness Month lectures, and local patient-information sessions. Locally and nationally distributed news releases garnered coverage in key trade publications and local newspapers, and on patient Web sites such as Gilda's Club and Wellness Centers, cancercare.com, and cancer.org. Total enrollment in the Phase II trial increased from zero to 34 in just 10 months.
In this case, the company opted not to use advertising, but chose to rely exclusively on public relations and online communications as its outbound marketing tools. This strategy worked because of the educational component implicit in public relations and the Internet. Rather than appealing to potential patients via paid advertising, messages were conveyed via third-party channels where the messages resonated, and those channels targeted the right messages to the right patients.
Public relations and online communications can be important tools for successful trial recruitment and enrollment. Trials are complex experiments. Patients often have a lot of anxiety about considering being part of a trial. Advertising alone, besides being expensive, cannot convey enough information to overcome those hurdles. PR can.
John Smith is senior vice president and director of healthcare at Manning, Selvage & Lee. He can be reached at email@example.com
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