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/, http://centerwatch.com/, nih.gov/—as well as cancer-focused Web sites, such as http://cancer.org/, http://lungcancer.org/, http://cancernews.com/, http://cancercare.org/, and http://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.