Clinical trials benefit from aggressive patient outreach

ABSTRACT: Good public relations are part of any successful business, and cancer trials are no exception. Drs. Charles Weaver and Robin Zon discuss their tactics for recruiting patients.

With clinical trial involvement stalled at around 5% for adult cancer patients, there is much room for improvement. Oncology News International spoke with two experts who have found that common sense marketing strategies can boost enrollment.

“Market research shows that 70% of cancer patients using the Internet are looking for clinical trial information, so we have a motivated audience looking for solutions to their problem and a vehicle that allows patients to search.

Why then does this situation not change?” asked Charles H. Weaver, MD, founder and CEO of Cancer Consultants, which represents trials for 120 cancer clinics (www.cancerconsultants.com).

One problem, he said, is too much information. Between government websites, advocacy blogs, and cancer center portals, patients are confronted with an overwhelming amount of information to dig through.

“No single website has it all,” Dr. Weaver said. “You have to be very motivated to sort through the morass of irrelevant information. Also, patients want trials that will give them access to something they cannot otherwise get, and most trials don’t do that.”

At Cancer Consultants, Dr. Weaver has been successful in matching patients with trials by taking a targeted approach, trying to identify the most motivated patients and reaching out to them.

“We have 300,000 patients from around the U.S. coming to our website every month looking for clinical trials,” Dr. Weaver explained.

“We ask them to sign up to receive updates and disease-specific newsletters. We try to identify those who are most motivated (they tend to be newly diagnosed) and target them for enrollment. We have reasonable success with this,” he added.

But patients shouldn’t have to go looking outside their own community, noted Robin Zon, MD, an oncologist with Michiana Hematology Oncology in South Bend, Ind. Dr. Zon is the principal investigator of the Northern Indiana Cancer Research Consortium and a member of the ASCO Clinical Trials Workshop Committee. She maintains that it is the responsibility of a medical team to make patients aware of trials and steer them toward recruitment opportunities.

‘It’s about outreach’

“Patients simply do not know about the option to be treated in the context of a clinical trial. Their physicians don’t tell them,” Dr. Zon said. Not so in her practice, which claims a 10% clinical trial enrollment rate, double the national rate.

“In my opinion, campaigns to raise awareness come down to good marketing, which is part of the business model for any successful business,” she said. “It’s about outreach. It’s about taking the extra step.”

Dr. Zon outlined some of the methods her practice uses to entice patients to trials:

• Emphasizing cutting edge treatments on the website home page.
• For new IRB-approved studies, placing ads in newspapers and brochures in physicians’ offices.
• Direct telemarketing to patients.

Dr. Zon also markets aggressively to community physicians and not just oncologists. Surgeons, radiation oncologists, pathologists, and others involved in treatment decisions are fair game. She sends out a monthly newsletter that highlights her protocols and research needs. The newsletter goes to other investigators and their staff , the Michiana board of directors, and hospital administrators. No tumor board presentation is considered complete without mention of a clinical trial that may be appropriate for the patient. “Very often, we put these patients on our studies,” she added.

In 2007, Michiana enrolled more than 600 subjects in trials of cooperative groups, other research organizations, and academic centers, including 168 on treatment protocols and 443 on cancer control protocols.

Dr. Zon acknowledged that her efforts are not so much intended to bring money into the practice as to advance the field of cancer research and, hopefully, benefit the patient.

“But you can do cancer clinical trials without losing money,” she emphasized. “We offer a mix of publicly and privately funded studies, which allows us to support our budget. And we receive donations from outside groups in our community. We even have an active patient advocacy group that hosts fundraisers to encourage trial enrollment.”

In the end, a patient must consider that trial worthy of his or her time and effort. The patient needs to see the research as a value proposition with some personal gain, Dr. Weaver added. “We have consulted with many patients who are well educated and motivated. They pay us to identify appropriate trials for them,” he said. “We take them through the whole process. In the end, they say: ‘I’m not sure a clinical trial offers me anything more than the standard of care, which is easier, closer to home, and covered by the insurance company.’”

Nonetheless, persistence in promoting trials can pay off , as Dr. Zon said. For a phase II study of a nonestrogen treatment for hot flashes, she targeted breast cancer survivors who were unwilling to take estrogen. “We had tons of responses,” she reported. “Patients traveled hundreds of miles to see me about this study.”