Can Twitter Be Used to Boost Clinical Trial Recruitment?

Mina S. Sedrak, MD, MS

Mina S. Sedrak, MD, MS

A new study has found that Twitter may be an effective and heretofore untapped resource to stimulate interest in cancer clinical trials and boost enrollment.

Enrollment into clinical trials can provide promising new treatment options for patients. But only about 5% of adult patients with cancer participate in these studies.

The study, published online March 3 in JAMA Oncology, is based on an analysis of thousands of lung cancer—related tweets. The research found that a surprisingly large number were about clinical trials, particularly ones on immunotherapy, although none were used for recruitment.

“This is an unsolved societal problem,” said lead study author Mina S. Sedrak, MD, MS, a fellow in the division of Hematology/Oncology at the Perelman School of Medicine at the University of Pennsylvania and the Abramson Cancer Center.

“Twitter provides a promising and novel avenue for exploring how cancer patients conceptualize and communicate about their health, and may have the potential to promote much-needed clinical trial recruitment."

Numerous cancer centers and care organizations actively use Twitter as a platform for health promotion and education, but few studies have examined the existing cancer communication on Twitter, and none have examined the extent to which Twitter provides useful information about cancer clinical trials, the authors noted.

Sedrak and colleagues analyzed a randomly chosen sample of 1516 tweets out of a total of 15,346 unique tweets that contained "lung cancer" that were sent from January 5 - 21, 2015, and observed where they were directed.

Although the majority of tweets analyzed (56%) focused on giving and receiving psychological support or dialogues about prevention, the study found that nearly 18% (221) of the tweets were about clinical trials, 42% of which were tweeted by individuals (including self-identified patients, healthcare professionals, advocates, and non-health users).

“We were surprised to see that after dialogues concerning support and prevention, the next largest category of tweets were about clinical trials,” Sedrak said. The majority of these clinical trial tweets were about human research involving a drug or a device, and quite a number were focused on the excitement around immunotherapy, which was still investigational at the time of the study.

Among the therapeutic clinical trial tweets, 79% (144 of 183), in fact, concerned immunotherapy and 86% (158 of 183) had embedded links directing users to relevant news articles.

What the study also uncovered was that virtually none of these tweets were used for recruitment nor did they provide links to enrollment websites. Only one tweet linked to a patient recruitment website.

Although this work adds to the emerging literature and helps us understand how the public uses Twitter to get information about lung cancer, further efforts are needed to see if Twitter may be a viable method of disseminating health information, which may not only improve treatment and support for cancer patients and survivors, but also enhance public awareness of and enrollment into cancer clinical trials, the authors said.

Moreover, social media patient recruitment and retention programs may pose some new challenges to institutional review boards (IRBs) with respect to both noncoercive content and the assurance of privacy. IRBs will need to think about appropriate policies on how to review social media recruitment campaigns and address emerging ethical dilemmas inherent to the use of social media and research, the authors said.

“We need to learn more about the ecology of social media, because it is clearly not consistently directing patients to the right places,” Sedrak said. "Social media may provide an infrastructure for cancer centers, researchers, and physicians to interact with the public in new and productive ways, including stimulating interest in new clinical trials with targeted messages that connect patients, caregivers, and families with trial enrollment websites. This potential remains largely untapped.”

Sedrak MS, Cohen RB, Merchant RM, Schapira MM. Cancer communication in the social age [published online ahead of print March 3, 2016]. JAMA Oncol.