Data Driven Doc: A Diagnostic Lack of Clarity

shutterstock_262687568In war torn Iraq, Taufiq was unfortunately diagnosed with lymphoma. At 60, he had a widowed daughter and grandkids whose future he was deeply worried about. Now this diagnosis of cancer was clouding his world more than the local strife. The pathologists were hedging between a diagnosis of mantle cell lymphoma (more aggressive) vs marginal zone lymphoma (slow growing). His doctors were recommending an aggressive four-drug combination therapy. He was worried about the lost days of work, the risk of infections and heart disease, and toll on his body and his spirit.

From an Indian friend, he had heard about the wealth of experience at Tata Memorial Center, Mumbai in treating thousands of patients every month with liquid cancers. Desperate, he reached out for advice on a cure. The TMC website led Taufiq to Navya’s online expert opinion service.

The TMC website led Taufiq to Navya’s online expert opinion service.

Navya analysts in Bangalore received the case from Taufiq the same afternoon at 3:48pm IST he had contacted TMC. After gathering a brief history from Taufiq, his case details were entered in the Navya system within a couple of hours. The expert system crunched the patient details, searched hundreds of similar cases and trials, and concluded that Taufiq had another option – a two-drug regimen that was less toxic and more suited to marginal zone lymphomas.

Since there was diagnostic lack of clarity, I received the case for medical review. Just getting off an overnight ER shift in Los Angeles at 6:36am PST- less than four hours since Taufiq reached out to us. A quick review of the facts confirmed that the systems analysis looked right, albeit surprising. I sent the case onwards through our Navya mobile expert app to one of India’s most senior and thoughtful lymphoma specialists at 7am PST.

The TMC expert’s push notification about a new case received showed up instantly in Mumbai, India. Caught in legendary Mumbai traffic on his way home, he reviewed the structured summary of the case and the system recommended options and selected the two-drug regimen. He added a concise and thoughtful note about why he believed the diagnosis favored mantle cell lymphoma, and recommended additional tests on the biopsy specimen at TMC to finalize the diagnosis. His response reached the team by 8:16pm PST- about 4.5 hrs since Taufiq had reached out to us.

The evening shift at Navya worked on a clearly worded patient report explaining the new diagnosis, and the specific protocol for the two-drug regimen. The evidence, guidelines, experience, and expert advice was synthesized into a report that Taufiq could easily understand. After a quick review of the report, it was uploaded by 10pm IST the very same day!

Imagine Taufiq’s relief at being able to receive a clear recommendation from an expert on the same night!  Not only was his chemotherapy regimen going to be less toxic, his prognosis seemed better with a less aggressive diagnosis than his doctors in Iraq originally gave him. He felt he had been granted additional years to secure his family’s future. Suddenly, the night must have seemed just a little bit brighter.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh

Tata Memorial Center: tmc.gov.in

Tata Trusts: tatatrusts.org

Navya: navyanetwork.com

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