Category: Cancer

Navya: My Family – Thank you

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“The suspicious lump in my left breast could be cancerous” was suggested to me soon after my mammography and I was devastated. My husband and I felt numb with fear. But luckily our doctor friends: my gynaecologist,  my family doctor and an NGO for Cancer were my pillars of strength.

They removed the tumor with wide excision and sent the blocks for biopsy. As everyone who has encountered this phase knows how difficult it is to wait for the reports. Once the report came all of us were jubilant because the report indicated that it was first stage and II grade infiltrating carcinoma cancer.

My surgeon suggested that I may not need a chemotherapy but I should undergo some other tests to confirm. For a second opinion, we decided to meet a different doctor. He said chemo would be required. We were a little confused.

And at that time one of our relatives and a close friend who was a doctor sent us links to www.navya.care. I decided that I will register my name on this website and maybe upload my reports. I read about their collaboration with Tata Memorial Hospital. It said you just have to pay Rs.7500 and you will get your expert advice in three to four days. It also said it was free for people with economic challenges. It was too good to be true.

On 28th of April I registered my name and left it at that. 29th April was my birthday. At about 1p.m. I get this call from Chirom. He introduced himself as a Patient Advocate from Navya. He spoke to me and my husband Sandesh from almost one and half hour. I think that was one of the best birthday gifts of my life and beginning of a beautiful relationship.

I uploaded all my reports. Gitika Srivastava and Pooja were constantly guiding me regarding the reports sometimes by sending emails and sometimes by calling me up. Within a couple of days of uploading the reports, the expert opinion report was received by me. More or less the suggestions given by the panel was similar to what my surgeon had opined. They suggested hormone therapy and irradiation of partial breast for seven days.

The support that was given by Chirom and Pooja was untiring. Actually maybe once reports are given Navya’s duty should  end but Chirom has been kind enough to chat, guide, and motivate me till date.

We decided that we would get the chemo administered from a hospital in Goa. I am following the regimen given by Navya.

What I would like to highlight about Navya is:

  1. The second opinion that Navya  gives is based on the reports that are uploaded by the patient but they are very careful about analysing the reports also. In my case it was very clearly seen.
  2. They guide the patient regarding the reports.
  3. The patient Advocate is constantly there to help the patient/their companion.
  4. The Navya analysts continuously contact the patient to find out how he/she is doing
  5. It feels like a family.

The support that I got from Friends, family, the NGO, all doctor friends and Navya made me strong in this phase of tackling chemo with positive attitude.

Prashanti Talpankar,
Associate Professor,
DnyanPrasarak Mandal’s College and Research Centre
Assagao.

 

The Clarity of an Expert Opinion Prevents Unnecessary Chemotherapy

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Reshma Singh, a 22 year old, working with a multinational in Pune received a call from her father. Her mother, Mamta, 50, who lived in Sehore, a small town midway between Indore and Bhopal was diagnosed with Resectable Ovarian Cancer following severe abdominal pain and was advised immediate surgery. There was a mass detected in the uterus which meant that a complete hysterectomy was deemed necessary. The family had to travel to Indore where, in consultation with a Laparoscopic surgeon at a private hospital, she underwent a successful procedure where the tumor was removed.

This was supposed to be the end of the ordeal but things turned out very differently. “That one week in the hospital post surgery was a stressful time for us where each doctor visit would cost us several thousand rupees” said Reshma. After a biopsy, the surgeon recommended that she go through a chemotherapy regimen of 7 cycles. “The doctor told us that this was a precautionary measure to ensure the cancer does not recur. This came as a shock to all of us. I also felt that the surgeon was pressuring us into starting an expensive and possibly unnecessary treatment.” A heated debate ensued within the family with some members feeling that the doctors word must be trusted and Reshma insisting that such a big step should not be taken without getting another unbiased opinion from an expert.

Reshma wanted to get an opinion from Tata Memorial Center in Mumbai but her mother was in no shape to travel. She reached out to TMC NCG Online, Navya Expert Opinion Service to get the advice of world renowned experts. She uploaded all her mother’s reports following which a patient advocate reached out to her to understand the medical history and to know what the family wanted to ask the experts. A clarification was sought about the marginal status of the surgery as well as the planned treatment.

The case was compiled and sent to an expert at the Gynecology disease management group and his opinion was sought. The response was that as per the globally accepted guidelines for the treatment of cancers, surveillance was the recommended course of option. This would require the patient to undergo a physical examination and a battery of recommended tests every 3 months for the next two years. Chemotherapy was not a recommended course of treatment at this time. The report was shared with Reshma who shared it with the elders in the family. “When my father saw that the Tata Cancer hospital doctors had given this opinion, there was a sense of relief.”

There is scarcity of cancer experts in India, located mostly in metropolitan cities, but the number of cancer patients in need of an expert opinion is in the millions. Traveling to consult an expert at each of the many treatment decision points is costly, logistically complex, and delays the onset of treatment. In this case, reaching out to TMC NCG Online -Navya Expert Opinion Service, meant that the patient was not administered Chemotherapy which would have been against globally accepted guidelines for that particular situation.

Urging family members of cancer patients, Gitika Srivastava, Founder of Navya, shares her personal viewpoint:  “Most people who have had any experience with cancer are aware of TMC and that it is one of the largest tertiary care centres in the world. However not everyone from far flung areas can come to Mumbai or is aware of the significance of a proper choice in treatment to a change in outcomes. Given the cases we have seen; we would urge everyone to get an expert opinion through TMC NCG Online. You can be assured that the opinion rests on the experience of world renowned cancer experts and follows evidence based protocols best suited to your loved one’s specific case.”

National Cancer Grid (NCG), tmc.gov.in/ncg Tata Memorial Centre (TMC) tmc.gov.in

The NCG is a consortium of 104 cancer centers, with a mandate to standardize cancer care, nationally. NCG is the largest global network of cancer centers collaborating to use technology and training to bring cancer expertise to every oncologist and cancer patient in India. TMC is Asia’s largest leading tertiary care expert cancer center, seeing over 67,000 cancer patients every year. Its strength necessitates a responsibility to make its expertise available to patients across India and developing countries, especially those who reside in locations where there are no expert cancer care centers.

Navya www.navya.info

Navya is a clinical informatics and patient services organization with a unique understanding of cancer patients and oncologists and a core commitment to cancer care. With a proven track record of successfully implementing innovative solutions that are low cost and effective, Navya is the first to develop technology systems specific to Indian cancer data for use by cancer patients and oncologists in India.
Contact:  Gitika Srivastava | gitika@post.harvard.edu

Twitter: https://twitter.com/NavyaCare

Facebook: https://www.facebook.com/NavyaNetwork/

LinkedIn: https://www.linkedin.com/organization/15236089/

PRESS RELEASE 06/05/2017

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CS Pramesh
Dr CS Pramesh – Coordinator National Cancer Grid

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Expert Oncologists from Tata Memorial Centre (TMC) and National Cancer Grid (NCG) Use Navya to Provide Rapid Online Opinions to Patients across 22 Developing Countries

The results of a prospective study presented at the 2017 American Society of Clinical Oncology (ASCO) meeting demonstrates the global impact of an informatics-based scalable and low cost online service to maximize outcomes for patients in areas without ready access to expertise

CAMBRIDGE, Mass., MUMBAI, India and Chicago, Ill. – June 5, 2017: “TMC NCG Navya Online” provides multidisciplinary evidence based expert opinions within 24 hours to thousands of cancer patients in urban and non urban areas in the developing world.  A prospective study assessing the real world impact of this service concluded that patients shared the expert opinions with their treating providers and received evidence-based treatment. Expanding the service to non urban USA and the western world, can maximize cancer care outcomes, globally.

There is a scarcity of expert oncologists in the world. Patients in non urban areas have poor access to evidence-based treatment decisions and worse outcomes. In India, there are circa 1600 oncologists for 1.8 million patients and the lack of expertise translates to suboptimal and expensive treatment decisions. Navya’s informatics based expert opinion service, scalably provides multidisciplinary evidence based treatment opinions on-time, empowering every patient.

Since its creation in 2014, 10,779 patients from 22 developing countries have registered with TMC NCG Navya Online. The technology based operation with a median turnaround time of 24 hours, consists of clinical analysts who collect patient data and an informatics system that generates patient-specific evidence-based treatment options.  Experts take into account  patient preferences and rapidly review and vet the options within 1-2 minutes on the mobile ExpertApp.  The system generates a consensus multidisciplinary treatment decision and analysts create an expert opinion report in simple layman language which is sent to the patient online.

“The online expert opinion service is a game changer for regions where the demand for cancer expertise far outstrips supply, by democratizing access. This has enabled proliferation of standardized evidence based treatment recommendations for patients who lack the access to tertiary care centers and thereby expertise” said Dr Pramesh, Coordinator National Cancer Grid, the world’s largest consortium of 108 cancer centers in India. Dr Pramesh made an oral presentation of this abstract at ASCO on the 5th of June, 2017.

The study included 914 patients who registered with the service between July 2016 and March 2017 and were asked via phone follow up: 1. If report was shared with treating provider, 2. Final treatments received. Of the 90% of patients who responded (n=824), 72.3% [CI 3.05%] of patients shared the Expert Opinion Reports with their treating oncologists. 78% [CI 2.95%] of patients received treatments recommended by TMC NCG Navya.  Common reasons why patients received different treatments included decline in performance status after receiving the online opinion and not testing for biomarkers (Estrogen Receptor/Progesterone Receptor, etc.), likely due to lack of access to resources.

“The finding that a high proportion of the patients are sharing the reports with their treating oncologist and most proceed treatments that TMC and NCG experts would recommend,  demonstrates that the online service has wide approval both among patients as well as local physicians and oncologists” said Dr Rajendra Badwe, Director of Tata Memorial Centre, one of Asia’s largest leading tertiary care cancer centers.

Says Gitika Srivastava, Founder of Navya: “Navya’s vision is to meaningfully move the needle in the way cancer care is delivered. This study shows that the informatics based system and service is scaleable and has positively impacted patients from all over the developing world. Expanding the reach of this service can maximize outcomes for patients, especially those in non urban areas, across the world.”

National Cancer Grid (NCG), tmc.gov.in/ncg Tata Memorial Centre (TMC) tmc.gov.in

The NCG is a consortium of 108 cancer centers, with a mandate to standardize cancer care, nationally. NCG is the largest global network of cancer centers collaborating to use technology and training to bring cancer expertise to every oncologist and cancer patient in India. TMC is Asia’s largest leading tertiary care expert cancer center, seeing over 67,000 cancer patients every year. Its strength necessitates a responsibility to make its expertise available to patients across India and developing countries, especially those who reside in locations where there are no expert cancer care centers.

Navya http://www.navya.info

Navya is a clinical informatics and patient services organization with a unique understanding of cancer patients and oncologists and a core commitment to cancer care. With a proven track record of successfully implementing innovative solutions that are low cost and effective, Navya is the first to develop an end to end expert decision system for use by cancer patients and oncologists globally.  Navya’s online expert opinion service is also the first of its kind to offer evidence based opinions from world leading experts at low cost, answering every single question of the patient, within 24 hours.

Twitter: https://twitter.com/NavyaNetwork

Facebook: https://www.facebook.com/NavyaNetwork/

LinkedIn: https://www.linkedin.com/company/15236089

Contact:  Gitika Srivastava | gitika@post.harvard.edu

Data Driven Doc: As Easy As ‘Tak, tak, tak’

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Early on in creating Navya- Gitika and I met with the CEO of a private hospital in Mumbai exploring interest in Navya’s expert opinion services. He dismissed us offhand- saying he could email his friends ‘tak, tak, tak’ (Indian/Desi colloquialism for ‘instantly’) and get a response from them on any questions he had. Funnily enough – he was a radiologist who didn’t see the power of asynchronous and instantaneous collaboration on medical information. Today teleradiology is one of the largest medical services online.

A few years later, I’m impressed with how many ‘tak, tak, tak’ connections Navya has created for our patients across the world. We had 20 requests for consultations today, and we were able to get instantaneous reviews of many of the cases by international experts.  Where one expert’s response wasn’t confident enough, we got two or three to confirm! Back to the patient in a day!

A well-connected CEO of a hospital may get his medical questions answered by specialists in a jiffy, but the true value of Navya on democratizing expert information across the world, instantaneously, is beautiful. It’s truly as easy as ‘tak, tak, tak’.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh
Tata Trusts: tatatrusts.org
Tata Memorial Center: tmc.gov.in
Navya: navyanetwork.com

Tata Memorial Centre and Navya Create Experience Engine (XE) that “Thinks” like Expert Oncologists

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Press Release

Tata Memorial Centre and Navya Create Experience Engine (XE) that “Thinks” like Expert Oncologists  

System Mines Knowledge of World Leading Experts for Cancer Treatment; Promising Results Presented at San Antonio Breast Cancer Symposium (SABCS) – December 6-10, 2016 – San Antonio, TX  

CAMBRIDGE, Mass., MUMBAI, India and SAN ANTONIO, Texas – Dec. 7, 2016 – Tata Memorial Centre (TMC), seeing over 50,000 new cancer patients a year, and Navya, a clinical informatics and patient services organization focused on complex decision making, announced Experience Engine (XE), a machine learning solution to structure experiential knowledge relevant for treatment decision making. The learning solution derives a similarity metric for patients who have received similar treatments and predicts treatment decisions that experts are likely to recommend. XE goes beyond evidence, solving patient cases that clinical trial data does not.

Promising results from the first trial of organized learning from past tumor board decisions at TMC and UCLA-OVMC to predict treatment decisions that oncologists would make for a new set of patients are being presented at SABCS 2016. The abstract titled, “Building an Experience Engine to Make Cancer Treatment Decisions Using Machine Learning,” is being presented on Wednesday, December 7, 2016.

Dr. Rajendra A. Badwe, Director, TMC said, “The Experience Engine captures the way experts think and outputs treatment options for each patient in line with what they would recommend. This is how we can scale access to expertise. The resulting database of opinions is also an excellent companion for online training.”

Being a tertiary care referral center, TMC’s experts treat highly complex, nuanced and rare cases from across the Indian subcontinent, Asia and Africa. Multidisciplinary tumor board decisions at TMC represent an unparalleled wealth of intelligence and experience, currently trapped in the minds of experts and electronic medical records.

Dr. Naresh Ramarajan, graduate of Harvard College and Stanford School of Medicine, and Founder and Chief Medical Officer at Navya said, “Tata Memorial Centre and Navya create a new source of knowledge. The Experience Engine has implications for training oncologists, standardizing cancer care across the world and driving accurate decisions for complex patients not addressed by the evidence.”

Navya’s Engines synthesize evidence specific to a patient and learn from relevant tumor board decisions to make treatment decisions. The Navya Evidence Engine (EE) was validated in three clinical trials at Tata Memorial Centre and UCLA-OVMC. Results showing 98 percent concordance between the EE decisions and TMC and UCLA-OVMC tumor board decisions were published at the SABCS in 2014 and American Society of Clinical Oncology (ASCO) in 2016.

Tumor boards at tertiary centers like TMC and UCLA-OVMC provide solutions to complex cases not addressed by high quality evidence. Experts intuitively retrieve patterns from years of experience to make treatment decisions. Short of personal consultations, there is no way to access this vast “experience database.”

Richness of Navya’s ontology represents each patient with 690 individual features. XE uses relevance learning to identify the core set of highly informative features for decision making.

Multiple similarity distance metrics were systematically evaluated for each decision point. When a new patient was presented to XE, the learned similarity metric was used to identify similar patients. XE then predicts a decision based on the treatment received by these similar patients.

XE’s predicted decision was compared with the expert’s actual decision. The primary endpoint of comparison was accuracy (defined as AUC – Area Under Curve). In addition, state of the art multiclass classification algorithms were also evaluated. Winning XE algorithms were chosen specific to each decision point. The algorithms were used on a completely new prospective group of patients who were seeking an online opinion from tumor board experts of Tata Memorial Centre.

Accuracy of prediction for each decision point was significantly (~40 percent) more accurate than baseline of weighted random guessing. When XE predicted whether a patient needed standard evidence based therapy or a non-standard experience based therapy, it was highly accurate (70 percent to 99 percent based on the decision point).

The XE is a truly novel source of knowledge, containing learning from patients with significant comorbidities, multiple lines of prior treatments and poor performance status for whom standard evidence-based treatments from randomized control trials are not applicable. The analysis of hundreds of similar patients to these complex patients uncovers new insights into possible treatments.

Further, XE enables oncologists to evaluate why similar patients may receive different treatments. Variations in practice patterns, treatment centers, expert preferences, affordability of patients and patient preferences, are features that influence decision making. These are considered by XE, but not possible to consider by medical evidence guided by randomized clinical trials.

About Tata Memorial Centre
Tata Memorial Centre, founded in 1941, leads the Indian subcontinent in cancer care by evidence based practice of oncology, and research and services which are affordable, innovative, and relevant to the needs of the country.   Every year nearly 50,000 new patients visit TMC from all over India and developing countries in Asia, Africa. Approximately, 70 percent of these patients are treated almost free of charge.   Visit: https://tmc.gov.in.

About Navya
In 2009, Navya was founded in Cambridge, MA by graduates of Harvard, MIT Sloan, and Stanford.  Navya’s patented system uses clinical informatics, predictive analytics and machine learning technologies. It combines several clinical information sources as inputs – and outputs a treatment decision most applicable to a unique patient.  For the first time, quick and affordable access to evidence and experience based expert treatment decisions is available to every cancer patient. Navya’s Online Expert Opinion Service has been used by 8000 patients in 42 countries. Visit: www.navyanetwork.com.

Twitter: @NavyaNetwork
Facebook: https://www.facebook.com/NavyaNetwork/
LinkedIn: https://www.linkedin.com/company/15236089

Media Contact:
Tracy Wemett
+1-617-868-5031
tracy@broadpr.com

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The Convenience of Access

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Convenience matters, as does commitment to access.  Access to expert cancer care.

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Three things compelled me to write this today.  One, each time I think of decision making in cancer care, be it for a cancer patient or his or her family, or an oncologist, I fall back to the basics of evidence (applicable clinical trials), experience (treating thousands of complex or rare cases), and experts (true experts, of which there are only a handful, do not be fooled).  Boil this down further, and you are left to the ability to identify and use the few really applicable high quality clinical trials (evidence) and consult the experts at tertiary care cancer centers (true experts), especially for nuanced decision making (experience treating the uncommon).  Why then is there the talk of digesting millions of records when only a few trials are high quality and it is the applicability that matters, not the large volumes of any and all data?  (I don’t understand, and hence I write…) When there are only a handful of true experts and only their experience matters, then why are we spinning our wheels on doing anything but increasing access to their expertise?  (Beats me, when there’s blatant publicity on hospitals without any bearings to whether it’s a peer-recognized world class institute…)

This brings me to my point #2.  I’ve been helping a friend of a friend get a pathology review from a leading hospital, for her sister’s rare tumor.  I am a sister.  I know her fight and will fight with her.  Despite my fantastic everything, this person was stuck in the logistics of figuring out how to send a sample, to whom, how, packaging difficulties, courier challenges, unclear billing instructions, completing online forms, invoking treating doctors for telecommunications, and most importantly finding a person on the other end to just talk to and make this work!  Wait, wait, wait — is what she got at each instance, and if you’ve ever waited for a month to just send a sample and expect to wait a month to receive a report, you know what I mean (especially if the cancer-word is in play).

Why are we spinning our wheels on doing anything but increasing access to their expertise?

So, my third point:  operations matters.  A one day turnaround that my analysts strive to deliver, using simple and powerful tools to expedite the opinion of true experts (handful in the world, in India, in the US, in the world…), really matters.   Leveraging only the applicable clinical trials and the nuanced machine learning from expert opinions on complex cases, is all that is needed to make intelligent decisions.  The commitment to make this available to you – really matters.

We offer that, because we want to, because we know what it feels like to want it and not have it – but need it; and because we have worked really hard to use teamwork, clinical informatics and machine learning, and relevant high quality data, to deliver it.  When we work with only the true experts, we know that no other service can do what we do, and it is our duty to bring true expertise to everyone, conveniently and quickly.   And hence, I confidently ask that everyone in need of an expert opinion, an expert treatment decision in cancer care, please reach out to Navya online.  8,000 patients from 42 countries, are testimony to our commitment to convenience and access to expert cancer care.

-Gitika Srivastava

Online Expert Opinion: navyanetwork.com/tmh

Tata Trusts: tatatrusts.org

Tata Memorial Center: tmc.gov.in

Navya: navyanetwork.com

Data Driven Doc: The Ampulla of Vater

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The Ampulla of Vater sounds like something straight out of Hogwarts, but it’s a special vase we all carry within our gut. Digestive juices from the bile ducts and the pancreas pool together in the ampulla to meet the food coming into the small intestine (duodenum) from the stomach in this action-packed area of the GI tract.

Naturally, even small tumors in and around the ampulla cause major problems. Blocking bile ducts causes a quick yellowing of the skin and eyes. When the ampulla is blocked and the juices do not flow freely, the pancreas, the liver and the stomach all start to back up.

Ms. Khan had been living in South Korea for years. Recently, her skin had started to get a jaundiced look, and she wondered if it was something in her diet catching up to her liver. The gastroenterologists at South Koreas premier hospital unfortunately diagnosed her with a periampullary mass in the duodenum, and the surgeons promptly completed a Whipple procedure – named after the surgeon who devised the elaborate surgery to remove the head of the pancreas, common bile duct and duodenum from a patient.

Her surgery was a success! The tumor was completely removed. But three nodes near the duodenum were positive. Mr. Khan wanted to ensure that the cancer didn’t come back or spread.

Experience matters. Indian oncologists see a large number of young patients with advanced GI tumors. Gallbladder and ampullary malignancies appear to affect Indians more frequently, younger and at more advanced stages.

Experience matters.

Mr. Khan reached out to Navya for a review of his wife’s case. Promptly, the Navya Expert System, Vyas matched her case with similar patients seen before. Experience matters again- not just for humans.

Confronted with a duodenal periampullary cancer, Vyas looked up data related to duodenal/intestinal malignancies and recommended fluorouracil based therapies. The structured summary was quickly compiled and sent to an Indian medical expert in London affiliated with Tata Memorial Center for review.

The expert quickly responded, correcting Vyas. Treating the tumor as periampullary rather than as dudodenal/intestinal made more sense, said the expert. The treatment recommended was a two-drug regimen recently shown to increase survival in pancreatic cancer at ASCO 2016. The periampullary arm of the trial was still recruiting, but the true experts were treating ahead of the data, as always.

The patient report reached South Korea within 13 hours of Mr. Khan reaching out to Navya. Needless to say, Mr. Khan’s family was grateful and impressed.

Vyas learned something new from the case. The experts quick review and feedback pointed Vyas to emphasize periampullary origin over intestinal origin of cancers while looking for treatment options. Vyas integrated the knowledge it already had about the ESPAC4 trial from ASCO’s conference in 2016 for pancreatic cancers in a new manner into its experience engine for ampullary tumors.

Experience matters. For patients, experience is the bedrock on which they extend their faith to a physician. For Vyas, the wealth of experience of experts and patients at Tata Memorial Center give it an enormous head start in deciphering complex cases. The opportunity to learn from every patient in the engine with expert feedback makes Vyas an enormously rich and accurate predictor of decisions. Vyas starts out with a bedrock of evidence and guidelines. And with every case it sees, it gets stronger and better at guiding patients towards the best treatments.

The experience of seeing Vyas learn is truly magical. Some days, it feels like something out of Hogwarts.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh

Tata Trusts: tatatrusts.org

Tata Memorial Center: tmc.gov.in

Navya: navyanetwork.com