Category: Oncology

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

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

Decision Making

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flowers-164754_1280Decision making is about pros and cons.    I was on my way to Boston Logan, to catch my flight to Bangalore.  My cofounder called me, and said “it’s a Navya moment.”    There was a personal, family, decision that he was helping coordinate, while he was at the Maui airport to fly across the country to get to his family in New York City.   Between our flight schedules and travel times, we had about an hour or so to chat before certain important decision had to be made.   The clock was literally ticking, and we started our process.   He had looked up the papers that discussed clinical trials and retrospective analysis of individuals in similar circumstances as his kin.  (He will write about these experiences in a blog post, soon.)  The advantage of waiting versus proceeding with a surgery was about five days at most.   That, was the known.  The evidence.  That we could likely delay surgery by five days and gain the benefit that would bring.  However, the disadvantage, the unknown, the risk of any complication while waiting, far outweighed the known disadvantage (mandatory stay in a well-managed, top of the line, intensive care unit).   Then, the experts.    Experts known to us pointed to their experience of being able to manage any complexity of surgery at the time.   They were comfortable, confident, yet let us (the patient and the family) decide.  What did the patient want?  There was anxiety.  There was anxiety about the known and the unknown – what was worse?  What did she prefer?  Patient preference.  And then, the much talked about guidelines – the international guidelines that indicated that both, surgery and non-surgery were acceptable options at this time.  Brilliant!  Not helpful.   It was a Navya moment.  We had to reconcile, hold each other’s hands, and decide from the patient’s perspective.

There are many elements to decision making.  Evidence, experience, experts, and patient preference being the most measurable, computable, elements.  Guidelines of course are the most general and are the weakest link.   At the center though, is the process of utilizing and combining all of the above.  The Navya process, which is extendable from oncology to obstetrics decision making.   The gentle consideration, the conversations, the repeated conversations on the various considerations, the data, the people, the process.  Always results in a decision that is well thought out, bringing clarity, and rooted in the best evidence and experience of experts.   The Navya process that we followed in an hour long conversation lead to two beautiful outcomes, a pair of healthy baby twins, born at the right time to a mother who felt relieved with confidence in her decision. 

Evidence

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Today I was reminded that evidence matters.   Evidence is the premise of Navya.  It is where we started.   Why we started.  We added on Experience, Experts, Patient Preference, and always knew that Guidelines are a sum total of many things but not enough to make a patient-specific decision.  With so much noise about so many systems and so many sources of information, (from structured guidelines to unstructured patient blogs and doctor’s notes and specific institution practices), all away from the core of Evidence, (clinical trial data), I began to wonder whether our premise was not what many would value.  (What a convoluted sentence construction – pretty similar to the obscurity of that thought).  Evidence matters.  Experts (or should I say mother of all experts…!) at Tata Memorial Centre are singularly focused on how an evidence based system can empower their decisions, above and beyond what their experience and standard guidelines can already do.  That, is the hallmark of expertise.  The definition.  An evidence based expert decision.

When I was asked to momentarily scrap everything else and home in on the evidence based results of the Navya Expert System, and the informatics that enables it, I knew that my system is in the hands of the right critiques and the perfect users who will use it to empower their patients.  When I was reminded that it is the Navya Evidence Engine that is the heart and core of what an expert desires, I was reassured, reaffirmed, reignited to remain focused on what we set out to do:  use evidence to make treatment decisions that are uniquely applicable to an individual patient.

Thank you, Dr. G and Dr. B for your constant push and faith in evidence based expert decision making; and for the opportunity, the privilege, to build Navya with you.