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Confronted With Complex Cancer Treatment Decisions – Navya Empowers Patients With the Consensus Opinion of an Expert Panel of Multidisciplinary Oncologists

 

Navya in partnership with Tata Memorial Center (TMC) and National Cancer Grid (NCG) enables cancer patients to have their cases reviewed by a multidisciplinary panel of experts, to arrive at the best possible treatment plan. This is critically important as cancer decisions are complex and often involve several organs and types of treatments.

A woman with advanced breast cancer may need surgical removal of the breast, radiation therapy to the brain, and multiple lines of chemotherapy with side effects impacting the heart and the liver.  Therefore, it is critical that experts in each of the specialties collaborate to determine the treatment plan; from radiologists reading mammograms and brain scans to breast oncology surgeons, neuro oncology radiation experts, and medical oncology experts.

While leading medical institutes across the world consider multidisciplinary treatment planning to be the standard of care, extreme shortage of cancer experts in India means that this is not the norm. A medical oncologist may treat breast cancer (solid tumor) and Leukemia (liquid tumor), and determine the radiation dosage for treatment.

Further, choices such as chemotherapy versus surgery, aggressive therapy versus supportive care, or Hail Mary attempts with expensive targeted therapies or enrolling in clinical trials, require evidence based knowledge and experience treating thousands of complex cases.  Such nuanced decision making weighing pros and cons of each treatment path is only possible when experts collaborate on a multidisciplinary tumor board.

At world renowned cancer centers such as TMC in Mumbai or Dana Farber Cancer Institute at Harvard, all cases are reviewed by a tumor board of cancer experts who jointly arrive at a treatment decision.  By leveraging its patented technology and collaboration with the best cancer experts in the country, Navya replicates this gold standard in cancer treatment planning.

“TMC and Navya have collaborated since 2011 to develop an expert decision system that uses clinical informatics, predictive analytics and machine learning to recommend evidence and experience-based expert treatment decisions, similar to decisions made by expert tumor boards,” said Dr. Rajendra A. Badwe, Director of Tata Memorial Centre.

At multidisciplinary tumor board meetings, a pathologist, radiologist, surgeon, medical oncologist, and radiation oncologist get together in the same room to discuss each case.  Sometimes the surgeon will suggest that the tumor be shrunk through chemotherapy or radiation and then the patient get operated. At other times the radiation oncologist may determine that the tumor site is not safe to radiate. If the radiologist determines spread of cancer across organs, the medical oncologist may recommend chemotherapy alone.  Having all relevant specialists weigh in and review the case is the ideal scenario but this is unfortunately not the modus operandi in most hospitals.  This is where Navya comes in.

Mr. Shah’s father in Rajkot was diagnosed with a form of lung cancer following a routine checkup. Several tests followed and there was confusion as it could have been metastatic mesothelioma that may or may not be operable and therefore whether to proceed with surgery and radiation therapy or chemotherapy alone was unclear. They consulted oncologists in Ahmedabad, Mumbai, and also reached out to oncologist friends in the US.  The conflicting opinions meant that even though they had access to reputed oncologists, each was making a decision in a silo. In their relentless search for credible advice, they were made aware of http://www.navya.care and the fact that it offered multidisciplinary opinions. While the previous three weeks were chaotic with several view-points and a plethora of tests being recommended, the next 24 hours served to create order where there was chaos. Mr. Shah’s case was looked at by a team of experts that included the top thoracic surgeon in the country collaborating with a senior medical oncologist and radiation oncologist. The treatment path was clear and precise and helped the family move forward with confidence.

Says Mr Shah, “By the grace of God, we are not constrained by a lack of resources, and I was able to connect with several oncologists across India and the US. However, it was tough for us to assimilate the opinions and determine the one clear path to follow. We found that only Navya was able to do this and we are grateful for the clarity and thoroughness.”

To ensure that the treatment plan is comprehensive, Navya processes cases by incorporating opinions of several experts from Tata Memorial Centre and National Cancer Grid, a consortium of expert centers in India.

“Patients at small or remote centers will now have access to the world class expertise of cancer experts in India,” said Dr. C.S. Pramesh, Coordinator of the National Cancer Grid. “Treating oncologists can consult with multidisciplinary experts online in a simulated tumor board that results in expert treatment decisions for patients everywhere.”

www.navya.care leverages the power of the internet to make access to expert treatment decisions convenient, cost effective, and ubiquitous so every cancer patient receives a multidisciplinary opinion.  Patients simply upload their medical reports and decision questions and receive an expert opinion report within 24 hours.

Gitika Srivastava, Founder of Navya, says: “Most people who have had any experience with cancer know it’s not always possible to gain access to cancer experts.   Tata Memorial Centre, National Cancer Grid, and Navya are working to change this.  Every cancer patient has the right to an expert opinion.  We urge you to leverage  www.navya.care for an online opinion. You can be assured that the opinion rests on the multidisciplinary experience of world renowned cancer experts collaborating to deliver the best possible treatment plan uniquely suited to your case.”

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

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.  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.\

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 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/company/15236089

 

Tata Trusts and Tata Memorial Centre (TMC) Join Hands with the National Cancer Grid (NCG) Comprising 89 Cancer Centres to Make Cancer Expertise Accessible and Affordable to Patients Across India

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PRESS RELEASE

Tata Trusts and Tata Memorial Centre (TMC) Join Hands with the National Cancer Grid (NCG) Comprising 89 Cancer Centres to Make Cancer Expertise Accessible and Affordable to Patients Across India

In a Move to Standardize Cancer Care Nationally, Tata Trusts and TMC Bring Together Experts from NCG to Grow the Online Expert Opinion Service, Launched with Navya

CAMBRIDGE, Mass., MUMBAI, India – Dec. 20, 2016 – In keeping with their strategy of harnessing technology for social good, the Tata Trusts had supported the Navya online expert opinion service at Tata Memorial Centre last year. This service aids in standardising cancer care, by providing treatment opinions from the world’s leading experts to every cancer patient, irrespective of  their geographical location or ability to understand medical information.

“The Trusts and TMC plan to expand this service now to the National Cancer Grid”, said Mrinalini Pandit, who leads cancer projects at the Trusts, “Expert oncologists from NCG will join experts from TMC to provide evidence and experience-based opinions—online—using the Navya decision system.” (Patients visit:  navyanetwork.com/tmcncg)

TMC is one of the world’s largest tertiary care cancer centers and convenes the National Cancer Grid, a consortium of 89 cancer hospitals.  Navya is a leading clinical informatics and patient services organization in cancer decision making. Leveraging the Navya decision system and team of committed patient advocates, Tata Trusts has empowered over 5,000 cancer patients, pan-India and from over 30 developing countries in Asia and Africa, with evidence and experience-based information.

Expertise is defined as evidence and experience-based knowledge necessary to determine the individualized treatment for a cancer patient.  Expert decisions can maximize outcomes:  increase lifespan or number of cancer free years, improve quality of life, etc., no matter the stage and type of cancer.

There is a real 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.

Further, application of medical evidence at the point of care is difficult as there is a rapidly increasing number of clinical trials and knowing which trials will be relevant for a given patient requires a technology system and clinical informatics. Experience is trapped in the minds and practice of experts at tertiary care centers, and unlocking that learning from medical records and past treatment decisions with machine learning is critical.

“TMC and Navya have collaborated since 2011 to develop an expert decision system that uses clinical informatics, predictive analytics and machine learning to recommend evidence and experience-based expert treatment decisions, similar to decisions made by expert tumor boards,” said Dr. Rajendra A. Badwe, Director of Tata Memorial Centre. “The system has been validated in clinical trials at TMC and the University of California Olive View Medical Centre, showing 98 percent agreement between the system’s decisions and the tumor boards’ decisions.  These results have been published at the San Antonio Breast Cancer Symposium and the American Society of Clinical Oncology.  Collaboration between NCG, TMC, and Navya will be a force multiplier to extend the reach and impact of providing expert cancer care opinions throughout the country.”

“Patients at small or remote centers will now have access to the world class expertise of cancer experts in India,” said Dr. C.S. Pramesh, Coordinator of the National Cancer Grid. “Treating oncologists at non-expert centers can consult with experts online in a simulated tumor board that results in expert treatment decisions for patients everywhere. Treating oncologists or oncologists in training can learn to make expert-grade treatment decisions by using the Navya system and learning from the treatment decisions made by experts for their patients.”

Experts from TMC and NCG volunteer their expert opinion in conjunction with the Navya system to empower cancer patients and treating oncologists from northeast to urban India, from Bangladesh to Mozambique, from remote cancer centers in Bihar to large hospitals in Delhi, from Below Poverty Line (BPL) card holders to wealthy patients.

Dr. Raghunadharao Digumarti, an expert from one of the NCG centers, the Homi Bhabha Cancer Hospital & Research Center in Vishakhapatnam, is committed to using the Navya system to guide patients everywhere.  He said, “I am able to provide opinions on a daily basis, and within minutes on my mobile.  The system displays the relevant data and options to choose from, so it is easy to provide an online opinion.  It brings me great satisfaction to know that I am able to help patients with complex or advance disease, without them having to travel from Jammu or Jharkhand or Chhattisgarh, to my center in Vishakhapatnam. I hope more patients reach out to my colleagues and me at the NCG.”

To access TMC NCG Online – Navya Expert Opinion Service, patients or treating oncologists simply register at http://www.navyanetwork.com/tmcncg and upload the patient’s medical reports. A Navya patient advocate contacts them immediately. Navya’s decision system and TMC NCG experts suggest evidence and experience based treatment options.  Within 1-2 days of uploading their medical reports, patients or treating oncologists receive the expert opinion report. They administer the treatment locally, enabling standardized high quality cancer care throughout the country.

“A system and a service are essential to bring expertise to every patient – together with good hearted experts from TMC and NCG,” said Gitika Srivastava, Founder of Navya. “Our innovations in decision making enable our dedicated patient advocates to empower every cancer patient. Navya is the glue that brings all elements of expertise together –with the cancer patient at the center of our system enabled service.”

Decision making is an iterative process, and patients have many questions.  Even if expertise is accessible, it is difficult for a patient to comprehend and factor it in decision making. There is a need for an intermediary to communicate pertinent medical information to a patient in laymen’s terms.   Handholding empowers the patient with information about their cancer treatment, but requires immense dedication, patience, and hard work.

Navya’s patient advocates bridge the gap of communication between the patient and the expert.  They use the Navya system to translate a patient’s medical report and decision questions into “physician-speak”, and translate the evidence and experience-based expertise into “patient-speak” (i.e. simply reports with supporting references ).

TMC NCG Online is supported by Tata Trusts and is free for patients who are Below Poverty Line. A processing fee of Rs. 5000/- applies to other Indian patients, which is significantly lower than the costs of travel, lodging, associated with in-person consultations with experts in metropolitan cities. Most importantly, it eliminates inaccessibility to expertise in large parts of India, and uniformly brings expert care to cancer centers and patients.

About Tata Trusts  tatatrusts.org
Tata Trusts are amongst India’s oldest, non-sectarian philanthropic organisations comprising of Sir Ratan Tata & Allied Trusts (estd. 1919) and Sir Dorabji Tata & Allied Trusts (estd. 1932). The Trusts work in several areas of community development. Tata Trusts seek to be catalysts in development by supporting institutions in the areas of Natural Resources Management, Rural Livelihoods, Urban Livelihoods & Poverty, Education, Civil Society and Governance, Health and Media Arts, Crafts and Culture.

Twitter:  https://twitter.com/tatatrusts
Facebook:  https://www.facebook.com/TataTrusts/
LinkedIn: https://www.linkedin.com/company/tatatrusts

About National Cancer Grid (NCG), Tata Memorial Centre (TMC)  tmc.gov.in
The NCG is a consortium of 89 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. 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.

About Navya  navyanetwork.com 
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 in India. 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.

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

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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An Expert Opinion makes the difference – not another 2nd opinion. Cancer patients know that difference.

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11143552_1657596077813277_6232528969219220839_nWhen Naresh and I first started Navya, many asked us why we were setting-up an organization to offer second opinions. First, who would like to second guess their doctors, especially an oncologist (after all, cancer is a dreaded mystery for most); and second, it sounded like a basic service – what’s the value. We struggled hard to explain because our vocabulary was so new. Navya was an evidence and experience-based expert decision system. First, we were focused on empowering patients with all the relevant information, from every credible source, so there is no mystery, except the destiny of the Almighty. And second, we never proposed to enable an Nth confusing second opinion for any patient. We were focused on an expert opinion, a single consensus opinion that combined relevant and applicable knowledge from clinical trials, international guidelines, outcomes of similar patients, and true experts from only the handful of true expert centers. That reconciled opinion – the expert opinion – would remove all complexity of what treatment to undertake (preventive surgery or just sit tight… surgery first or chemotherapy… benefits of radiation versus risk of incontinence or infertility… chemotherapy or new targeted therapy or both… reinduction protocol or maintenance protocol or wait and watch…)

Navya and Tata Memorial Centre, one of the world’s largest tertiary care expert cancer centers, have empowered patients from over 34 countries, and most contently from developing countries and in remote towns in India, who would have otherwise not had the privilege of an expert opinion. Every cancer patient has the right to an expert opinion. Know, and let your friends know. Expert Opinion Online at navyanetwork.com/tmh is powered by the visionary support of Tata Trusts. Together, we are working to ensure that every cancer patient is comforted and strengthened with expertise to fight.

I am one of the founders of Navya, and it is a true privilege to have this opportunity.

– Gitika Srivastava

Online Expert Opinion: navyanetwork.com/tmh

Tata Memorial Centre: tmc.gov.in

Navya: navyanetwork.com