Tag: treatment

Navya Scales Access to Rare Cancer Care Expertise and Tailors Evidence-based Treatment Plans to Individuals Based on Affordability and Access to Therapies

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Navya Presents Joint Study with National Comprehensive Cancer Network at San Antonio Breast Cancer Symposium, December 5-9, 2017

CAMBRIDGE, Mass. and SAN ANTONIO, Texas – Dec. 8, 2017 – “TMC NCG Navya Online” (Navya) has scaled access to rare cancer care expertise, tailoring evidence based treatment plans to individuals based on affordability and access to therapies. Navya, a clinical informatics system and online expert opinion service, provides evidence based multidisciplinary expert opinions within 24 hours to thousands of cancer patients around the world. Navya learns from evidence, prior tumor board decisions and quick review from expert oncologists to recommend tailored treatment plans to patients at all levels of affordability.

A joint study presented at San Antonio Breast Cancer Symposium on December 8, 2017 by National Comprehensive Cancer Network (NCCN) and Navya demonstrated that 88.3 percent of Navya’s treatment decisions mapped to NCCN’s Resource Stratified Framework (NCCN-RSF) for Lower Middle Income Countries (LMIC).

Navya is sensitive to the needs of resource constrained patients.  Expert oncologists from Tata Memorial Centre (TMC) – one of Asia’s largest tertiary cancer centers, and National Cancer Grid (NCG) – a consortium of 108 cancer centers and specialty centers in India, provide online opinions to patients via Navya.

In most of the world, the cancer burden is disproportionately greater than the scarce access to tumor board expertise.  Patients often do not receive evidence based treatment plans. Further, patients are resource constrained and are unable to afford or access therapies that are optimal per global guidelines like NCCN.

Since its creation in 2015, over 17,000 patients from 22 LMIC’s have reached out to TMC NCG Navya Online to receive an online expert opinion.

Dr. Ben Anderson, vice chair of the NCCN Breast Panel and chair of the NCCN International Program Committee and the senior author of the study said, “While there is significant drug discovery and treatment  research happening worldwide to combat cancer, the therapies are often unviable to LMIC. Tailoring treatment plans to patient constraints is critical and Navya’s online expert opinion service does that in a scalable manner.”

Dr. Rajendra Badwe, Director of Tata Memorial Centre, stated, “In India and low and middle income countries, patients are challenged to receive evidence based therapies within available resources. NCCN-Resource Stratified Guidelines is an attempt by a globally reputable standard of care organization to determine treatment pathways based on resources.  This study shows that only 8.6 percent of parent NCCN guidelines could be mapped directly to patient care in India.  Additionally, 79.7 percent required tailoring for resource constraints, and even so 11.7 percent of guidelines did not map.  There are several expert practices in India that are not yet included in the global guidelines.  For instance, unlike TMC’s clinical practice, NCCN-RSF does not recommend shorter courses of expensive targeted therapies like Trastuzumab for patients who cannot afford year-long therapy.  Our informatics system captures and disperses such expertise to resource constrained patients nationwide.  NCCN can scale adoption and learning of resource constrained treatment guidelines by leveraging on the ground systems.”

Dr. Naresh Ramarajan, Founder of Navya and Chief Medical Officer further stated, “Navya’s vision is to transform delivery of cancer expertise to impact cancer care at a global level. This study shows that the informatics based system and online service is scalable and individualized to each patient’s condition and constraints. Expanding the reach of this service across the developing world can maximize outcomes for financially underprivileged patients.”

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 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.

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

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

Tata Memorial Centre (TMC) National Cancer Grid (NCG) Online – Navya Expert Opinion Service: Empowering cancer patients with expertise and information on their treatment options

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TMC NCG Online – Navya Expert Opinion Service empowers patients with critical information within 24 hours enabling families to make robust decisions in cancer care with adequate inputs from oncologists at Tata Memorial Centre and National Cancer Grid . This service, available at www.navya.care, allows patients to upload their reports and get a response from world renowned experts.

While diagnosing the presence of cancer can be relatively straightforward, treatment is highly specialized and the number of experts experienced in managing complex cases is very few. Many cancers are curable or can be managed for a number of years if diagnosed early and treated appropriately. Choosing the right therapy can be the difference between the best possible outcome and failed treatment. Patients are able to receive the best possible treatment opinion which includes what therapy to choose (surgery, chemotherapy, radiotherapy or immunotherapy) as well as dosage, duration, side effects and other details pertinent to the treatment. The detailed report, that answers all questions asked by the patient in language that is simple to understand, can then be shared with the local oncologist to proceed with the treatment locally.

Since 2015, over 12,000 patients from 22 developing countries have reached out to Navya to get expert opinions. Abdul Rahman, who lives in Erbil, in the Kurdish region of Iraq, had previously undergone surgery for pancreatic cancer. Five year later, he started experiencing acute pain in his abdomen and a subsequent CT scan showed a tumor on his liver that had metastasized to his lungs. The local physician asked his family to take him to a tertiary care center that could adequately advise a treatment plan and recommended Tata Memorial Center in Mumbai, India.

Abdul’s brother in law, Haseeb, started evaluating the logistics of traveling to Mumbai and found that the travel and lodging expenses for a trip for him and Abdul would be upwards of $5000. Further, the procedure of getting a medical visa would take at least a few weeks. They would also need to travel with no visibility on how long they would need to stay in Mumbai as they did not know what treatment would be recommended.

Haseeb started finding out more about Tata Memorial Center by going online when he came across the TMC NCG Navya expert opinion service. He was initially skeptical about the veracity and thoroughness of the service as he did not know if it would be comparable to making a trip to Mumbai. He decided to register at www.navya.care and explore the service further.

On registering, Haseeb received an email that explained the complete process that the expert opinion service followed. He would need to upload Abdul’s reports, which would then be summarized and sent to relevant experts at Tata Memorial Center who would provide a treatment plan that would be detailed in a patient report. This patient report could then be shared with the local physician in Erbil and he could be treated there. “The expert opinion service was a boon to us as this was more convenient and cost effective than traveling to Mumbai and Abdul could get treated locally”, said Haseeb Mohammad.

The necessary reports were uploaded following which a patient advocate spoke to Haseeb to understand the case in detail. Some additional reports were sought which the family had but didn’t know were relevant. “I found the person who spoke to me to be very empathetic and thorough in understanding the history of the case. This gave us comfort that the case was being comprehensively analysed.” He was immediately able to upload the additional reports that had been requested.

The case was summarized and sent to a gastrointestinal expert who had trained at National Cancer Institute designated cancer centers such as Harvard, Stanford and UCLA affiliated cancer centers. The expert’s recommendation was detailed in a patient report and the treatment plan included chemotherapy that could be administered in the local hospital. The report was shared with the local physician who started the treatment immediately.

Mr Haseeb said: “Our experience with the online expert opinion service was all that we had hoped for and more. In addition to it being cost effective and quick, we were able to get a treatment plan from an expert without the patient having to travel long distances. The patient advocate was thorough, the process was efficient and the report that we received was detailed and the treatment plan followed international guidelines. Our doctor in Erbil felt that we had made the right choice in approaching TMC NCG Navya online to get an expert opinion.”

Families seek to vet treatment plans with experts but often access to experts is limited. Balancing the need to act quickly while ensuring the decision is made with all relevant inputs is when Navya’s Online Expert Opinion Service becomes a powerful ally. The timely response from experts through Navya has meant that the treatment followed standards accepted globally and may have been the difference between a failed treatment and the best possible outcome.

PRESS RELEASE

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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

 

Data Driven Doc: Staying Informed on the Diagnosis (Part 2 of 2)

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(Continued from previous post here)

We struggled with how to let my dad know about this upstaging. I intensely felt the need to protect him from bad news and at the same time the need for disclosure to move ahead. But I couldn’t move past the diagnosis and into treatment planning until he knew. We waited for his appointment that evening and then broke the news to him.

Perhaps overwhelmed by this unforeseen information, I dropped my guard. The urologist recommended surveillance to see if the cancer cells at the positive margins would grow. We did not start any anti cancer therapies. We were not even referred to see a radiation oncologist.

For a high-grade tumor that was outside the capsule of the prostate already, this approach should not have passed the smell test. But all the energy I had put into researching my options were now focused on helping dad recover from the surgery. We simply took the urologist at his word and waited. I didn’t even lookup my online medical references.

No surprise to anyone but us, the tumor markers quickly started inching up and doubling. Imaging showed that the recurrence was not spread in the body, and was still local. Alarmed, I went back to my information-first mode, and read every study on local salvage therapies. I was surprised to find out that early salvage radiation and hormones immediately after surgery were already becoming standard.

I discovered that in most other locally advanced tumors with a high grade, positive margins aren’t simply ignored, rather are treated with repeat surgery or adjuvant therapies!

Although reeling for lost time, I was also exceptionally thorough this time. We went through every possible radiation and hormone therapy option – to radiate the pelvic nodes or not, use protons or photons, what dose, to use short course or long course hormones or no hormones.

I read every study and guideline that was applicable. I spoke with every expert in the area I knew at UCLA, Stanford and nationally. I wanted to be certain that I was making a decision with the best information at hand.

After extensive discussions with my father on his preferences, and discussions with his radiation oncologist, we embarked on round two of beating his prostate tumor. My dad was fully aware of his diagnosis, his options, and his choice of therapy. The clarity of that knowledge and reassurance that we were doing everything possible gave us so much strength. Instead of being victims to the process and the disease, and have something to hide from and be protected from, we were open, clear, calm and as much in control as we could be.

That was almost 5 years ago. Luckily, my dad continues to have his 3 month check-ups that are coming back clear. He is not out of the window of recurrence just yet, but it is safe to say we are getting there.

Not all stories have happy endings. Despite being treated at the best cancer center in America, my aunt succumbed to inflammatory breast cancer in 2009. She was diagnosed the same year as my father, and we went through the same exhaustive search for therapies and options that we did with my father. When she went on hospice, she knew she had exhausted every option medical science could offer us at the time. I still carry that little piece of reassurance inside me today.

While my physicians have my best interests in mind, they are limited in ferocity as this is not their battle to fight. It is mine.

I see a diagnosis of cancer for what it is now. Without knowing the name of my enemy, I cede power of fighting to others. While my physicians have my best interests in mind, they are limited in ferocity as this is not their battle to fight. It is mine. Staying informed on the diagnosis, science behind the options, and the experience of true experts in the field is the only reassurance I can have that the best possible decision has been made.

-Dr. Naresh Ramarajan

Online Expert Opinion: www.Navya.Care
Tata Trusts: tatatrusts.org LinkedIn Facebook  Twitter
Tata Memorial Center: tmc.gov.in  Facebook
Navya: navyanetwork.com  LinkedIn  Facebook  Twitter

Expert Opinion for Cancer Care in 24 Hours

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TMC NCG Online – Navya Expert Opinion Service empowers patients with critical information within 24 hours enabling families to make robust decisions in cancer care with adequate inputs from oncologists at Tata Memorial Centre and National Cancer Grid (including cancer centers like AIIMS, Kidwai, Max Hospital, etc.). This service, available at www.navya.care, allows patients to upload their reports and get a response from world renowned experts.

Families seek to vet treatment plans with experts but it can be challenging as doctors often recommend the treatment start immediately to prevent cancer from advancing. Balancing the need to act quickly while ensuring the decision is made with all relevant inputs is when Navya’s Online Expert Opinion Service becomes a powerful ally.

While diagnosing the presence of cancer can be relatively straightforward, treatment is highly specialized and the number of experts experienced in managing complex cases is very few. Many cancers are curable or can be managed for a number of years if diagnosed early and treated appropriately. Choosing the right therapy can be the difference between the best possible outcome and failed treatment. Patients are able to receive the best possible treatment opinion which includes what therapy to choose (surgery, chemotherapy, radiotherapy or immunotherapy) as well as dosage, duration, side effects and other details pertinent to the treatment. The detailed report, that answers all questions asked by the patient in language that is simple to understand, can then be shared with the local oncologist to proceed with the treatment locally.

Maya Fonseca, 27, of Goa had a situation where following a routine checkup and follow up tests, her mother was diagnosed with stage IV cancer. The tests administered at the time were inconclusive as to the origin of the cancer. A slide review was recommended which would have taken 14 days but the treating oncologist advised that chemotherapy be commenced immediately. Maya and her family were understandably unsure of how and when to proceed with treatment. She reached out to Navya Online Expert Opinion Service and uploaded the reports. Navya’s patient advocate called her, got a thorough understanding of the case and noted all the questions that she wanted to ask the expert. The medical history along with evidence based treatment options were presented to an expert using Navya’s patented system for an opinion. The experts at Tata Memorial Centre were able to conclude that the medical reports and clinical history were consistent with cancer of the ovaries and chemotherapy was the next step followed by surgery.   On receiving the expert’s response, a report was created that answered all questions asked by the patient in language that was simple to understand. With the treatment opinion that included the chemotherapy, dosage and frequency, Maya’s mother was able to proceed with immediate treatment safe in the knowledge that she was making the right decision.

Urging families of cancer patients, Gitika Srivastava, Founder of Navya, says: “Most people who have had any experience with cancer are aware that given time and logistical constraints, it is not always feasible to go to tertiary care centers in metropolitan cities at each treatment decision point. Given the importance of treatment decisions in yielding the best possible outcomes, we would urge everyone to get an expert opinion through TMC NCG Online. We understand the anxiety in knowing what to do as quickly as possible, and hence have strived to ensure that we facilitate the opinion from the experts within 24 hours of getting all necessary medical reports. When making a decision on treatment, you and your oncologist can be assured that the opinion rests on the experience of world renowned cancer experts and follows evidence based protocols best suited to your specific case.”

Online Expert Opinion: Navya.Care

Tata Trusts: tatatrusts.org LinkedIn Facebook  Twitter

Tata Memorial Center: tmc.gov.in  Facebook

Navya: navyanetwork.com  LinkedIn  Facebook  Twitter

Unstructured data versus structured data – what is better for clinical decision making, in cancer?

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A lot of talk has been ongoing on unstructured data – as in this Facebook note, your blog post, a patient’s question on a support group, a doctor’s response on a newsgroup, a PDF scan copy of your aunt’s prescription, a journal article, its rebuttal, and you get the idea. There clearly is a lot of information pertaining to health and it may be an overkill, when it comes to decision making. Ask a cancer expert. They trust raw data, primary data from clinical trials that are high quality, randomized control. They trust their own experience treating large volumes of patients firsthand, observing the toxicities and managing the comorbidities (other health conditions like a weak heart or compromised liver) that may complicate a cancer treatment. And ultimately, data is only valuable when it is credible and lends itself to crisp, crystal clear, decision making: i.e. 1) sources of data matter (a randomized controlled clinical trial versus many doctors’ notes… or outcomes of patients at an expert cancer center versus self reported comments by patients on an online forum), and 2) structuring data in a way that doctors think from the get go, allows valuable information to be retrieved for decision making.

Hence, I am a fan of structuring data, which in and of itself is a complex challenge (Navya has developed an ontology for decision making, cancer by cancer, and that ontology is derived from the credible sources of data itself – like clinical trials and international guidelines and the handful of true experts themselves), rather than spinning cycles (computational power, manual processes, resources in time and money), on parsing mountains and mountains of any and all health related data and then trying very hard to derive accurate, usable, precise meaning from it for clinical decision making.

When it comes to cancer care, start with structured credible data and focus (spin wheels if you must) on analyzing it for decision making.