From Virtual Tumour Board (VTB) to quick online expert opinion for cancer treatment, Indians can now have high quality cancer care advice at their doorstep. The National Cancer Grid has added more power to its already existing capability, in the form of VTB and advancements in Navya network. Recently, the Virtual Tumour Board was launched in the presence of Union Health Minister J.P. Nadda at an international conference in Mumbai. The virtual board will ensure simultaneous participation of experts from multiple disciplines and from various locations, to discuss complex cancer cases in the country. Advancements in the capability of online cancer treatment portal navyanetwork.com have also ensured that cancer patients get the best treatment advice within 24 hours of them enrolling on the website.
“The Tata Trusts have been working closely with the National Cancer Grid towards a broad goal of uniform cancer care regardless of socioeconomic or geographic constraints—the Virtual Tumour Board is a big step towards this goal,” Ratan Tata, chairperson of Tata Trusts, said. The Virtual Tumour Board (VTB) will provide multi-disciplinary medical guidance to cancer patients. “The board comprises cancer experts, surgeons, paramedics from major government-run as well as private hospitals and cancer institutes, who discuss complex cancer cases and give their opinions on treatment and procedure,” an official statement by Tata Medical Centre stated.
Dr Rajendra Badwe, Director of Tata Medical Centre, said, “The goal of both the interventions—Virtual Tumour Board and Navya network—is to deliver universal high quality cancer care. Because of the Virtual Tumour Board, patients will benefit immensely from the collective wisdom and experience of multidisciplinary experts. A large number of experts will be able to discuss treatment of complex cancer cases due to the Virtual Tumour Board. On the other hand, Navya will deliver evidence-based, guideline-based opinion to the patients. The patients will be assured that whatever opinion they have got, is a part of the National Cancer Grid. The opinion is given within 24 hours of the patient uploading all the information. In one-and-a-half years, Navya has catered to 6,000 patients within and outside India. The goal is that nobody should enter the large hospitals in big cities. Patients should be able to get good care at their doorstep, at their local hospital.”
At present, Tata Medical Centre alone (TMC) treats 67,000 cancer patients in a year. The aim is to provide universal cancer care to patients across geographical locations in the country, to reduce the burden on TMC to around 50,000 patients per year.
Talking about the importance of VTB, Dr Soumya Swaminathan, Director-General of ICMR (Indian Council of Medical Research), said, “There is adequate evidence which supports multidisciplinary decision making in the management of cancer—this will be a game changer in bringing multidisciplinary cancer care to patients in all parts of the country.”
Recently, the Virtual Tumour Board was launched in the presence of Union Health Minister J.P. Nadda at an international conference in Mumbai.
VIRTUAL TUMOUR BOARD
VTB has completed three dry runs till date. It is expected to discuss 9,000 complex cancer cases in the country within a year from the launch. Elaborating on the functioning of the Virtual Tumour Board, Dr C. Pramesh, professor and chief of thoracic surgery, department of surgical oncology, at Tata Medical Centre, said, “In simple language, VTB is a video conferencing facility for specialised hospitals, along with the capability to share reports and other details about a particular case. The very fact that multidisciplinary experts like medical oncologists, radiologists, surgical oncologists, pathologists, palliative care experts can sit together and discuss a complex case, ensures that the patient gets the best advice. It also broadens the knowledge of each expert due to exposure to a panel of multi-disciplinary experts. This eliminates individual variations.”
Currently, over 26 of the 96 cancer speciality institutes of the National Cancer Grid have been enrolled on the VTB. These 96 centres handle half of India’s cancer burden.
Under this system, each enrolled cancer care institute has to download a software from the internet. It is then issued a unique login ID. At present, two such meetings are held every week. Experts from various fields participate at a particular given time. “So, during one session, you have over 30 experts talking with each other, and giving information of evidence-based medicine. Approximately, 15 cases get discussed in each clinic. Each meeting specialises on one particular type of cancer. We are aiming at having 12 clinics per week. 12 different disciplines of cancer will get discussed in them. Due to the VTBs, the treatment decisions are much better. Also, the smaller institutes which lack the expertise, get trained in the process,” Dr Pramesh told The Sunday Guardian.
Currently, the challenge for smooth functioning of VTB is still the logistic part of it. “It is challenging to get all the experts from different places to log in together at the same time. This will be easier when it goes on auto-pilot mode,” he said. “The other part is that there are very limited experts in each specialised cancer care in our country. So, the board will primarily function as a training ground for the smaller institutes which lack capability. The biggest advantage though is that an expert from a TMC will be able to listen to the opinion of another expert from an AIIMS,” another doctor associated with the National Cancer Grid said.
The aim of the National Cancer Grid is to create uniform high quality cancer care for patients through consensus treatment guidelines, institutional peer review, pathology EQAS, palliative care upgradation, virtual tumour boards, second opinion service, national cancer library.
Recently, the Navya network added another feather to its cap. It presented at the San Antonio conference its experience engine, which showed a whopping 96-98% concordance with the opinion of the experts. This means the “experience engine” developed by the Navya network, can by itself give medical advice, which is almost completely concordant with what the leading experts through the world would opine. “This means that the system itself is agnostic of where the patient is. It can scale access to experts infinitely,” a proud Gitika Srivastava, founder and CEO of Navya Network, told The Sunday Guardian in an exclusive interview. Today, Navya’s capability has increased so much that it can deliver world-class expert opinion to patients within 24 hours of the patient giving all the details to it. It caters to patients from 20 countries, including India, US, UK, EU, Bangladesh, Iraq, Pakistan, Nigeria, Africa.
“The system itself is so structured, that it takes experts barely a few minutes to give opinion on a case. That is because the system summarises the entire case and picks up only those pieces of information out of the vast pool of reports that the experts would want. This selective information is then sent to experts on their app, which they can access on the go. They take barely a few minutes to give an opinion on the case then. The system itself does much of the labour intensive job in an extremely structured manner. Now, our system by itself gives expert-grade, tumour board level decisions,” Gitika told The Sunday Guardian.
navyanetwork.com was launched in 2014. It uses clinical informatics, predictive analysis, and machine learning to make evidence and experience-based treatment decisions. The same year, it conducted a trial in breast cancer cases. It found that its own system generated treatment options that were 98.6% concordant with the recommendations of an expert panel at Tata Memorial Centre, India’s leading cancer research, diagnostic and treatment institute. These results were presented at San Antonio Breast Cancer Symposium in 2014.
The next year, it successfully conducted a trial which showed that its system was 97.3% concordant with breast tumour board of world-renowned UCLA Olive View Medical Centre. These findings were published at American Society of Clinical Oncology.
Asked how the system gives such highly concordant opinions on its own, without taking opinion of any experts, Gitika said, “The system is based on two bodies of knowledge which experts rely on. So, we have one ‘experience engine’ and one ‘evidence engine’. Machine learning is an important part of our experience engine. Evidence engine draws on randomised clinical trials. Since we have patients from 20 countries, our experience engine is rich. Most experts practise evidence-based medicine. No two cancer patients are the same. The nuances are different. But our experience engine has learnt from the outcome after the treatment of patients. So, when we get data about any patients, we know with reasonable accuracy what the experts would recommend.” Medical experts opined that a machine being able to learn from doctors’ expertise, and being able to unlock their experience, was an achievement in itself.
Today, the Navya network offers free treatment advice for BPL patients. It charges Rs 6,500 for other patients. The cost is considered negligible considering that it saves the patient the time and money and journey to approach one of the few leading cancer centres in the country. They can get expert, world-class, tumour board level advice in the confines of their house, at the click of the mouse. The system is interactive in nature, and addresses all the concerns and preferences raised by the patients and the family members. The processing of cases within 24 hours, adds to the efficacy of the service.
“Today, non-communicable diseases are a great challenge for the government. We are investing on cancer hospitals in Jhajjar, in Kolkata. We want to have one cancer institute in each state. For that, we have given Rs 100-Rs 150 crore to every state. We also want to build 50 tertiary cancer care centres. We have allocated Rs 45 crore for each centre. We want Tata Medical Centre to become a mentor for these care centres. We can take care of the hardware, but you will have to take care of the software,” J.P. Nadda said. Tata Medical Centre is India’s leading cancer research, diagnostic and treatment centre.