IndiaMedToday Feb 2019 by IndiaMedToday

FEBRUARY 2019, VOLUME 3 ISSUE 2 `200 INDIA MED TODAY

www.indiamedtoday.com

HOLY GRAIL OF

CANCER DIAGNOSTICS TOP 10 INTERVENTIONS POSITIVELY AFFECTING CANCER CARE PATIENT ENGAGEMENT PHILANTHROPY CAN WIDEN THE REACH OF CANCER CARE FEBRUARY 2019

INTERVIEW DR MAMMEN CHANDY

GY O L IAL O C NC PE O S

Plexus Training Academy

Expert Training from Experienced Doctorâ&#x20AC;&#x2122;s Plexus Training Academy is an important link to implement the companyâ&#x20AC;&#x2122;s philosophy of creating Cardiac excellence. In order to successfully operate centers with evolving technology, there is a continuous need to create a pool of skilled and experienced manpower across emerging countries. We provide the best in class curriculum with a true hand on experience and 100% merit based placement assurance for anyone willing to grow and excel with the growing Plexus network. We are driven to maximize access and affordability to quality healthcare for all patients. At Plexus we cherish the sound of a healthy heartbeat & a hearty laugh !

Plexus Course Available Non Invasive Clinical Cardiology Fellowship in Cardiology Cath Lab Nurse Training Cardiac Cath lab Technician Course ICU/CCU Training Physician Assistant

CURING

ACROSS THE COUNTRY

www.plexushospitals.com

contact@plexushospitals.com

EDIT NOTE www.indiamedtoday.com

FEBRUARY 2019 EDITORIAL

BOARD OF ADVISORS

Editor Neelam Kachhap editorial@ indiamedtoday.com

Dr Dr Dr Dr Dr

Alexander Thomas Girdhar Gyani Prem Kumar Nair Bhabatosh Biswas Alok Roy

ART & PRODUCTION

CONSULTING EDITOR

5Th eLLemenT sTudio Prasshant

Dr Libert Anil Gomes Dr Salil Choudhary

ADVERTISING Gunjan Chauhan gunjanc@indiamedtoday.com The Media Ant help@themediaant.com DIGITAL MARKETING Vivek Nair

EDITORIAL ENQUIRIES editorial@indiamedtoday.com CUSTOMER SERVICE: Subscription support and other assistance for readers subscribe@indiamedtoday.com ADVERTISING ENQUIRIES sales@indiamedtoday.com OFFICE 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 www.indiamedtoday.com IndiaMedToday expressly disclaims liability for errors and omissions in this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medical advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main,

Re-imagining Cancer Screening and Diagnostics CANCER IS one of the most deadly disease known to humans killing 9.6 million people in 2018 globally. It is thus surprising that we have made little progress in identifying the disease early. Even though we know that early diagnosis can help manage the disease better and in most cases save lives. We have made some progress to identify biomarkers but the clinical tests developed are very expensive and are only taken by people at risk, determined by lifestyle habits or familial history. The Cancers we look for are the ones that are most prevalent in the population, like breast and prostate cancer. But what about other cancers like pancreatic or blood cancers. Should we not have a universal screening test for these to be able to catch the disease early? The work of researchers in finding new biomarkers combined with new age diagnostic methods along with compelling data, gives us hope that soon we will have the test to detect cancer early. Bringing the cost of cancer treatment down has been the fulcrum of early diagnostic movement. A large scale screening tool has to be cost-effective to be adopted widely. It has to be easy to administer and interpret so that ground level workers can use it. The current tech intensive, people intensive methods elude those who most need early cancer diagnosis, like the marginally deprived populations living and working near carcinogen inducing industries.

The Cancers we look for are the ones that are most prevalent in the population, like breast and prostate cancer A tool with high sensitivity to detect early cancer across tumor types would be an ideal for screening. The tool should be specific with little window for false positives and enhanced PPV. It should predict the disease and the tumor site for specific drug delivery and should be able to monitor the effects of the drug. Alas! A tool with these criteria has not been developed as yet, researchers are working on some promising new candidates which might just fit the bill. Do read about these promising next gen diagnostic tools in our cover story. Do let us know about the ones not listed here. Write back to editorial@indiamedtoday.com / mneelam.kachhap@ indiamedtoday.com

2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

Editor M Neelam Kachhap

www.indiamedtoday.com

FEBRUARY 2019

CONNECT WITH US Join the conversation with IndiaMedToday through our social media pages Twitter

CONTENTS

Facebook Linkedin

UPFRONT 03 Editorial 05 Letters 06 News roundup

DRIVE

Quest for Better Cancer Care

SHOWCASE

How Patient Engagement Helped Epilepsy Management in Maharashtra

29 15

INTERVIEW

COVER STORY

Holy Grail of Cancer diagnostics Cancer detection in a test tube, are we there yet?

PULSE

Top 10 Interventions Positively Affecting Cancer Care in India

34 4

February 2019

IMPACT

How Philanthropy Can Widen the Reach of Cancer Care

APPROACH

Why Invest in Cardiac Care in Tier-II and III Cities

Emotional Support Wins

WWW.INDIAMEDTODAY.COM

CHECK IT OUT ONLINE

LETTERS

INTERIM BUDGET 2019 A forward-thinking budget with a definitive vision to accelerate much greater progress and enhance wellbeing of Indians, the allocation of Rs. 6400 crores for Ayushman Bharat is very welcome. Now it is paramount, that India ramps up its efforts to arrest the upsurge of non-communicable diseases (NCDs), which are increasing like an epidemic.

Measures must be undertaken to provision public-private partnerships to create a sustainable healthcare system under good governance in addition to provisioning the availability of skilled manpower for the hospital sector. Ishiqa Multani, Executive Director, Sagar Hospitals

Dr. Prathap C. Reddy, Chairman, Apollo Hospitals Group

We hope that the Skill India program will include training of youths to become dedicated paramedics to help efficient and quality ambulance services. One avenue that should have been looked at is making Healthcare services “zero-rated” under GST provisions, instead of being exempted, as the cost of inputs throughout the industry could further be reduced by claiming refunds of taxes paid on these inputs. This would help to enable these specialized services to reach out to the masses.

Budget 2019 is an interim budget benefiting mostly middle class, farmers and tax payers. Regarding healthcare we expected larger spends on Ayushman Bharat but the current increase is insufficient. Ganesh Sabat, CEO, SMT

Apart from announcing about 14 new AIIMS since 2014, the announcement regarding setting up of 22nd All India Institute of Medical Sciences (AIIMS) in Haryana is a welcome move towards enhancing advanced medical research in India, producing a greater number of qualified medical professionals and expanding opportunities for the aspiring medical students of the country.

Manish Sacheti, CFO, Ziqitza Healthcare Ltd

Shanthini Arunthavanathan, Chief Financial Officer (CFO),

Westminster Healthcare, Chennai

@indiamedtoday

We expected the government to provide sops for the healthcare service providers and encourage them to adopt technology like Artificial Intelligence, Virtual Reality, and the likes. These technology implantations will revolutionize precision based diagnosis, detection and prevention of diseases and benefit the citizens of the country.

facebook.com/indiamedtoday PLS ADDRESS YOUR LETTERS TO: The Editor, IndiaMedToday and mail to editorial@indiamedtoday.com Pls indicate clearly if you want to publish you views/opinions for this page.

Dr. Somesh Mittal, Managing Director & CEO, Vikram Hospital Bengaluru

OCTOBER 2018, VOLUME 2 ISSUE 10 `200

NOVEMBER 2018, VOLUME 2 ISSUE 11 `200 INDIA MED TODAY

INDIA MED TODAY

www.indiamedtoday.com

www.indiamedtoday.com APRIL 2018, VOLUME 2 ISSUE 4 `200 INDIA MED TODAY

Innovation in Healthcare

SPECIAL FEATURE AMERICAN ACADEMY OF EMERGENCY MEDICINE

www.indiamedtoday.com

Are we on the right track?

Subscribe Now

CEO’S PERSPECTIVE DR. HARISH PILLAI, CEO – ASTER HOSPITALS & CLINICS INNOVATE PROTEMBO CEREBRAL PROTECTION SYSTEM

What Ails

EMERGENCY MEDICINE

SPECIAL FEATURE

HOW TO DISRUPT STATUS QUO RAMESH KANNAN, PARTNER, SOMERSET INDUS HEALTHCARE FUND

CAN QUALITY

TOOLKIT

SPECIAL FEATURE

HEALTHCARE INNOVATION: WHERE IS IT GOING SUNIL THAKUR, MANAGING DIRECTOR, QUADRIA CAPITAL ADVISORS

in India

IMPROVE CARE

A simple quality toolkit can improve the quality of care in Acute Coronary Syndrome management

IMPACT

APRIL 2018

WILL THE NEW PMA POLICY NEGATIVELY IMPACT INDIAN DEVICE MANUFACTURERS?

Lack of standardisation, fragmented training landscape and distrust relation among doctors

CAHOCON

2018

15 INNOVATIONS CHANGING THE MANAGEMENT OF CARDIOVASCULAR DISEASES

NOVEMBER 2018

OCTOBER 2018

HOW SWITZERLAND IS LEADING INNOVATION GOING FORWARD

M Neelam Kachhap

HOW A SMALL HOSPITAL IN RAIPUR MADE HUGE GAINS IN CHD

Never m iss a n issue , subscr ib e now to Pr i nt a nd Di g ita l e dit ions

www.indiamedtoday.com

NEWS ROUNDUP FIRST EVER ONSITE NLSIU MEDICAL LAW & ETHICS COURSE AT THE CMC VELLORE The first NLSIU PGDMLE course being held outside NLSIU at CMC, Vellore was inaugurated on Jan 14, 2019. This is the first time post-graduate diploma in medical law & ethics is being held outside NLSIU. This was made possible by the joint efforts of three visionary organisations the National Law School of India University, Association of Healthcare Providers India and Association of National Board Accredited Institutions. In the current day scenario, there is an urgent need for every medical professional to be knowledgeable of medical law and ethics, governing the profession. This will empower them to serve fearlessly and at the same time ensure that the patient derives the best out of his expertise. The main objective of the Course is to bring an interlink between ‘law’ and ‘medicine’. The Course helps an interdisciplinary study between law and health and identifies specific

nature of relationship that exists between a medical practitioner and his patient. As the medical professionals are usually hard pressed for time, the one year Distance Post-Graduate Diploma in Medical Law and Ethics course being offered by National Law School of India University, Bengaluru, wherein contact classes are being held at the NLSIU campus was not very convenient for medical professionals to enroll. In order to overcome this difficulty the National Law School of India University, Association of Healthcare Providers India & Association of National Board Accredited Institutions have joined hands and have been successful in organising the first ever “onsite” NLSIU PGDMLE course at the CMC Vellore, where 23 Medical Professionals have enrolled. The entire process of admission, delivering contact classes and conducting examination will be held at the CMC campus. Many more such “on site“ centres where the NLSIU PGDMLE course is to be offered , has been planned throughout the country. This is certainly bound to empower the medical professionals to offer their best to the patients.

CARESTREAM EARNS 42 U.S. PATENTS IN 2018 Carestream Health was awarded 42 new patents from the U.S. Patent and Trademark Office last year for innovation in digital radiography, extremity CT imaging and other healthcare technology areas. The company also received 37 additional patents in European and Asian countries last year. “These valuable patents demonstrate our continued success in developing advanced diagnostic imaging technologies that serve healthcare providers around the world,” said Susan Parulski, Carestream’s Chief Patent Counsel. “Our employees are committed to delivering new products that can enhance image quality, deliver greater productivity and offer new capabilities to help improve the quality of patient care.” New patents earned by the company’s scientists and engineers include:  New medical image capture technologies

related to the development of computed tomography (CT) systems designed for extremity exams; and

Dr. Vikram Mathews, Acting Director, CMC Vellore, Prof. VenkatRao, Vice Chancellor, NLSIU, Dr. Alexander Thomas, President, AHPI along with other Dignitaries

February 2019

Vice President of India, ShriVenkaiah Naidu, Governor of Tamil Nadu, Shri. BanwarilalPurohit along with other dignitaries

 Continued

technology advances that further enhance the image quality delivered by Carestream’s growing portfolio of radiology imaging systems and detectors. The company’s product portfolio includes digital imaging systems for general radiology and specialty areas such as orthopaedics and pediatrics; digital laser imagers that output medical images to film and paper; and the latest healthcare IT solutions and cloud-based services for hospitals, clinics and physician practices.

APOLLO HOSPITALS OPENS SOUTH EAST ASIA’S FIRST PROTON THERAPY CENTRE FOR CANCER Apollo Hospitals Enterprise Ltd., India’s first multi-speciality chain of hospitals opened the Apollo Proton Cancer Centre (APCC), giving cancer patients access to a specialised form of radiotherapy that is extremely precise in destroying cancer cells. The Apollo Proton Cancer Centre was inaugurated in Chennai by the Hon’ble Vice President of India, ShriVenkaiah Naidu in the presence of the Hon’ble Chief Minister of Tamil Nadu, ShriEdappadi K. Palaniswami and Dr. Prathap

C. Reddy, Chairman, Apollo Hospitals Group. Opening a new frontier in cancer care, the 150-bed APCC is an integrated cancer hospital in Chennai providing world-class 360o comprehensive cancer care. The APCC will offer patients advanced multi-room proton therapy with cutting-edge pencilbeam scanning technology that provides the highest degree of precision. The APCC strengthens Apollo Hospitals’ position at the frontline in the war on cancer. The clinical advantages of proton therapy as compared to conventional radiation therapy are many, with more than 200,000 patients successfully treated worldwide. Proton beam therapy takes the fight to cancer with increased precision and greater dose delivery at the precise site of the cancer, minimizing damage to healthy tissue, better quality of life and a higher cure rate. This ultimately results in better results with fewer short and longterm side effects. Speaking on the occasion, the Hon’ble Vice President of India, ShriVenkaiah Naidu said, “Cancer is a leading cause of death worldwide and is a major cause of mortality in India. My heartiest congratulations to Dr. Prathap C. Reddy and the Apollo Hospitals group on the launch of the first Proton Cancer therapy centre that will serve patients not just in India, but also our neighbours in South East Asia. This pioneering treatment also marks a

www.indiamedtoday.com

NEWS ROUNDUP new milestone in the medical journey of our country.” The Chief Minister of Tamil Nadu, Hon’bleShriEdappadi K. Palaniswami said, “The Proton Therapy Centre at Apollo Hospitals will make this advanced treatment for cancer care easily accessible to patients. Tamil Nadu has always been in the forefront when it comes to healthcare and with the opening of this centre, the State shall continue to offer the best to patients. We extend our best wishes to Dr. Reddy and his team for this ground-breaking effort to make the best-inclass healthcare facilities available to cancer patients in India and abroad.” Shri G. NageswaraRao, Chairman, AERB said, “AERB appreciates the efforts of Apollo Hospital for establishing the state of art “Proton Therapy” facility, the first of a kind in South East Asia. AERB earnestly hopes this most advanced “Apollo Proton Cancer Centre” will conquer the dreaded Cancer disease at affordable cost in a safe manner to the needy people of India and others in the region.” Speaking at the launch, Dr. Prathap C. Reddy, Chairman, Apollo Hospitals Group said, “Today is a red letter day in the history of healthcare in India. The launch of the Apollo Proton Cancer Centre puts India on the global map for the best and latest in cancer treatment and will give new hope to cancer patients not just in India, but across South East Asia, the Middle East and Africa, i.e., countries that comprise over 40% of the world’s population! It is pertinent to note that even a first world country like the U.K. launched a Proton Beam centre just last month, in December 2018, making our achievement in bringing this best and latest medical technology to India truly praiseworthy. It is with a sense of pride that we dedicate the Apollo Proton Cancer Centre to the health of the nation!” Proton therapy is effective against many kinds of cancer, but is particularly effective in challenging cancer sites including tumours affecting the eye and brain, tumours close to the brain stem, spinal cord or other vital organs, head and neck cancers, deep seated abdominal and pelvic cancers, recurrent cancers and paediatric cancers where

February 2019

children and young adults are at a particular risk of lasting damage to organs that are still growing. Our Oncologists regulate the energy of the protons and using advanced treatment planning systems target the tumour at the precise site of the cancer, thereby resulting in minimal damage to the surrounding healthy tissues and reduced side effects. Proton therapy also helps in situations where treatment options are limited or conventional radiotherapy presents an unacceptable risk to the patient.

DIABETES MAJOR ERIS LIFESCIENCES JOINS HANDS WITH MEDTRONIC FOR DIABETES MONITORING INITIATIVE In a first of its kind collaborative initiative in India between a pharmaceutical and medical device company, Eris Lifesciences, one of the leading players in the chronic drugs segment and India Medtronic Pvt. Ltd, a wholly owned subsidiary of Medtronic plc, the global leader in medical technology, announced their collaboration for a diabetes monitoring initiative in India. The two companies will utilize their respective strengths in helping patients monitor their diabetes better. Medtronic will bring to India its latest US FDA approved Guardian™ Connect devicefor

real-time evaluation of glucose variability in diabetes patients. Eris through its national reach will provide the device at clinics and healthcare delivery units under its patient care initiative. Guardian Connect is the world’s first Smart Continuous Glucose Monitoring System connected with smartphone displays for real-time data viewing of glucose levels, without a separate hardware monitor. Commenting on the development, AmitBakshi, Chairman and Managing Director, Eris Lifesciences said,“For better patient outcomes in diabetes, we believe that a holistic approach of medicine, diet and continuous monitoring is important. Technology has emerged as a great enabler in healthcare. While technology is transforming healthcare delivery, on the patient and physician end there is a need to create more awareness of how to use technology and how technology can make managing diabetes easier. Through this initiative, we aim to make patients and physicians adopt newer technologies for better health.” Describing the benefits of the collaboration, Madan Krishnan, Managing Director & Vice President, India Medtronic Pvt. Ltd., said, “Medtronic’s innovations in the space of Continuous Glucose Monitoring and Insulin Pumps has transformed diabetes management. Guardian Connect is a technological breakthrough that will change the diabetes treatment landscape. It empowers the patient

Eris Lifesciences Madan R Krishnan, Amit Bakshi,Sandeep Chalke

to take control in real-time and the physician to be fully-equipped with data and evidence. In a large country like India, with high incidence of diabetes, we are happy to align with a partner who understands the challenges of diabetes management and has the reach to take our solutions across the country.”

or mobile application owner can integrate the SDK without any hassle.We are confident that the SDK integration of DocsApp will offer a seamless experience not only to our customers but also other users who are seeking doctor consultation but are not logged into DocsApp yet,” he added.

ONLINE DOCTOR CONSULTATION PLATFORM DOCSAPP OFFERS SDK INTEGRATION

BRAIN HEALTH PROGNOSIS STARTUP IN-MED PROGNOSTICS RAISES RS 50 LAKHS FROM BIRAC

In its constant endeavour to provide access to specialist doctors instantly to Indians, DocsApp, the leading online doctor consultation platform, has announced the launch of its software development kit (SDK) for android and web platforms. The SDK integration will enable DocsApp customers to consult a doctor without downloading DocsApp, therefore making the lives of patients easier and more convenient. In addition, users will be able to easily access their DocsApp profiles from any website or android app that has integrated the DocsApp SDK. The SDK integration will also help other businesses to offer doctor consultation services without requiring their customers to move outside the application. With the integration, their users can also talk to doctors within 8 minutes. Few medicine delivery apps, a popular chat app and a medical information website have already initiated the process of integrating the DocsApp SDK with their platforms. “As we enter the next phase of our growth, the SDK integration will enable us to cater to a larger section of the population with our on-demand and high-quality doctor consultation. Since the beginning, DocsApp has been committed to making quality healthcare accessible by all, breaking geographical as well as socio-economic barriers. And, the latest development further reinforces our purpose,” said SatishKannan, CEO/Co-founder of DocsApp. “We will be making SDK open for any business who wants to provide specialist doctor access to their customers. Any website

Pune-based startup, In-Med Prognostics has received Biotechnology Ignition Grant of Rs. 50 Lakhs for a duration of 18 months from the Biotechnology Industry Research Assistance Council (BIRAC), Government of India. The grant will be used to develop a cloud-based software platform that will label, visualize, and quantify the volumes of brain structures using 3D MRI images. Startup incubator Venture Center in Pune is one of the partners and is associated with In-Med Prognostics for providing mentoring support and project monitoring. In-Med Prognostics was founded by Rajesh Purushottam, Dr. LathaPoonamallee, and Dr. Al Curran with the aim of bringing affordable, accessible, evidence-based brain health diagnostic and prognostic tools to India and other emerging markets. After having been selected as one of Top 20 Global Sciencebased ventures in the prestigious Falling Walls Venture competition, Berlin, 2016, the team has made great strides in bringing the state-of-the-art knowledge and technology in neuroscience, image processing, artificial intelligence, and data analytics, to assist Indian physicians in accurately diagnosing various neurological disorders such as epilepsy and dementia. Speaking about this grant, Rajesh Purushottam, Co-founder In-Med Prognostics, said, “Our proprietary software ‘Neuroshield’, addresses the need of the hour in neurology: accurate volumetric analysis of the brain and its structures. We will be leveraging deep

www.indiamedtoday.com

NEWS ROUNDUP learning algorithm and machine learning to provide time saving accurate Neuro analysis which will aid in assessment and early detection of neurological disorders such as Dementia, Alzheimer’s and Parkinson’s at affordable prices. The proposed solution is to provide a self-explicative volumetric report within an analysis time of 20 minutes”. The Biotechnology Ignition Grant (BIG) scheme is an initiative of Biotechnology Industry Research Assistance Council (BIRAC), Department of Biotechnology, Government of India. It is India’s largest early stage biotech startup funding program that supports innovative ideas right from concept to proofof-concept to advanced validation stage.

ROCHE DIABETES CARE INDIA APPOINTS DR GAURAV LAROIA AS GENERAL MANAGER

Roche Diabetes Care India, a pioneer in the development of blood glucose monitoring systems, and a global leader for diabetes management systems and services, announced the appointment of Dr. Gaurav Laroia as General Manager for its India operations. He assumes his new role with effect from 01st January, 2019. Gaurav will report to Pedro Goncalves, Head of Roche Diabetes Care Asia Pacific and will be a member of the Roche Diabetes Care Asia Pacific Leadership Team. He relocates to Mumbai from his current role as Head of Program Management Office (PMO) APAC in Singapore. Gaurav has more than 18 years of experience in commercial operations, business development, and management consulting in healthcarerelated multinational organisations in India, Singapore and the USA. He holds a Ph.D. in Molecular & Cellular Biology from New York University School of Medicine, USA and a Masters in Genetics from the University of Cambridge, UK. Dr.GauravLaroia, GM, Roche Diabetes Care India, said, “I am excited to be heading the India entity of Roche Diabetes Care. This role that comes with great responsibility towards patient care and I look forward to driving

February 2019

Dr. Gaurav Laroia

the development of integrated diabetes management solutions. Roche persistently endeavours to improve the quality of life and provide cohesive solutions for people with diabetes and I am privileged to be part of this journey. India is a very important market for Roche and our aspiration in the near future will be to be India’s topmost integrated diabetes solutions provider, touching millions of lives who need smart solutions for diabetes.”

MOU BETWEEN KALAM INSTITUTE OF HEALTH TECHNOLOGY (KIHT), VISAKHAPATNAM AND CSIR – CGCRI, KOLKATA The Kalam Institute of Health Technology (KIHT), at the AP MedTech Zone, Visakhapatnam and Council of Scientific & Industrial Research (CSIR) - Central Glass & Ceramic Research Institute (CGCRI), Kolkata have signedMoU on 04 January 2019. KIHT created with support of DBT (Dept. of Biotechnology) whose mandate is to reduce country’s import dependency and increase affordable medical devices through

indigenous manufacturing, while CSIR-CGCRI mission is to provide scientific industrial research and development in the area of glass, ceramics and related materials that maximizes the economic, environmental and societal benefit for the people of India. Both these institutes are going to work together to transform the medical device implant industry where glass and ceramics are highly applied in bio-implants. For the fiscal year 2017 – 2018, the import value of Biomedical Implants is approximately INR ₹2100Crores while export value is INR ₹400Crores. As a national lab CSIR-CGCRI is dedicated to carry out applied research in the fields of Bio Active Coating for Orthopaedic and Dental Application and Ceramic based hip joint prostheses and hydroxyapatite based integrated orbital implants which can significantly reduce the import dependency in the Biomedical implant and Biomaterial sector. KIHT can facilitate these innovations of CSIR-CGCRI using its e-Auction portal where any interested Indian manufacturer can bid the technology and start indigenously manufacturing thereby reducing import dependency. In addition, KIHT would support CSIRCGCRI scientists, researchers, and students to engage with medical device companies, innovators, incubatees, R&D institutions, and technical service providers. KIHT also facilitates access to the Common Scientific Facilities (CSFs) of its affiliate company, AMTZ for accelerating medical product development and commercialization. Further, both the institutes are going to encourage and facilitate industries, innovators, biomedical and related R&D institutions for exchange of information in relation to healthcare technology.

IN A FIRST FOR INDIA, 20-DAY-OLD BABY WEIGHING JUST 1.160 KG UNDERGOES BRAIN SURGERY Surgeons at Faridabad-based, 300-bed Sarvodaya Hospital & Research Centre

have successfully conducted brain surgery on a 20-day-old baby boy weighing only 1.1160 kg. This is the first time in India that neurosurgery of such a low-weighing baby has been done by opening the skull and removing a life-threatening blood clot from the brain which caused a seizure in the neonate. The condition would have proved fatal had it not been treated promptly. Sarvodaya Hospital has applied for LimcaBook of Records and Guinness Book of World Records to recognize this unheard-of surgical feat. The premature baby was one among twins born preterm at 33 weeks to parents DeevakarJha and Deepa Mishra. The baby, who cried late after birth, was referred to Sarvodaya Hospital for respiratory distress and perinatal asphyxia, where a team of surgeons led by Dr. PankajDawar and Dr. MukeshPandey took the child under their supervision. Explaining the case, Dr. PankajDawar, Senior Consultant, Centre for Brain & Spine, Sarvodaya Hospital &Research Centre, said: “At birth, the baby weighed 1160 kg, but had perinatal asphyxia and respiratory distress thereafter and was immediately admitted to Sarvodaya Hospital. He was put on ventilator for five days. On the 19th day of his birth, the baby suffered from seizure. A MRI scan revealed a large intracranial blood clot inside the skull, probably from bleeding disorder. On Day 19 of his birth and weighing only 1.160 kg, he was wheeled into the operation theatre for brain surgery. His skull was opened to expose her brain (minicraniotomy) and the blood clot (hematoma) was successfully removed. With this, he has become the baby with the lowest weight to ever undergo brain surgery in India and probably in the world.” Added Dr Manish Pahuja, Consultant, Department of Anaesthesia, Sarvodaya Hospital and Research Centre: “Brain surgery of a baby of such low weight has not been done before in the country. This requires very careful consideration and specialized equipment for anaesthesia. As per Dr SushilSingla, senior consultant and

HOD, Department of Paediatrics, Sarvodaya Hospital and Research Centre“ presence of a blood clot in the brain of a baby of such age and low weight posed a huge challenge for us. If untreated, the condition would have proved fatal. Even if the baby had survived, he would have suffered from neural problems and the brain would not have developed fully. After successful brain surgery and removal of the blood clot, the baby is perfectly fine. He is gaining weight and meeting all neural milestones adequately at last follow up visit.” Sarvodaya Hospital recently expanded its footprint in the national capital by opening a unique standalone daycare centre for cancer patients in South Delhi. It provides full nursing care and support to cancer patients in surrounding areas who need to undergo chemotherapy, immunotherapy or targeted cancer therapy, but do not wish to visit a hospital.

DOCPRIME.COM EXTENDS ITS SERVICES TO KARNATAKA To make healthcare available to all, docprime. com, the latest healthcare venture of Policybazaar Group announced its expansion to Karnataka. With a strong network of over 3,000 doctors and labs, the servicess of the company are currently available only in Bengaluru. However, it will be extended to other parts of the state by the end of the year. With this, docprime.com that is already well-established in Delhi and NCR has a significant presence in a total of 34 cities in the country. docprime.com is a platform that offers free online consultation and allows patients to book appointments with over 20,000 doctors and 5,000 diagnostic labs at discounted rates across the country. It will also invest USD 15 million over three years in preventive healthcare. According to Ashish Gupta, CEO, docprime.com, “With lifestyle diseases and other illnesses substantially increasing in India, preventive healthcare is becoming a necessity rather than an option for the people of the country. Thus, to help curb out-

www.indiamedtoday.com

NEWS ROUNDUP of-pocket healthcare expenses, docprime. com’s expansion to Bengaluru with over 3,000 doctors and 200 diagnostics centres aims at providing better healthcare at affordable pricing to everyone.” “Our latest investment of USD 15 million will be used towards encouraging people to look after their health proactively by regular monitoring and taking preventive measures. For this, the company also plans to expand to 100 cities nationally, with 1,00,000 doctors and 20,000 labs in 2019,” he further added. The objectives of docprime.com is to spend the money on educating people, spreading awareness on preventive healthcare and servicing customers with affordable solutions. A highlight feature of

the company is its cashless transactions. This means that the customers pay directly at the time of booking an appointment and no extra charge is levied post the doctor’s consultation. It also allows flexibility in rescheduling it and providing 100% refund in case of cancellation. The company is committed to providing best-in-class service to its customers and hence, offers a discount of up to 60% on doctor and lab bookings and up to 80% on health check packages. This is a first and a rare in the healthcare industry. The company that was launched in August last year is the third venture of the Group which already owns insurtech player PolicyBazaar.com and lending marketplace, Paisabazaar.com. It received initial internal

funding of USD 50 million from the parent company Etechaces Marketing and Consulting Private Limited in September. The company also aims to expand B2C business to corporates which will potentially contribute 20-30% to the company’s total revenues going forward.

TWO GUINNESS RECORDS STRENGTH MOVEMENT TOWARDS HOLISTIC HEALTHCARE OF WOMEN

The 62nd AICOG is about women’s health nation’s wealth. To drive this message in a unique and forceful manner, two Guinness World Records were set at AICOG 2019 in Bengaluru.

AICOG 2019 organising committee chairperson Dr HemaDivakar, secretary Dr Sheela Mane, writer UrvashiBhutalia and FOGSI 2019 president Dr NandithaPalshetkar cheer the certificate of Guinness World Record

February 2019

First record is about sanitary pads. Main role in second record is for calcium tablets. A sanitary napkin is about women’s health and hygiene, calcium is synonym with women’s wellbeing. AICOG 2019 (All India Congress of Obstetrics and Gynaecologists) created an image of uterus using 10,105 sanitary pads at Place Ground Bengaluru. In terms of length it is over 1 km (1,078 meters) and as AICOG 2019 organising committee chairperson Dr HemaDivakar said, this distance of 1 km is the beginning for the doctors to cover 1000s of kms to provide healthcare to the women of India. A typical woman uses between 10,000 to 15,000 sanitary pads or tampons over the decades that she has her period. This is as essential as her clothing. After the event, these 10,105 pads will be donated to four girls’ schools. “This is a start to a great movement of Parivarthan pan Karnataka and will be a stepping stone to initiate the much-needed change in mindset of our society. Decisions around reproductive health and making healthy choices and particularly right information and the right message through #parivarthan #whodecidesis expected to go beyond Bengaluru and Karnataka and reach millions of adolescents through digital media,” Dr Hema said. Another record made at the AICOG venue was India map. ‘Largest blister pack mosaic’ was made using 23,121 calcium drug strips covering an area of 90 square meter. AICOG organizing committee secretary Dr Sheela Mane spoke on the importance of calcium tablets for women while explaining the record attempt. “A woman normally, and due to pressure of domestic work, does not consume wholesome food and ignore to take calcium supplements. This record creation is an effort to spread the need of calcium for women’s health” Bollywood has also contributed to desensitize India about sanitary napkins with the movie ‘Padman’. The officials of Guinness World Records handed over two certificates confirming the records to Dr HemaDivakar and Dr NandithaPalshetkar, new president of FOGSI (Federation of Obstetric and Gynaecological Societies of India.

HEALTH MINISTER CONFERS ‘AWARD OF APPRECIATION’ TO RAJIV NATH, AIMED Rajiv Nath, Founder and Forum Coordinator of Association of Indian Medical Device Industry (AiMeD), was conferred the prestigious ‘Award of Appreciation’ by Shri. Ashwini Kumar Choubey, Hon’ble Minister of State for Health & Family Welfare for his contribution to the Global Public Healthcare sector at The Award of Appreciation Ceremony held at the Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, organized by Diaspora Foundation. The award was received by PradeepSarin and ManojTiwari on behalf of Rajiv Nath from ShriAshwiniChoubeyji, Hon’ble Minister of State for Health & Family Welfare at Ministry of Health, Delhi. Rajiv Nath is also the Jt. Managing Director of Hindustan Syringes & Medical Devices Ltd. which is having a turnover of over 600 Crores, one of the largest manufacturers of Disposable Syringes in the World and the largest for Auto Disable syringes along with being the President of All India Syringes & Needles Mfg. Association (AISNMA). Mr Nath was honoured for his valuable, remarkable and outstanding achievements in the field of healthcare & community

services for affordable medtech access and patients safety initiatives. His eminence and dynamic leadership to drive innovations and contributions in medical devices for healthcare has helped India to carve out a niche for itself in the global map. He has demonstrated remarkable and exceptional performances in setting the agenda and road maps for the future healthcare by setting an exemplary entrepreneurial competency and leadership in the healthcare industry not only by his own manufacturing company Hindustan Syringes & Medical Devices Ltd but also for the entire MedTech industry segment to realize his vision to position India among the top 5 manufacturing global hubs of medical devices. As the Founder and Forum Coordinator of Association of Indian Medical Device Industry (AiMeD), with over 350 Members nationwide, Mr. Nath has taken many initiatives of establishing a collaborative framework with various Dept. of the Govt. and media to bring to their attention issues troubling the industry and attract investments into India in his quest to make India as the Global Manufacturing Hub of Medical Devices – Make in India, Preferred Manufacturing Destination and the leading supplier of Medical Device worldwide. AiMeD is an Umbrella Association of Indian Manufacturers of Medical Devices covering all types of Medical Devices including

Pradeep Sarin and Manoj Tiwari receive the award on behalf of Rajiv Nath from Shri Ashwini Choubeyji, Hon’ble Minister of State for Health & Family Welfare at Ministry of Health, Delhi

www.indiamedtoday.com

NEWS ROUNDUP consumables, disposables, equipment’s instruments, Implants, electronics and diagnostics. With a Primary Membership of over 350 Manufacturers and additionally of over 200 Associate Members representing the interest of over 700 Manufacturers of Medical Devices to address the manufacturer’s problems. Mr Nath expressing his gratitude to Shri. Ashwini Kumar Choubey and Diaspora Foundation said “I am pleasantly surprised and humbled to receive this award. It validates the contribution and efforts made by us at AIMED, HMD and AISNMA to better the healthcare sector in the country and internationally in areas of Injection Safety, Drug Delivery , Patients Safety & Affordable access . This recognition by the Indian NRI Diaspora is an appreciation of the hard work and dedication we have made towards transforming the healthcare sector in India. I thank the teams of all three organisations who were always behind me, supporting my vision and working relentlessly to meet our common goal.” Recently Mr. Rajiv Nath has also been appointed as the Member on Board of National Medical Devices Promotion Council by DIPP established to Boost & Strengthen the Indian Medical Devices Sector and lead India to an export driven market in the Medical Devices sector. “We are glad MoH is serious about making PM Modi’s mission of making quality

healthcare affordable and available to the masses at large” said Mr. Rajiv Nath. Nath also applauded Union Minister of State for Health and Family Welfare Shri. Ashwini Kumar Choubey’s remarks for considering to increase custom duty on medical devices by 15-20% to promote indigenous manufacture of medical devices in order to reduce India’s 70% to 90% import dependence on Medical Devices and ensure affordable access in long run to homegrown Indian made devices .

TRIVITRON HEALTHCARE LAUNCHES STATE-OFTHE-ART RADIOLOGY EQUIPMENT AT ARAB HEALTH 2019 Kiran Medical Systems, the radiology division of Trivitron Healthcare, introduced its innovation driven Elite – Flat Panel Digital C-arm & Felicia – Digital Mammography system during the Arab Health Convention in Dubai. The Elite Digital C-arm offers a World-Class Surgical Imaging experience for high precision image Guided Procedures. Elite Digital features high resolution digital image acquisition with 1K X 1K Flat Panel Detector and 16 bit image processing. With World-Class 5 kW, 40 KHz X-Ray Generator with ABS for optimized dose, Elite Digital delivers superior imaging with higher grayscale resolution that makes

Dr. GSK Velu, Chairman and Managing Director, Trivitron Healthcare with Satyaki Banerjee, CEO of Kiran Medical Systems and other executives at Arab Health

February 2019

various anatomical structures visible with greater accuracy. Elite Digital features DSA – Digital Subtraction Angiography that is used in Vascular Procedures and Road Mapping feature that allow surgeons to find the path to reach the target location in branches during the surgery. The Equipment offers extra power for complex cases and active cooling to prevent overheating during long procedures. With User friendly Workstation and a Storage capacity of more than 100,000 images, Elite Digital offers wide Intra-Operative Imaging Applications. Speaking on the occasion Mr. Satyaki Banerjee, CEO of Kiran Medical Systems commented, “Kiran is committed to the field of Radiology developing products that help enhance medical imaging, significantly enhancing Diagnostic Confidence and Surgical Accuracy depending on the application. The launch of the Digital Mammography and Digital C-Arm is the first step towards launch of a comprehensive suite of Smart Imaging Equipment with integrated image processing, reconstruction and diagnostic software tools that would help Healthcare Providers store, retrieve, process, multiplex images leading to significant enhancement in the healthcare delivery process. In the near future Kiran would be enhancing the imaging software platform incorporating Artificial Neural Networks using Deep Learning algorithms to assist the radiologist in differential diagnosis.” Commenting on this development Dr. GSK Velu, Chairman and Managing Director, Trivitron Group of Companies said, “Trivitron Healthcare’s driving goal is to make WorldClass Healthcare Affordable and Accessible to everyone across the Globe. With a strong focus on Research & Development and Manufacturing, Trivitron has made significant strides in last few years in developing highend medical technology at affordable cost which is improving the healthcare penetration across the globe. Kiran’s launch of WorldClass Products like Elite – Digital C-arm & Felicia Digital Mammography systems is just the beginning of a suite of Radiology Products to be launched by Kiran in 2019 and it’s one of the most defining moments in the history of Trivitron Healthcare.”

DRIVE

Quest for Better Cancer Care Dr Mammen Chandy’s vision and work echoed the patient’s call to make quality healthcare accessible and available in India HE WANTED to be a vet. But fate had different plans for him. Dr Mammen Chandy, who grew up reading stories by James Herriot, a British veterinary surgeon and writer, did not realize when his love for animals transformed into love for medicine. “I wanted to be a veterinary and don’t really know when I decided to do medicine,” says Dr Chandy. Luckily, he did fall in love with medicine and went on to dedicate his life for the development of a specialty that is today synonymous with his name. Dr Chandy is well known not only in India but around the world for his passion for hematology, bone marrow transplantation and stem cell transplantation. This 70-year-old Director of Tata Medical Centre, Kolkata is the pioneer who changed the way patients of aplastic anemia, thalassemia and acute leukemiaare treated in India. He has dedicated his life to the development ofhemato-oncology in India and was recently conferredone of the highest civilian honours of Indiathe Padma Shri. Early Life Dr Mammen Chandy was born in Kerala on August 30, 1949 to late TP Chandy, a leather businessman from Chennai and late Aleyamma Chandy. Young Mammen was a bright student and and avid reader. His collections had books from famous English writers of the time as well as classics. He discovered medicine through the A J Cronin’s novels. Books like The Citadel, a tale of a mining company doctor’s struggle to balance scientific integrity with social obligations,left a lasting impression on him.

February 2019

Getting into one of the most prestigious medical colleges of India, Christian Medical College, Vellore, was thus a natural progression for him. “CMC is a great institution, which has given me the space to grow and the values on which to work,” says Chandy. CMC Vellore, is ingrained in Dr Chandy as he has spent almost four decades of his life at CMC, first as a student and later as a lecturer and researcher. The Scholar Academician Dr Chandy’s acumen and focused interest won him constant recognition by his teachers and peers. His formativeundergraduate and post graduate training laid the foundation for an outstanding academician in the making. He was the best out-going student of his batch in the undergraduate training program and went on to win the Madras University gold medal for the first rank in MBBS in 1971. He finished his post graduate training in 1978 and joined CMC as junior lecturer in the department of Medicine. While carrying out the regular activities of the department of medicine Dr Chandy got interested in hematology which was not recognized as a clinical specialty then. His interest in hematology was also fueled by legendry Dr John Carmen who was the then the Head of the department of Clinical Pathology at the same institution and under Dr Benjamin Pulimood who was the Head of the department of Medicine. “After working for about a year after PG, I realized that I needed some specialised training in hematology. However, there was no formal course in clinical hematology in India at

that time so I joined the Hematology and Pathology fellowship in Westmead Center, Sydney, Australia. Here I was trained by Dr. Peter Castaldi, who was an eminent hematologist at that time. After completing the fellowship by 1983, I returned to Vellore and joined the Department of Medicine,” recounts Dr Chandy. Development of Hematology It was not until 1985, that Dr Chandy formed a team and formally started the department of Hematology at CMC Vellore. “In the beginning, no one would refer hematology cases to me.

There were informal queries on management of some cases by post-graduate registrars but no formal referrals. It took some years before hematology cases were referred to me.” This did not dampen his enthusiasm and he continued to work towards rooting hematology at CMC. “After the initial slow start, we found that we were overwhelmed with work. Gradually, other clinicians who had specialized in hematology joined me and we formed a small team. This was how the Hematology department started and grew,” he shared. A year later, Dr Chandy was able to set up

I wanted to be a veterinary and don’t really know when I decided to do medicine

Dr Mammen Chandy, Director of Tata Medical Centre, Kolkata

www.indiamedtoday.com

DRIVE After the initial slow start, we found that we were overwhelmed with work. Gradually, other clinicians who had specialized in hematology joined me and we formed a small team. This was how the Hematology department started and grew

an allogeneic stem cell transplant unit and conducted the first allogeneic stem cell transplant. However, his initial efforts were not successful. “The initial efforts taught us a lot. We were able to fine tune our processes. I realized that things that I had learnt in Australia may not always work with Indian patients. In Australia, I had learnt that gut sterilization with antibiotics was important before a transplant, but what I realized was that this only killed the drug-sensitive bacteria and allowed the resistant bacteria to survive. Now I do not do gut sterilization in Indian patients,” explains Dr Chandy. His team rode the waves of despair to hope and finally were able to succeed in their efforts. Since then, there has been no looking back and even in the face of numerous adversities this stem cell transplant program has grown from strength to strength. Till recently, this center did approximately 120 transplants per year, with about 90 of them being allogeneic stem cell transplants, which is quite a feat in itself. Over the years, as the numbers of transplants increased, the complexity of the transplants being under taken has also increased. In fact, Dr Chandy and team have successfully transplanted a six-month-old baby weighing just five Kg with Wiskott Aldrich Syndrome, which is a feat in itself. Thalassemia Trails Dr Chandy was highly focused on allogeneic stem cell transplant for β thalassemia major patients as there is no cure for Thalassemia. This inherited disorder is highly prevalent in our country and prior to this program being set up patients would have had to go to abroad for an allogeneic stem cell transplant for this condition. With Dr Chandy’s efforts this procedure was made available in India and the cost was reduced 10 fold compared to the least expensive western center offering a similar procedure. Dr Chandy’s work echoed his mission to make quality healthcare accessible and available in India. “I had a patient with a rare form of leukemia who was from a middle class family and needed a bone marrow transplant, which we were not doing inVellore at that time,” recounts Dr Chandy. “The parents got Air India to give them free tickets, took the child to Nebraska,

February 2019

got him adopted by an American couple and got him admitted for a transplant in the US. Why should any Indian parent have to do this? Can we not provide this treatment for our own people in India and that to at a fraction of the US cost ( $250,000 versus $15000 in India),” lements Dr Chandy. It were incidence like this that did not allow Dr Chandy to rest. He took on the problem head on and created a lot of firsts for his team and CMC. “The BMT program in Vellore started in 1986 and is today the single largest BMT center in India. We did the first BMT for thalassemia and first matched unrelated stem cell transplant in India in collaboration with the National Donor Marrow program, USA and a donor registry in Germany (DKMS, Tubingen),” he adds. Dr Chandy’s team achieved a result of 85 per cent disease free survival in patients with thalassemia in Lucarelli Class II, which is equivalent to the results achieved by the pioneers of transplants for this condition in Pesaro, Italy. Education and Research Teaching brought great joy to Dr Chandy. In fact, he has trained distinguished hematologists both in India and abroad. It is interesting to note that in the last decade a number of centers for bone marrow transplant have been established in India and almost all of the specialists have been trained by Dr Chandy and his team. “The first DM Hematology course was started at CMC and I believe is the best training course in hematology in the country today,” Dr Chandy says. He has received numerous awards which recognized his contributions to teaching and mentorship, but none can equal the acknowledgement of having made a difference in someone’s life. “The immense satisfaction of being able to set up something that was relatively new and making a contribution not only to my alma matter but also to the life of students, patients and the society is something that will always be there with me,” he says. Dr Chandy’s passion and commitment to research led to the development of a world renowned Hemophilia reference and training center at CMC. His contribution to research in promyelocytic leukemia and thalassemia

has not only been recognized in India but also around the world. With support from the Department of Biotechnology he along with his team members have established one of the best molecular genetic services for patients with blood disorders in the country offering a range of services from mutation analysis to fluorescence in situ hybridization. One remarkable thing about Dr Chandy’s career is that he not only nurtured students but also nurtured a pool of talented people. He made sure that he facilitated specialist training and opportunities for these intellectuals. It is not surprising then that most of them came back to CMC after training abroad and started first-of-its-kind services in India. Delving Deep He believes that life is lived among simple moments like the smile of a child or the blossoms in spring. One should enjoy such moments and be thankful to God for having lived to see such moments of joy feels Dr Chandy. He also believes that families make life meaningful. Dr Chandy has three siblings, eldest sister Shantha Bose; currently the principal of Good Shepherd English Medium School, Kurianoor, Kerala. His brother Thomas Chandy runs a successful business in Chennai and younger sister Prema Clarke, an educationist who worked with World Bank. He is happily married toAnuMammen, who now runs a play school for children with cancer in Tata Medical Center Kolkata. He has two children who are well settled. The eldest son AjitMammenChandyis a pediatric intensive care specialist in Philadelphia and younger son Ashok Chandy is a computer engineer working with Amazon in Austin. CMC Vellore has been a big part of Dr Chandy’s life and he says that the institution has been guiding him and giving him strength through all the difficult times in life. “My training in Christian Medical College Vellore has given me a sense of values and purpose and this has guided me in all difficult situations. One woman’s (Dr Ida Sophie Scudder) vision to train India women to be doctors has resulted in a multispecialty hospital which trains numerous health care personnel and treats 6000

patients every day. The legends of CMC have become a part of my life,” he says. He remembers his teachers fondly and attributes a great deal of his success to them. “The founder of CMC Vellore Dr Scudder and many of my teachers have left a lasting impression on my life. My patients and their courage and perseverance to fight all odds has been a constant source of encouragement throughout,” he shares. Dr Chandy has received numerous awards for this work, but as a true physician he finds his patients appreciations to be the most prized honor in life. “The accolades don’t matter: a child with leukemia who you have treated many years ago and who is now leading a normal life gives me more satisfaction than any award,” he says. He signs off saying, “We must always seek to provide the best possible treatment within the resources available,” a message for his fellow oncologists and doctors working in cancer management.

Dr Chandy with a post transplant child from Yemen

www.indiamedtoday.com

COVER STORY

HOLY GRAIL OF

CANCER DIAGNOSTICS Cancer detection in a test tube, are we there yet? M Neelam Kachhap

February2019 January 2019

f you look at the most pressing needs of cancer care providers today early diagnosis of the disease would be on the top of the list. And an accurate non-invasive cancer screening test would not be far behind. This is simply because globally most cancers are detected at advanced stages with high treatment burden and low cure rates. Hence, early detection of cancer is critical to treating and improving the quality of life of patients. In fact, early detection is seen as an unquestionably important way to add more years to a cancer patient’s life. According to the International Agency for Research on Cancer, in 2018, there were more than 18 million new cases of cancer diagnosed of which nearly 5 million cases of breast, cervical, colorectal, and oral cancers could have been detected sooner and treated more effectively. Chief Executive Officer, Union for International Cancer Control, Dr Cary Adams says, “We want people to know that many cancers can be managed and even cured, especially if they’re detected and treated as early as possible. By detecting cancer at its earliest stage, we seize the greatest opportunity to prevent millions of avoidable deaths worldwide.” Researchers around the world are working on breakthrough solutions in cancer diagnostics and

management that can be affordable and available. Noninvasive cancer diagnostics has emerged as the Holy Grail of cancer detection and management. “This is potentially the holy grail of cancer research, to find cancers that are currently hard to cure at an earlier stage when they are easier to cure,” said Dr. Eric Klein, Taussig Cancer Institute,Cleveland Clinic, Ohio while talking about his work on development of a noninvasive cfDNA-based multi-cancer detection assay.

By detecting cancer at its earliest stage, we seize the greatest opportunity to prevent millions of avoidable deaths

The SUMMIT study will support the development of our blood test for the early detection of multiple cancer types in a diverse population

Dr Cary Adams, CEO, UICC

Anne-Renee Hartman, MD, Vice President, Clinical Development, Grail

This is potentially the holy grail of cancer research, to find cancers that are currently hard to cure at an earlier stage when they are easier to cure Dr. Eric Klein, Taussig Cancer Institute,Cleveland Clinic, Ohio

www.indiamedtoday.com

COVER STORY Non-Invasive Cancer Diagnostics Non-invasive cancer diagnostics are diagnostic methods that do not need tissue samples to be taken out of the body by cutting or piercing the body. One of the reasons why non-invasive cancer detection methods are gaining popularity is because they are almost painless, quicker than existing detection methods and are far more sensitive and therefore, provides more accurate results. At present, tissue biopsy, an invasive diagnostic method is routinely used to determine clinical characteristic of the diseases cells. After, imaging the diseased organs tissue biopsy is done to study the morphology of the cells and grade the tumor. Tissues have to be removed surgically or with needles and if the tissue location is difficult to reach the biopsy becomes risky for the patient. The procedure requires precision and is performed by highly trained doctors at select hospitals across India. The samples are then sent across to large diagnostic laboratories for tests and interpretations. This process is both expensive and time consuming, but it is a sure way of knowing about the disease. However, this process may be traumatic for many patients as taking tissue samples from organs like bone marrow are very painful and surgical removal of tissue has its own risks. Other than biopsies, procedures like endoscopies such as colonoscopy, gastroscopy and laparoscopy are also used for cancer diagnosis. These procedures are clinically accepted but they have their limitations. The information gathered by these processes allows oncologists insights of the disease state at a single point of time. These methods do not allow continues observation because of its invasive nature.These

processes cannot be used for screening or monitoring the patients during therapy. For better patient care, there is an urgent need for an easy non-invasive, affordable cancer diagnosis method. Additionally, experts believe that a rapid diagnostic method will not only measure the disease progression but also monitor the effects of the administered therapy over the treatment period, which is a huge advantage during cancer treatment. New Age Techniques Deriving actionable information for cancer management has become possible because of advances in the area of molecular diagnostics, specifically the screening of tissue or blood samples for tumor-specific genomic, proteomic, and epigenetic signatures. These are the techniques that are driving the non-invasive cancer diagnostics markets today. Liquid biopsy is generating a lot of interest among the oncologists, researchers and the industry; as liquid biopsies not only surpass the limitations of invasive diagnostic procedures but provide more benefits too. Simon Stevens, CEO, NHS England, told The Guardian that new techniques such as cancer blood tests could unlock enormous survival gains, as well as dramatic productivity benefits in the practice of medicine. Researchers hope the test will become part of a universal screening tool that doctors can use to detect cancer in patients. Today liquid biopsies analyze body fluids like blood, urine or plasma to detect biomarkers and cells related to cancer such as circulating tumor cells (CTCs), circulating tumor DNA/RNA (ctNAs) or exosomes.In addition, liquid biopsies give the oncologist the freedom to study the tumor cell when detected and observe the changes in the cancerous cell over the course of treatment. This will help expand the scope of personalized medicine as practiced currently. Besides biopsies there are other experimental candidates for noninvasive early cancer detection that use either skin lesions, bronchial fluid or exhaled breath as samples to look for traces of cancer. These tests use gene expression profiles, biomarker analysis, volatile organic compound detection and other advanced techniques of molecular genetics to detect cancerous cells. Circulating DNA At Johns Hopkins Kimmel Cancer Center researchers have developed a single blood test that screens for eight common cancer types and helps identify the location of the cancer. The test, called CancerSEEK, is a unique noninvasive,

February 2019

Photo credit: Elizabeth Cook and Kaitlin Lindsay Photo source: John Hopkins Medicine

multianalyte test that simultaneously evaluates levels of eight cancer proteins and the presence of cancer gene mutations from circulating DNA in the blood. The research results published in the journal Science in Jan 2018, reported that the test aimed at screening for eight common cancer types and five of the cancers covered by the test currently have no screening test. The test was evaluated on 1,005 patients with nonmetastatic, stages I to III cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung or breast. The median overall sensitivity, or the ability to find cancer, was 70 percent and ranged from a high of 98 percent for ovarian cancer to a low of 33 percent for breast cancer. For the five cancers that have no screening tests—ovarian, liver, stomach, pancreatic and esophageal cancers— sensitivity ranged from 69 percent to 98 percent. CancerSEEK is noninvasive and can, in principle, be administered by primary care providers at the time of other routine blood work. “This has the potential to substantially impact patients. Earlier detection provides many ways to improve outcomes for patients. Optimally, cancers would be detected early enough that they could be cured by surgery alone, but even cancers that are not curable by surgery alone will respond better to systemic therapies when there is less advanced disease,” says Anne Marie Lennon, M.D., Ph.D., associate professor of medicine, surgery and radiology, clinical director of

A number of studies have shown an association between fecal microbes and colorectal cancer; however, there is limited agreement in the types of microbes reported Dr. Manasi Shah, Graduate Student, The University of Texas School of Public Health

Principle of the CancerSEEK Screening test

gastroenterology and director of the Multidisciplinary Pancreatic Cyst Program. The CancerSEEK will be validated in large scale-screening studies before it can be made commercially available. Micro RNAs University of New South Wales (UNSW) Sydney researchers have published promising discovery of a new way to detect ultralow levels of microRNA in a blood

What this means is the technology has the potential to determine the levels of microRNA just from a finger prick test

We urgently need to develop new tools, like this breath test, which could help to detect and diagnose cancer earlier

Justin Gooding, Scientia Professor and founding co-director of The Australian Centre for Nano Medicine

Professor Rebecca Fitzgerald, Cancer Research UK Cambridge Centre

www.indiamedtoday.com

COVER STORY Photo credit: K. Prince/Texas Children’s Hospital

standard nucleic acid amplification methods. And we can do it in unprocessed blood.What this means is the technology has the potential to determine the levels of microRNA just from a finger prick test,” he added. Professor Gooding said he would expect the technology to be available for patients within three years, pending regulatory approvals.

Researchers reanalyzed raw bacterial DNA sequence data from several studies and confirmed previously reported types of bacteria associated with colorectal cancer and identified other bacteria not previously associated with the disease.

sample which could make diagnosis of cancer and other illnesses quicker and more efficient. Published in Nature Nanotechnology, Aug 2018, this study reported that nanoparticles latch on to the targeted microRNAs (miRNAs) which enabled them to be easily extracted. The researchers used modifying gold-coated magnetic nanoparticles with DNA to match the miRNA they wanted to detect. One of the main benefits was that it was effective even when the miRNA was in minuscule amounts in the blood sample. Previously, a much larger sample was needed to extract similar amounts. MicroRNAs are short RNA molecules that target some messenger RNAs (genetic material used to synthesize proteins) to prevent them from coding for a specific protein. Impaired miRNA activity has been linked with the formation of cancerous tumours as well as metastasis, the spread of cancer to other parts of the body. Key to the new technology is not just the ability to detect lower concentrations of miRNA but the ability to detect a broad range of concentrations.“This is really important to determine whether the levels of different microRNAs have increased or decreased,” said Justin Gooding, Scientia Professor and founding co-director of The Australian Centre for NanoMedicine. “We can do this very quickly compared with the gold-

February 2019

Gut Bacteria DNA Researchers at Baylor College of Medicine and other institutions have reported on specific types of bacteria that seem to be abundant in individuals with colorectal cancer. Using a combination of markers specific for these fecal microbes, scientists anticipate that a noninvasive, sensitive clinical diagnostic test potentially can be developed. Published in May 2018, in journal Gut, the study reanalyzed raw bacterial DNA sequence data from several studies and confirmed previously reported types of bacteria associated with colorectal cancer and identified other bacteria not previously associated with the disease. “A number of studies have shown an association between fecal microbes and colorectal cancer; however, there is limited agreement in the types of microbes reported,” said first author Dr. Manasi Shah, who was a graduate student at The University of Texas School of Public Health during the course of this project. “I was interested in finding a microbial marker for the disease. One way to do this is by carrying out a single-institution study, but this takes a long time for sample collection, involves sequencing the microbes’ DNA and is expensive. I noticed that some of the published studies provided the means for accessing the raw microbial DNA sequencing data of the samples. How great it would be, I thought, if I could leverage existing raw data across multiple cohorts and come up with a generalizable marker for the disease.” Volatile Organic Compounds In another development, researchers from the Cancer Research UK Cambridge Centre have launched a clinical trial to develop a breath test, analyzing molecules that could indicate the presence of cancer at an early stage. The trial called PAN Cancer trial for Early Detection of Cancer in Breath in collaboration with Owlstone Medical are testing a Breath Biopsy technology developed by Owlstone. According to the researchers, breath samples from people will be collected in the clinical trial to see if odorous molecules called volatile organic compounds (VOCs) can be detected. Researchers explain that when cells carry out biochemical reactions as part of their metabolism they

produce a range of VOCs. If their metabolism becomes altered, such as in cancer and various other conditions, cells can release a different pattern of VOCs. The researchers aim to identify these patterns using Owlstone Medical’s Breath Biopsy technology. Professor Rebecca Fitzgerald, lead trial investigator at the Cancer Research UK Cambridge Centre, says, “We urgently need to develop new tools, like this breath test, which could help to detect and diagnose cancer earlier, giving patients the best chance of surviving their disease. Through this clinical trial we hope to find signatures in breath needed to detect cancers earlier – it’s the crucial next step in developing this technology. Owlstone Medical’s Breath Biopsy technology is the first to test across multiple cancer types, potentially paving the way for a universal breath test.” If the technology proves to accurately identify cancer, the team hope that breath biopsies could in future be used in GP practices to determine whether to refer patients for further diagnostic tests. Market Feel According to data published by Allied Market Research, the global Liquid Biopsy market was valued at $634 million in 2016, and is estimated to reach at $3,805 million by 2023, registering a CAGR of 28.9% from 2017 to 2023. Among specific indications, experts believe that prostate cancer is likely to capture the largest share of the market about 15 per cent. This will be followed by breast cancer 14 per cent, owing to the large target patient population. In addition, lung cancer is also likely to capture a significant market share of 12 per cent by 2030. For lung cancer, despite the low prevalence, the demand

of liquid biopsies is significantly high as tissue biopsy is extremely difficult in case of lungs. Innovative Companies Guardent health with Guardant360 test was one of the early movers in this space. Since its launch in 2014, Guardant360 has become the world’s market-leading comprehensive liquid biopsy test and has been used by more than 5,000 oncologists globally, over 70,000 patients and upwards of 50 biopharmaceutical companies. It is the most widely published test with over 80 peer-reviewed publications, more than 20 clinical outcomes studies. “Guardant360 can help avoid costs, complications and delays of invasive biopsies through a simple blood draw. This test is meant for advanced cancers and is changing the way cancer is tracked and treated,” says Divya Mehta, Head of Corporate Development, Asia, Middle East and Africa, Guardant Health AMEA. GRAIL Inc., a healthcare company focused on the early detection of cancer, is another player in this space. At the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, Grail presented data from its Circulating Cell-free Genome Atlas (CCGA) study that showed promising results in early detection of lung cancer. “Lung cancer is the single greatest cause of cancer death globally and is typically diagnosed at late stages when, despite recent treatment breakthroughs; survival is often measured in months.These initial data from CCGA are exciting because they suggest it is possible to detect lung cancer through DNA signals in the blood at earlier stages when survival rates may be higher,” says Geoffrey Oxnard, MD, Associate Professor of Medicine at DanaFarber Cancer Institute and Harvard Medical School. Photo credit: Owlstone Medical

Breath Biopsy

www.indiamedtoday.com

COVER STORY Recently Grail announced plans to initiate a study to evaluate the ability of an investigational blood test using next-generation sequencing (NGS) technology to detect multiple cancer types, including lung cancer. SUMMIT is a prospective, observational, longitudinal, cohort study designed to enroll approximately 50,000 men and women age 50 to 77 years who do not have a cancer diagnosis at the time of enrollment. SUMMIT will be conducted in the United Kingdom in partnership with UCL (University College London) and University College London Hospitals National Health Service (NHS) Foundation Trust (UCLH). Lung Cancer Alliance (LCA), a non-profit organization based in Washington, DC, is also a SUMMIT study partner and provided guidance on the study design. “The SUMMIT study will support the development of our blood test for the early detection of multiple cancer types in a diverse population,” said Anne-Renee Hartman, MD, Vice President of Clinical Development at Grail. Some of the other key players operating in the global non-invasive cancer diagnostics market include Roche Diagnostics, Hologic Inc., Qiagen, Gen-Probe Inc., Digene Corporation, Abbott Molecular, IVDiagnostics, Laboratory Corporation of America Holdings, OncoCyte Corporation, Arquer Diagnostics Ltd. and Affymetrix Inc. Another area of interest is companion diagnostics where genomic test predicts a person’s drug response, or helps to tailor therapy specifically for that patient. At present seven liquid biopsy tests are being explored for use as companion diagnostics. Companies have come forward to work together to co-develop liquid biopsy companion diagnostic products. Some of these are BMS and GRAIL (2017), Merck and SysmexInostics (2016), Biocept and Baylor College of Medicine (2015), QIAGEN and Tokai Pharmaceuticals (2015), ANGLE and MD Anderson Cancer Center (2015), and AstraZeneca and QIAGEN (2015). The India Story Core Diagnostics is a high end clinical laboratory focused on next generation diagnostics for disease stratification and therapy selection.In Nov 2018, the company partnered with Guardant Health AMEA, to bring their comprehensive liquid biopsy, Guardant360 to India. Earlier, in Aug 2017, Core introduced Canadian company Contextual Genomics Find It to India. The test evaluates the mutation status of tumor DNA at more than 120 well-characterized positions, identifying the somatic mutations that have the greatest potential to impact treatment decisions, making it possible for doctors to customize therapies with greater precision.

February 2019

Core has also partnered with CellMax Life to make CellMax Life’s genetic cancer risk test and ctDNA-based liquid biopsy available throughout India. The company has also partnered with New York based Star Health Network, Inc., to extend the use of the Celsee Diagnostics’ liquidbiopsy test in India. The test enumerates Circulating Tumor Cells (CTCs) from patients of metastatic breast, prostate, colon or lung cancer patients. ZoyaBrar, Founder & MD, CoreDiagnostics, says, “India has made excellent progress in the past five years in creating awareness about molecular diagnostics and precision medicine. Our aim is to make genomic sequencing accessible to a much broader population base.” Medgenome is a homegrown genomics driven research and diagnostics company that is vying for the noninvasive cancer detection market. Its OncoPept platform is used by researchers to help identify biomarkers aimed at delivering personalized therapies including more durable, improved and responsive cancer immunotherapy treatments. It offers a personalized cancer therapy approach leveraging a novel T cell receptor binding algorithm to predict personalized cancer vaccine candidates, and provides a high-throughput multi-dimensional view of the tumor microenvironment using NGS (Next Generation Sequencing) based solutions. Medgenome launched a liquid biopsy test in March 2017 that screens the samples by analyzing cell-free DNA isolated from the patients’ blood.Oncotrackidentifies specific gene mutations that are linked with Melanoma, Lung and Colon cancers and is the only test to be validated in India and verified from samples of cancer patients from across the country. “Liquid biopsy has the capacity to interpret infinite mutations which will pave the way for new drug discovery, research and therapies. Over thirty five oncologists in India have already screened patients using our Oncotrack. Further, since it has a very patient friendly approach, we are confident it will be very well accepted by the doctors and patients,” says Dr V.L. Ramprasad, COO, MedGenome. Another test available in the Indian market is from Singapore based genomic medicine company Lucence Diagnostics. Lucence’s flagship liquid biopsy test – LiquidHALLMARK targets a wide range of cancers, especially lung, colon and breast cancers. The test is based on Lucence’s proprietary molecular watermarking technology AmpliMARK with sensitivity and specificity of up to 99.9%, which is supported by its AI-powered clinical analytics engine SunTzu.AI. Lucence has partnered with iGenetic Diagnostics to make the test available in India

IMPACT

HOW PHILANTHROPY CAN WIDEN THE REACH OF CANCER CARE Ensuring greater awareness and accessibility to cancer screening, diagnosis and treatment

Dr. Arnie Purushotham, Medical Director, The Tata Trusts Cancer Care Program

CANCER IS the second leading cause of death globally according to the WHO , with 1 in 6 deaths due to cancer. The WHO also states that 70% of deaths from cancer occur in low and middle income countries (LMICs), 33% of deaths from lifestyle or dietary risks like tobacco, alcohol and obesity and 25% of cases from infections like hepatitis and human papilloma virus (HPV) in developing countries. Late stage diagnosis and difficulty in accessing high quality, affordable cancer care is the challenge that LMICs are faced with in regards to cancer care.The economic impact of cancer, which was estimated at US$1.16 trillion in 2010 is increasing and potentially will be a serious impediment in the growth and development of nations such as India. A pioneering move in medical history was made in 1941 when the Tata Trusts translated their philanthropic sentiments into reality through the creation of Tata Memorial Hospital as “a beacon of hope for the hopeless”. This was the first of many such path-breaking endeavours by the Trusts in the field of cancer care. Tata Memorial Hospital has since been handed over to the Government of India in the interest of the nation. Over the years, the Trusts’ vision and drive to fight this dreaded disease has been evident through its several initiatives, the chief among them being the development of Tata Medical Center in Kolkata in 2011. It has been set up considering the high cancer

prevalence in eastern and north-eastern states and to combat the lack of suitable facilities in the region. Both the hospitals have been engaged in education and research in oncology to improve treatment modalities. We have been fighting many small battles, winning some and losing many.The need is for a national strategy for comprehensive cancer care. Awareness, Early Diagnosis, and Accessibility It is with this approach (AEA) that many state governments are working today with NGOs and private partners to establish comprehensive cancer education, early detection, and treatment infrastructure. A case in point is the Assam state government working with the Tata Trusts to implement a distributed cancer care model. Assam reports more than 30,000 cases of cancer annually and the number is projected to increase significantly in the coming years. Nearly 70 percent of reported cases are in an advanced stage of the disease, leading to a high mortality rate. The problem of high incidence and late detection is further exacerbated by a dearth of infrastructure and skilled manpower. To address this grave situation, the Government of Assam and the Tata Trusts formed the Assam Cancer Care Foundation, in December 2017, and are creating a multi-level cancer grid in the state. This distributed model

www.indiamedtoday.com

IMPACT will carry cancer care closer to the homes of patients, create awareness among the public on a healthy lifestyle, risk factors including the harmful effects of tobacco and alcohol along with symptomsand signs of cancer. It will alsoemphasize the importance of identifying the disease early through the Government cancer screening programs. The distribution of the care facilities is needed because currently in Assam there are only three apex cancer centres for a population of 34 million. The distributed cancer care model of the Tata Trusts Cancer Care program has threelevels of cancer treatment facilities. At the top will be the firstlevel of apex centres. Present in the major cities, these apex tertiary care centres willdeal with patients with common as well as complex cancersthat need advanced treatment and care. These centres will also have an oncology research and education mandate. Thesecondlevel will be greenfield cancer hospitals that will cater to the majority of cancer cases and will be developed adjacent to Government Medical Colleges. The secentres will address the issues that patients have in accessing the tertiary centres in the urban areas. The thirdlevel will leverage the District Hospitals and provide day-care and diagnostic services. These centres will reduce the time taken for confirmatory diagnosis, day care treatment, and follow-up care. This will address the problem of patients dropping out due to long travel time for treatment and follow-up. All these levels of cancer facilities will offer community-based screening and diagnostic services as well as follow-up and palliative care for patients who need high quality, holistic care. Oral, Breast and Cervical Cancer Screening Programme Given that 70 percent of cancer cases in India are detected at late stages, health promotion, cancer awareness and early detection are key focus areas for the Trusts. The Tata Trusts have been working with the Government of India and multiple state governments to operationalise the screening programme for NCD which includes three common cancers

February 2018

(oral, breast and cervix). As part of this, the Trusts have supported the development of a digital platform for NCD screening in collaboration with the Dell Foundation. The purpose is for it to be a guiding initiative for replication and institutionalisation in India, with the end goal being diagnosing cancer at an earlier stage, thereby reducing the morbidity and mortality ensuing from the disease. National Cancer Grid To provide affordable and equitable cancer care through technology and to support the development of specialised human resources, the Tata Trusts are actively supporting the Department of Atomic Energy and Tata Memorial Center with the National Cancer Grid which is a network of 150 cancer centres, research institutes, patient groups and charitable institutions working in the area of cancer care across India. The purpose is to increase the training capacity for cancer healthcare professionals and drive the health promotion, cancer awareness and early diagnosis agenda. The NCG platform connects all hospitals and acts as a central portal which will allow a common framework for guidelines of treatment, ongoing training and education of healthcare workers, and research collaboration across doctors and institutions.

The WHO also states that 70% of deaths from cancer occur in low and middle income countries (LMICs), 33% of deaths from lifestyle or dietary risks like tobacco, alcohol and obesity and 25% of cases from infections like hepatitis and human papilloma virus (HPV) Reference: 1. http://www.who.int/news-room/ fact-sheets/detail/cancer

APPROACH

Emotional Support Wins Providing emotional support positively effect hospital’s top-line

Rajagopal Yadavalli, Director, Forum Business Research

WHEN KAMALA was diagnosed with cancer, she and her husband were devastated. With little information on prognosis and ready to do whatever it takes to overcome the disease, they put their life savings on the line and followed the doctor’s orders to the dot. But they were in for a ride into the unknown. Neither Kamala nor her husband knew that chunks of her hair would fall out, that her body would often feel tired and that she would have diarrhea, out of so many other side effects that chemotherapy causes. When they did begin to happen she felt mortified and depressed at the same time. It was all too real, and things were clearly out of her control. She was a physical body to be bombarded with radiation and chemicals - not a human with emotions and expectations. For Kamala, the doctor’s waiting room was the only source of information - from the other patients and their families also waiting their turn to see

the doctor. Kamala’s experience is not unlike many other cancer patients. Emotional Support Patients can perhaps be eased off of such mental torment if they are addressed in a more humane way. It is important to have an ecosystem that can handle the patient’s emotional needs and information gap as much as the clinical aspects. This ecosystem is generally made up of three support groups for the patients: friends and family, the doctors and the hospital. Let us look into each of them. Family Support For many families, it is their first close brush with cancer with little or no earlier experience about it to fall back on. The entire family is affected and is at their most vulnerable state, hanging on to everybit of hope regardless of where it comes from. It is not uncommon to see even the most agnostic and atheistic patients and their attendants turn to religion and faith or becoming more superstitious invery unique ways. Some turn to god figures (such as holding on to images of their favourite God, talismans and sacred threads) and others always request for the a particular nurse or room believing that it would bring them luck as it did during their previous stay. All these are indications that they are emotionally shot and are hanging on to the last straws of hope and sanity. Family as an ecosystem entity is not much of support to the patient. Doctor Support Expecting this kind of emotional support from the doctors, while reasonable, is practically difficultand rarely seen in practice. The doctors having seen many similar cases should ideally be in a much better emotional state. However, shortage of doctors in India means that they

www.indiamedtoday.com

APPROACH

are overworked and stressed out. Dealing with a roller coaster of emotions - hope of life on one end and despair of deathon the other - on a daily basis eventually makes them detach themselves from the emotional aspectsof their work. They often restrict themselves to the clinical aspects of the care; focus on the organsof disease and medical outcomes rather than treating the hopeful patient as a human. It may be justa coping mechanism for them, but it often leads the patients to think that the doctor does not care forthem. Again, not much of support to the patientâ&#x20AC;&#x2122;s emotional needs. Hospital Staff Support The third support group, the hospital staff and management, are not much of help either. Likedoctors, the support staff at hospitals (nurses, paramedical staff and others) becomes inured overtime to the needs of patients. It is all part of a daily routine for them wherein their performance ismeasured in terms of efficiency - number of patients serviced per day, which essentially makes themfocus on quantity and

February 2019

address quality to the extent required for clinical outcomes or regulatorybodies. Most private hospitals, generally run as for-profit businesses, are focused on increasingrevenue and reducing costs. Any initiative to improve patient experience and engagement isgenerally seen as an additional cost with little guarantee of equitable ROI. With this mindset andfocus of financials, it is not surprising to see that the entire private healthcare system is viewed witha suspicious eye by the public. Patientsâ&#x20AC;&#x2122; Emotional Needs It then seems that the existing ecosystem leaves the patients to fend for themselves, either due tolack of ability or incentive for any of the support groups to address the patientsâ&#x20AC;&#x2122; emotional needs.There does not seem to be an interested party to address this patient need, and so there seems to be no solution tothis problem. However, our experience over the last seven years working with a few select groups ofhospitals clearly indicates otherwise. Hospitals can clearly benefit from investing into improvingpatient

This ecosystem is generally made up of three support groups for the patients: friends and family, the doctors and the hospital

experience to improve their brand image, word of mouth referral patients, occupancy ratesand financial metrics. While the heart-warming smile of highly satisfied patients may be the just and only reason forinvesting into them, we know the more financially focused have always looked for justification interms of ROI. There are clear indicators from our experience that patient experience initiatives when implemented in a disciplined, systemic and focused manner have an unmatchable ROI compared to the traditional marketing and business development initiatives. Life Cycle Value For the professionals that have a financial bent, let us establish the Life Cycle Value (LCV) of acustomer for a hospital. Typically, this is defined as the marginal benefit to the hospital from servicing a patient. But this definition is not complete. This value can be a few magnitudes of timesmore, when the potential referrals of a happy patient are taken into account. On the other hand, anon-satisfied patient can cause many others to not choose this hospital for their healthcare needs. Wehave documented cases of patients that have referred over six other patients to hospitals that they were happy with; in less than a year. Assuming that a dissatisfied patient would impact about 10 other patients not to choose a hospital, the sum amount at stake for a hospital is 16 times the LCV of eachpatient. Add attendants into the mix and this number increases multi-fold. Essentially, every patientand their attendants are walking assets for the hospital to be groomed into fanatical promoters. The stickiness of cancer patients and their high LCV makes it even more imperative for onco-speciality focused hospitals to work actively in managing the experience of their patients. The cost of not taking up this initiative is just not worth the inaction. Indian Case Study This fact is not lost on some of the savvy hospital management groups, and they have begun to take initiatives to improve the patient engagement and experience. Patient feedback systems, an integralpart of any experience management initiative,

have typically focused on numbers and ratings. However, latest research in behavioral economics indicates that emotions that rule the subconsciousmind have a greater influence on buying and referral patterns than the logical or conscious mind that works with numbers. While emotions are more difficult to measure than ratings, the high LCV ofcustomers of a hospital provides large enough incentive for hospitals. Hospitals would be shortsighted not to invest into understanding and managing emotions - at every stage in the life cycle of apatient. A few innovative hospitals have taken proactive steps to manage the impressions and emotions oftheir patients. An oncology speciality hospital in Bengaluru is inviting cancer survivors from their hospital to share their experiences in group settings, with their current patients. Conducted twicee very week, survivors share their stories of success of hope over despair with patients going through the difficult phase of cure and recovery. These well attended forums provide a platform for the exchange of thoughts and experiences, supporting the patients emotionally and psychologically. Another hospital has recruited an active breast cancer survivor to address some of the mostrecalcitrant patients that have a â&#x20AC;&#x153;Why me?â&#x20AC;? attitude - essentially a feeling that the world has cheated them of their life. When these patients see someone that has gone through their phase of life andnot just survived but productively engaged in work, it gives them a new leaf of hope. A new emerging area of focus at oncology speciality hospitals is Psycho-Oncology. Psycho-Oncology addresses two major psychological dimensions of cancer: the psychologicalresponses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. By managing the patient ecosystem psycho-oncology helps provide a holistic environment that works to instill confidence, faith and hope in their ability to recover. By actively listening to their patients, understanding their emotions and managing them, a few hospitals are able to provide superior experiences to their patients. They are also able to grow at amuch faster rate than their peers.

A few innovative hospitals have taken proactive steps to manage the impressions and emotions of their patients

www.indiamedtoday.com

PULSE

Top 10 Interventions Positively Affecting Cancer Care in India These new interventions are setting in the next big wave of change in cancer care FROM IMAGE processing to liquid biopsies to on-demand digital pathology, these interventions have the potential to change the way cancer care is delivered in India. We spoke to innovators, oncologists and researchers to find the interventions that are at the fore-front of cancer care in India. AI and Image Processing Artificial Intelligence techniques are being used by the image processing researchers and industry to solve a wide range of previously intractable problems in cancer management. Mammo Assist launched by Telerad Tech is an intelligent AI algorithm developed using Deep Learning and Image Processing approach in the field of radiology which analyzes Mammograms for early stage breast cancer detection. It identifies critical clinical findings including BIRADS Categorization, in turn, enhancing the ability of a radiologist to accurately report cas-

February 2019

es with High Accuracy and EďŹ&#x192;ciency. It provides Standard Interface with Healthcare Systems through industry standard protocols in addition can generate fully automated preliminary analysis report. MammoAssist can integrate and processing any DICOM images and providing annotation for breast cancer detection with a Structured Report. The algorithm and tool can be plugged into any existing radiology workflow (RIS-PACS) and 2D DICOM Viewer. â&#x20AC;&#x153;In breast cancer, early detection is of paramount importance in terms of improving patient outcome and reducing healthcare costs. Today, in India, most breast cancer cases are unfortunately diagnosed at a late stage, in part due to the shortage of radiologists required for interpretation of mammograms for the early detection of breast cancer. The availability of an Artificial Intelligence solution such as MammoAssist has the potential to be a game changer in terms of assisting radiologists and

“Cancer treatment has been phenomenally transformed due to ProtonTherapy. It helps in treating tumors located especially in difficult to access areas such as in head, neck, pancreas and prostrate. It is most effective considering the possibility of giving higher doses of radiation to control and manage cancer while reducing damage to vital organs and healthy tissues” Dr Rakesh Jalali, Medical Director, Apollo Proton Cancer Centre

facilitating early detection of breast cancer,” explains Dr. Arjun Kalyanpur, Founder & Chief Radiologist of Teleradiology Solutions &Telerad Tech. Another notable mention here should be made of Predible Lung a solutions to enable hospitals carry out lung cancer screening from low dose CT imaging at scale using artificial intelligence. Being small, subtle findings – lung nodules, which are sign of early cancer have a propensity of being missed by reporting radiologists. Usage of AI can help ensure such errors do not occur and ensure high-quality of care for the screening population. The usage of AI can also be extended to help establish if the detected nodules are malignant or not, helping prevent unnecessary biopsies or warrant quicker follow-up scans to confirm the cancer. Proton Therapy ProtonTherapy is the most advanced and targeted cancer treatment due to its superior dose distribution and minimal side effects that helps treat cancer more effectively and efficiently.Standard radiation therapy comprises of X-ray beams that deposit their energy along the path of the beam, to the tumour and beyond, resulting in radiation

being delivered not only to the tumour but also to the healthy tissues around the tumour. This causes damage to the normal tissue or organs near the tumour. With protontherapy, it is possible to control the location of the release of the energy and precisely target the tumour, causing the most damage to the targeted tumour cells, while sparing healthy tissues and organs. A proton beam is just millimeters wide and allows the effective treatment of complex tumours in the eye, brain, prostate, as well as cancers in children with the advantage that healthy tissue and critical organs are not harmed. It gives the patient a better quality of life during and after treatment. The Apollo Proton Cancer Centre (APCC) in Chennai is South East Asia’s first ProtonTherapy Centre with a capacity of 150 beds. Dr Rakesh Jalali, Medical Director, Apollo Proton Cancer Centre said, “Cancer treatment has been phenomenally transformed due to ProtonTherapy. It helps in treating tumors located especially in difficult to access areas such as in head, neck, pancreas and prostrate. It is most effective considering the possibility of giving higher doses of radiation to control and manage cancer while reducing damage to vital organs and healthy tissues.”

www.indiamedtoday.com

PULSE Molecular HPV DNA Test Cancer Institute (WIA) launched India’s first molecular lab for Cervical Cancer Screening in collaboration with Roche Diagnostics India. Persistent infection with high-risk HPV has been established to be the principal cause of cervical cancer in women, with HPV implicated in greater than 99 percent of cervical cancers worldwide. It can take 10 to 15 years or longer for cervical cancer to develop, so regular screening to know a woman’s individual risk and finding disease early, before cancer develops, is an important prevention strategy. The cobas HPV testing is clinically validated for HPV primary screening, ASC-US triage, or co-testing (HPV and Pap cytology) using the cobas 4800 or cobas 6800/8800 Systems. The cobas HPV assays provide specific genotyping information for HPV 16 and HPV 18, the highest-risk types, while simultaneously reporting the 12 other high-risk HPV types as a pooled result, all in one test and from one patient sample. Dr. V Shantha, Chairperson, Cancer Institute (WIA) says, “Cervical cancer is preventable, hence, adopting a comprehensive approach that includes vaccination, effective screening, early diagnosis and treatment has the potential to reduce the existing mortality relating to this cancer. In India, the absence of organised screening programs have contributed to this situation. We in Tamil Nadu, however, have implemented a State-wide cancer registry and the Government of TN has been running a statewide screening program.” Data-Driven Cancer Care Decisions IBM Watson for Oncology, trained by Memorial Sloan Kettering (MSK), complements the work of oncologists, supporting them in clinical decision-making by enabling them to access evidence-based, personalized treatment options from more than 300 medical journals, more than 200 textbooks, and nearly 15 million pages of text providing insight and comprehensive details on different treatment options, including key information on drug treatment selections. IBM Watson for Genomics analyses massive bodies of genomic, clinical and pharmacologi-

February 2019

cal knowledge to help uncover potential therapeutic options to target genetic alterations in a patient’s tumour. Using this genomic analysis, Watson produces a report for physicians, which identifies genetic alterations that are actionable based on literature as well as drugs and clinical trials that target those alterations. Watson for Genomics has been tested and validated at more than 20 leading cancerinstitutes worldwide. Preetha Reddy, Vice Chairperson, Apollo Hospitals Group says, “Each person’s cancer journey is unique and hence each patient’s treatment plan must be unique too. IBM Watson for Oncology and Genomics will help the clinicians and oncologists augment their own expertise to deliver an unparalleled and personalized patient care across our hospitals.” Independent Oral Cancer Task Force An Independent Oral Cancer Task Force has been launched in India to develop a strategy for oral cancer control in India over the next decade. This multidisciplinary task force comprises leading specialists who will contribute their expertise to address the burden of oral cancer. The mission of the task force will be to ideate, educate and engage stakeholders, thereby effectively down-staging oral cancer in India. The expected outcome would be to develop a national, cost-effective, patient-centric and sustainable oral cancer control program. Dr Kiran Mazumdar-Shaw, Founder & Managing Trustee, Biocon Foundation and Convenor of the Oral Cancer Task Force said, “Treatment of oral cancer is a multidisciplinary approach, involving the efforts of dental practitioners, surgeons, medical and radiation oncologists and researchers. The task force that we have established reflects this multidisciplinary requirement. We have therefore come together as a group of independent professionals to constitute a task force to ideate, educate and engage stakeholders, in order to effectively down-stage oral cancer in the next decade.”

izing cell therapies for cancer management. It allows researchers to tailor cell treatments to individual patients without the cumbersome manual steps in state-of-the-art laboratories to isolate cells and tweak its genetic makeup. The CliniMACS Prodigy is the first machine to automate therapeutic cell production from start to finish. Itoffers a flexible platform for cell processing applications enabling the magnetic separation of different cell types as well as customized cell processing protocols. The cell processing unit for fully automated washing, fractionation and cultivation of cells represents an integral component of the CliniMACS Prodigy. For individual procedures, it will require a single-use chamber, which is included as part of specific CliniMACS Prodigy Tubing Sets. A Layer Detection Camera automatically determines the optimal cell fractionation endpoint by discerning the macroscopic layers of the source cell product. Dr. Pradeep Mahajan, Regenerative Medicine Researcher, StemRx Bioscience Solutions Pvt.

“Cervical cancer is preventable, hence, adopting a comprehensive approach that includes vaccination, effective screening, early diagnosis and treatment has the potential to reduce the existing mortality relating to this cancer,” Dr. V Shantha, Chairperson, Cancer Institute (WIA)

Automated Cell Processing and POC Gene Therapy A table-top cell processing unit is revolution-

www.indiamedtoday.com

PULSE

Ltd says, “For a long time, bone marrow transplant has remained mainstay for treatment of hematological malignancies. However, it was not possible to opt for a transplant unless a complete match between donor and recipient cells was achieved (haploidentical). The Prodigy system allows for unmatched transplant which eliminates long waiting periods and can save lives” This technology is a certified GMP-grade cell manufacturing system that involves reprogramming of immune system cells (T cells). These cells can then be introduced in the body which then target malignant cells. Scientists from Fred Hutchinson Cancer Research Center, USA have modified CliniMACS Prodigy to make gene-modified stem cells for transplantation, used successfully in animals. On-Demand Digital Pathology One of the advantages of digital pathology and whole slide imaging is to enable sharing of pathology images to eliminate the limitation inherited by microscope, location, and time using conventional glass slides. Digital pathology supports clinical decision making and is of great importance in cancer care. Optra SCANRUO, is the first On-Demand Digital PathologySystem to serve as the perfect tool for transition from conventional microscopy to Digital Pathology for the effective acquisition of whole slide images, viewing, storing, sharing, consulting, analysis and management of digital slides and associated metadata. The path-breaking solution has successfully completed the mass validation of its whole slide digital scanner with the continued support of the Government of India’s Biotechnology Industrial Partnership Programme (BIPP). “I have seen OptraSCAN product in action and also have validated whole slide scanner. The results are very encouraging and I am very impressed with the technology & affordability which will surely be very beneficial for easy adaption to our digital pathology needs,” says Dr Bageshri Gogate, Prof and Head, Dept of Pathology, Incharge, Central Clinical Laboratory, Smt. Kashibai Navale Medical College, Pune

February 2019

Robotic Surgery The da Vinci Surgical Robot combines the best of science and medicine. With nearly 4000 patents and pending patents da Vinci Robot is filled to the brim with innovation. What the robot adds is a way of seeing better and four flexible arms that enter the human body through tiny incisions can be guided to make the repair needed. It is the next breakthrough step in minimally invasive surgery and a major step up from laparoscopic procedures. When working with a da Vinci, the surgeon, a specialist not only in the use of the machine, but also in his or her own field of surgery, will sit at a console where there is a 3D and 10-fold magnified view of the interiors of the body. From here, the robotic arms are controlled and the right instrument sent in to remove or repair tissue. Because it is so precise, there is less chance of collateral damage. And because the cuts and incisions needed to send the robotic arms in are so tiny, the patient doesn’t have to suffer the trauma of traditional open surgery. A huge relief to just about anyone. It means negligible blood loss, less pain, quick recovery and shorter hospital stay. Robotic surgery works best in areas involving soft tissue. It is certainly proving better than traditional surgery in many gynaecological cancers, head and neck and thoracic surgery, removal of organs such as the kidney, liver, pancreas, thyroid, prostrate, and uterus, urology ailments and even organ transplants. Robotic surgery is also being used more and more for paediatric patients. In this form of surgery, suturing is flawless. “The robot does not and cannot perform any surgical step, without a surgeon. The surgeon’s finger movements on the console are transmitted to the robotic arms to the patient. In fact the robot filters the minutest tremor in the surgeon’s finger during surgery to make the it more precise,” says Dr Hemang Bakshi, Robotic Urooncologist, HCG Cancer Centre Hospitals, Ahmedabad.

“Each person’s cancer journey is unique and hence each patient’s treatment plan must be unique too. IBM Watson for Oncology and Genomics will help the clinicians and oncologists augment their own expertise to deliver an unparalleled and personalized patient care across our hospitals” Preetha Reddy, Vice Chairperson, Apollo Hospitals Group

Biosimilars Biosimilars are biologic agents that are similar, but not exactly the same, as currently approved reference biologic agents (immunotherapy agents); with no noticeable differences in efficacy, safety, and purity. Biologic treatments have revolutionized cancer treatment and now biosimilers are emerging as a cost-effective and accessible alternative to these biologic agents. Bevacizumab is a monoclonal antibody (mAb) targeting Vascular Endothelial Growth Factor- A (VEGF-A), a cell protein that induces growth of blood vessels that feed tumors. By blocking this protein, Bevacizumab cuts the supply of food and oxygen to the tumor, thus starving it. Bevacizumab is prescribed in the treatment of several cancers including metastatic colorectal cancer, ovarian cancer, advanced non-small-cell lung cancer, recurrent glioblastoma, cervical cancer and renal cancer. Dr Arun Chandavarkar, CEO & Joint Managing Director, Biocon said: “With KRABEVA we intend to provide a high quality, world-class biosimilar Bevacizumab as an affordable therapy option for patients of various types of cancer. We believe KRABEVA will be an important addition to our Oncology portfolio

of novel biologics as well as biosimilars, which are making a significant impact in the realm of cancer care in India.” Liquid Biopsy Liquidbiopsy, a non-invasive screening test is designed for early cancer detection and monitoring. The Celsee CTC (Core Diagnostics) test detects cancer cells in the blood stream and determines whether cancer treatment is working, or the disease is spreading. The test is a valuable aid to oncologists in evaluating prognosis of metastatic breast, colorectal, and prostate and Lung cancers. ONCOTRACK Cell free tumour DNA (ctDNA) analysis (Medgenome), screens the samples by analyzing cell-free DNA that is isolated from the patients’ blood. Using high end sequencing technology, the screening process identifies specific gene mutations that are linked with Melanoma, Lung and Colon cancers. The test facilitates detection of mutation where there is difficulty of obtaining biopsy or in the event of a damaged biopsy material and non-availability of tissue biopsy. This offers oncologists the power to look for actionable alterations in a patient’s treatment, management, without having to do an invasive biopsy or where biopsy is not an option.

www.indiamedtoday.com

PULSE

Promising Interventions Thermal Imaging

Thermography or thermal imaging detects and records temperature changes on the surface of the skin and produces a heat map, which is then analyzed for cancer diagnosis. NIRAMAIThermalytix, an automated diagnostic tool, which combines thermal imaging with artificial intelligence. The solution is radiation-free, accurate, automated, non-invasive, non-touch, and works on all women irrespective of their breast density. Thermalytix is their core technology that uses a high resolution thermal sensing device and a cloud hosted analytics solution for analyzing the thermal images. Their SaaS solution uses big data analytics, artificial intelligence and machine learning for reliable, early and accurate breast cancer screening. Braster Pro is a Polish device consists of a matrix which contains a liquid-crystal emulsion made via a proprietary technology. When the device is placed on the breast, a colored image is made on the matrix due to the “unique” characteristics of the emulsion. Temperatures are high in areas where the cancer is growing and the malignant tumor is developing. Braster Pro, with its liquid-crystal matrix successfully detects such areas in the breast. The device can detect tumors as small as 3mm regardless of the size and tissue structure of the breast.

Surface Guided Radiation Therapy (SGRT)

Surface guided radiation therapy, (SGRT) uses technology to position and monitor the patient’s external surface in order to ensure that they are in correct position throughout their radiation treatment. It provides transitional and rotational information of the patient’s skin surface and offers the potential to improve the accuracy of setup. The surface guided radiation therapy (SGRT) is used in both setup and therapy for breast, deep inspiration breath-hold (DIBH), head and neck, pediatrics and other indications. It is a rapidly growing technique that uses stereo vision technology to track patients’ surface in 3D during radiotherapy.

Hyperthermic Intra-Vescial Chemotherapy

The Combat BRS, by leading innovative UK-based manufacturers, Combat Medical, provides non-muscle invasive bladder cancer (NMIBC) patients, heat infused chemotherapy, HIVEC (Hyperthermic Intra-Vescial Chemotherapy) for an optimal chemotherapy treatment. The equipment is a conductive and closed recirculation system with precise temperature control mechanisms for an evenly heated distribution of the drug. The Combat BRS uses clinical hyperthermia which is defined as the application of temperature between 41°C and 43°C for therapeutic purposes. The equipment evenly provides heat along with the chemotherapeutic drug, Mitomycin C (MMC) via a catheter. With more heat, the permeability of the cell membrane is enhanced allowing the MMC to pass through the membrane resulting in higher intracellular concentration. This has a direct effect on the DNA and prevents the cancer cells from replicating. The thermotherapy activates the Natural Killer Cells (NKC) of the immune system which causes apoptosis of cancer cells.

Hyperthermic Intra-Peritoneal Chemotherapy

Peritoneal cancers are very difficult to treat. Cancer that has spread to the lining surfaces of the peritoneal (abdominal) cavity from primary colorectal cancer, ovarian cancer, gastric cancer, appendiceal cancer or from mesothelioma andpseudomyxomaperitonei are known as peritoneal carcinomatosis.HyperthermicIntraperitoneal Chemotherapy (HIPEC) is an option for such patients along with cytoreductive surgery. During the HIPEC procedure, the surgeon continuously circulate a heated sterile solution–containing a chemotherapeutic agent–throughout the peritoneal cavity, for a maximum of two hours. The HIPEC procedure is designed to attempt to kill any remaining cancer cells.The procedure also improves drug

February 2019

absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided.The Belmont Hyperthermia Pump is a device which can effectively warm the fluid at the appropriate therapeutic temperature. This allows patients to receive the optimal treatment for peritoneal cancer without compromising their safety. “HIPEC is a relatively new technology in the Indian cancer treatment scenario. However with advent of increased training programs, improved scientific evidence, availability of portable machines like ‘Belmont’, the reach is increasing,” ,” said Mumbai-based veteran surgical oncologist Dr. Ninad V. Katdare.

INTERVIEW

Why Invest in Cardiac Care in Tier-II and III Cities Cardio-vascular diseases have reached epidemic proportions among Indians. Innovation in care delivery and use of technology can help underserved areas says Karan Chopra, Co-Founder and Director, Plexus Heart Centre You come from energy industry background. Why did you choose to work in healthcare? I have always been passionate about healthcare and with time I realised that in India medical services are not reaching the common person at large. There was a last mile connectivity gap. It was only a matter of time until I finally decided to explore the sector professionally, which is still largely unexplored and offers a great potential for service providers as well as for consumers. Especially during last five years health index in India has throttled down toits lowest. Better medical service is something every Indian deserves. And with this thought I got into healthcare to make a difference and to serve the underserved.

per cent of world population and it accounts for 21 per cent of global disease burden. In addition, non-communicable diseases constitute 63 per cent of overall disease burden in India and their increasing incidence will adversely impact the economy to the extent of 230 billion INR in a decade, says a PWC report. Understandably, then the number of private hospitals and investments have been on the rise. According to an ICRA analysis profits of Indiaâ&#x20AC;&#x2122;s five biggest hospital chains rose 80 per cent,from 20122017. Sensing an opportunity, private equity investors have made an investment of over $3.4 billion in Indian hospitals between 2007-2017. The investments from overseas funds started after 2000, when India allowed 100% foreign direct investment (FDI) in the hospital sector.

Are there opportunities for small private providers and investors in India? India provides ample opportunities for healthcare delivery innovation. In fact, India has 17

What inspired you to work in healthcare delivery and that too in CVD? I have travelled extensively in India. As I traveled to different parts of the country over the years, I couldnâ&#x20AC;&#x2122;t help but notice the unavailability of even primary healthcare in manytier 2 and tier 3 cities. The situation of cardiac care availability was even worse. Even if cardiac care was available, the substandard conditions of both, infrastructure and skill was quite surprising and disappointing. And many were losing life, families were losing sole breadwinner and were being pushed into poverty as a result of CVD morbidity and mortality. Thatâ&#x20AC;&#x2122;s when we decided that this concern had to be addressed.

www.indiamedtoday.com

INTERVIEW What is the business model and why is it unique? Plexus Heart Centeris a chain of cardiac units based across the country with the vision to establish ‘Excellence in Cardiovascular Intervention’. It provides a standard model of operations with state-of-the-art technology run by a highly trained and experienced team of doctors, nurses and technicians. We have Flat Panel Digital CathLab, Modular Theaters ultra-modern fully equipped CCU’s. Our patient service charges and packages are very competitive and economical. The emergency services function 24X7which includes emergency admissions, patient management, pathological, radiological and other investigations. What are the major challenges that you encountered when you set out to build the business? The main challenge so far is to reach out to providers to spread awareness in Tier-I and Tier- II cities. We want to reach out to providers who are struggling to run small hospitals and would like professional help, but do not know who to connect to. Another challenge is to get the right infrastructure. The available infrastructure is seldom as per the requirements and it’s sometimes difficult to find the right skill set to establish a center. How do you overcome one of the most pressing challenges in healthcare delivery – trained manpower? We have been fortunate enough to find the right people at the right time and are quite proud of the team we have built over time. Each center is led by a team of highly experiencedcardiologists, surgeons and support staff. They have been delivering the best of treatments and services that people in far-fetched corners of the country have deserved all along. Though we understand the industry trend is quite contrary to this, we hope our lucky stride continues. Additionally, in the very near future, we plan on training our own manpower, primarily technicians and nursing staff.

February 2019

What is your growth strategy? We wish to work in areas that are deprived of cardiology services or trained specialists and modern equipment. Our center at Dibrugarh is the first-of-its-kind in eastern Assam. The other operational and underdevelopment centers are also based in areas with lack of infrastructure and faculty to service critical cardiac patients. Each center is led by a team of highly experienced cardiologists, surgeons and support staff. The centers are also equipped with sophisticated medical equipment to assist and provide the best possible diagnostic services to the patient. At present Plexus is present in Dibrugarh, Kanpur, Jaipur, Gorakhpur, Bangalore, Abu Road and Kathmandu. Where do you see plexus hospital in the next 10 years? For a company that came into being a year back, ten years sure seems like a lot to plan. We had planned fourcentres in the first year, which we have successfully achieved. This year, we expect to add 7-8 more. I believe in steady growth and that’s what we have planned for initial years.

Karan Chopra, Co-Founder and Director, Plexus Heart Centre