If there one thing that I regret throughout my cancer adventure, it’s not being properly prepared. There’s a lot going on and it’s easy to forget about your symptoms. You forget to tell your specialist what’s bothering, so to help you with that, in this episode you’re going to find out about Cancer Aid, a mobile application that helps you track your symptoms and so much more. I’m talking to Raghav Ganesh-Murali, COO of CancerAid and in this episode, we cover:
- The importance of logging and sharing your symptoms
- Being empowered and making better decisions
- Having the support of your champions through treatment
- Trends and symptom changes that integrate into patient’s medical record
- Online platform to share and connect via stories
Joe: Raghav, how did Cancer Aid come about? What problem were you guys trying to solve?
Raghav: Yes, so CancerAid is basically a solution to a problem that we save whilst working in clinical practice. My background is as a radiation oncology specialist. I trained here in Sydney. Basically, when we saw patients, we often were able to see the same problems time and time again for each of these patients. We did a survey of a few patients at the hospital we work at. We work in Chris O’Brien Lifehouse. We saw four main problems. To start with cancer patients and some of their diagnosis, they were looking for the right information. During treatment, they wanted tools to help them manage their illness.
They wanted to be able to connect with other people, their family, their friends and share with them their experiences, so they didn’t have to repeat themselves. Lastly, they wanted to connect with other patients that have gone through similar experiences and reduce the isolation that was perceived. We took those problems onboard and came up with a solution to try and address some of those problems. It took about a year to design it and Cancer Aid was released in August 2016. To answer the four problems, we provide patients with the right information, peer-reviewed, medically reliable information.
The second part, we give patients a personal journal and a symptom journal, so they can record their experiences and log their symptoms. The logging of the symptoms was especially important because patients were better engaged for health with better outcomes. Very recently, there has been some strong randomized evidence that has suggested that patients who logged symptoms share that with their clinicians, actually can potentially live longer, which is very exciting.
The third solution, which was connecting family and friends, we’ve got a component inside the app called the Champion’s Feature, so a patient who we call the hero going through their treatment can nominate a friend or family, a caregiver through the app and they get a deep link. They click on the deep link and they’re able to access the hero, which is a patient’s profile and can read what the journals they are logging are.
That helps with motivating a patient who’s going through a tough time, so they can log their journal and then they can share with the people that they choose to read with them. Lastly, the community, we’ve got a static community, not a dynamic community, which means patients can read about stories from other patients that have gone through similar experiences. Eventually, this will become a more dynamic community, where they can track other patients, but right now, it’s simply reading stories. There are a couple of reasons we haven’t done that yet, but it’s in our pipeline, we’ll get to it over 2018.
Joe: That’s fantastic that it works on so many levels. It benefits the patients, it benefits the doctors, it also benefits the community people who want to help out. You guys have had quite a journal from being an oncologist here in Sydney in Australia, and you got the investment from Shark Tank, where you had to justify the value of your application and the value that it delivers. Can you talk about that experience and what you got out of it?
Raghav: Yes, good questions, Joe. Shark Tank was a really interesting experience. For us, neither of us had really been on television before and it was an opportunity to basically share our message with the rest of Australia. That was a great opportunity to do that. Certainly, CancerAid is an innovation and for any innovation to succeed, it required funding. Funding comes in two forms, whether it comes from a sustainable business model or grant funding. CancerAid is a business model or had a sustainable business model where the app is free to patients, it will always remain free to patients.
We license the technology to hospitals because we improve their costs. Therefore, there’s a dollar cost there that will serve as a return on the investment from the hospital. That was the idea. We took it to Shark Tank and we said, we’re creating a socially responsible business, this app is free to patients and this is how we commercialise it by providing value to hospital, insurers, and pharmaceuticals. At present, we only have a commercial business model that’s sitting with hospitals and insurers. That was well received on Shark Tank. It was actually quite nerve-racking, we were in the tank for about 15 minutes, so there were a lot of questions to and fro.
It was actually a really nice experience, we got asked about the journey for how we developed it and what we were doing when we started the process and how we came up with the idea. All the bits and pieces and the evolution. We were actually lucky enough to get five offers from five of the sharks. We ended up going with Andrew Banks, who’s been a really good asset to our business, going forward.
Joe: Yes, I’ve seen that on YouTube. It was pretty confronting, wasn’t it?
Raghav: Yes, it’s pretty confronting, you get quizzed, but then you forget where you are, and it becomes a conversation. The it becomes a conversation about something that you’re deeply passionate about, which is CancerAid for both myself and Nick and Martin who was on the show, as well.
Joe: Yes, absolutely. Cancer covers a lot of ground, as you talked about, so can you talk about how the patient benefit from it can the most. If you’re a person who just downloaded the app, what is the best way for you to use it.
Raghav: Thanks for asking that questions, Joe. At the end of the day, Cancer Aid has to create some sort of clinical value. The strongest aspect of the app, which there are many aspects of the app that are helpful. The app that patients find very useful are the stories about other patients. One of the key messages that I really wish to share with patients who I look after, or who might listen to this podcast is, those patients who are more interested in their health and take more engagement in their own disease and their illness and their symptoms have better outcomes.
Last year, at the largest cancer conference in the world, there’s a randomized study that was presented, in terms of medical literature. What is showed was a very simple thing. Those patients that logged their symptoms regularly, like their pain, their nausea, their vomiting, and then shared that with their clinicians, had better outcomes. Not only were they more satisfied, so it improved satisfaction, they reduced the risk of admission. They had ten percent less risk of admission. Really importantly, they actually lived longer, so that in that randomised study, they had a survival advantage over the patients who didn’t log their symptoms. That’s a really strong metric and something I really wish I can convey to our patients, to try and take more engagement in your disease, certainly within the limits of how you can.
Then if we can share that with our clinicians who are looking after you, the doctors and nurses, it’ll help them make decisions about the care together. That’s one of the really strong messages I wish to send out.
Joe: That’s a great benefit. I know from personal experience that if I had a dollar every time I walked out of my oncologist office and gone, like, I should have asked him that. It’s so important because you just forget, don’t you?
Raghav: 100 percent. Patients, in your recent memory of what you’re thinking you have to juggle and you go to the oncologist and you speak about those little problems, but if you have been tracking your symptoms over the last few weeks, and then when you go there, you say, “Hey, this is what I’ve been tracking over the last few weeks.” There’s a graph to say, “Hey, my pain is getting a bit worse, my pain is getting a bit better.”
It’s really powerful in terms of how we can direct the discussions, both in the patient’s point of view because they feel like they’re empowered in their own care, and for the clinician because they have more points of data, objective data to make decisions. That shared decision-making becomes really good and that improves the communication. That’s one of the key aspects of what we’re trying to do. Cancer Aid is launching an integration into the medical records, so it makes this process simple.
Patients download the app, log their symptoms, and then they go to their clinic appointment, it’s already embedded within their electronic medical records. The doctors or the nurses pick up the patient’s screen, open up the medical record, and they can see all the patient logs, which is pretty powerful.
Joe: That is very powerful. What happens when patient is dealing with a number of conditions? Maybe they have other chronic diseases and they’re also managing those symptoms, how does Cancer Aid help with that? Does that mean that the oncologist will have to redirect their queries? How does it work?
Raghav: Good question. The symptoms they’re going to log are 16 symptoms that are not unique to cancer but cover most cancer symptoms. There’s also a space where you can add other symptoms and free text whichever symptom you wish to log. Now, certainly, in my experience, most oncologists will be comfortable dealing with the symptoms that generally are due to the cancer or the treatments related to that cancer. Yes, you’re right, lots of patients have other chronic illnesses.
Care isn’t given in silos, care is given in a multi-disciplinary setting, where you have your family physician, your emergency physicians, your other specialists, allied health, nurses. I think having the ability to log your symptoms in one place. The patient has that record and they will just share that with the other people looking after that particular patient. It’s pretty useful. It’s hard to say that there are one or two specific examples of how an oncologist would manage non-cancer symptoms, but certainly within reason, most oncologists would try.
At the same time, it’s important to have some expertise if it’s a specific symptom related to a specific condition. Potentially, it might be better treated by the specialist or the general practitioner who’s looking after that condition. There is that concept, as well.
Joe: Yes, that’s great. Have you had any feedback from oncologists, from medical specialists with patients share their symptoms through Cancer Aid?
Raghav: Yes, we spend a lot of time. We’ve had over 300 clinicians, both doctors, nurses, allied health, give us feedback on the designs of our new clinician link, which allows patients to connect with the electronic medical record. It’s been a really overwhelmingly positive response.
I think doctors welcome better communication with their patients and things like that are easy and within their workflow. Often, it’s time is a big pressure for the clinicians in the hospitals. Anything that reduces their time taking to get the information, if they can get good information, good quality information and see that about their patients, there’s certainly a lot of use in that.
Joe: That’s really important. I know that tele-medicine is a big part of Cancer Aid, as well. What is it and how can it help?
Raghav: Tele-medicine traditionally is a video consultation. The current Cancer Aid app doesn’t have a video consultation with patients. There are a lot of other technologies that have done that, and we don’t necessarily believe in redefining the wheel. The way we do our tele-medicine is a slightly different tele-medicine. It’s what we call the Champion’s feature, where patients can nominate friends or family. The friends or family have the access to the patient’s profile in real-time. It’s a bit like a Dropbox but patients can use it as a journal, so they can log their symptoms in their personal journal. Then their friends and family can access it. It’s a slightly different form of tele-medicine.
Joe: Okay, got you. It’s good to know that I got it completely wrong. I know that cancer is a really tough time when you go into treatment or you’re waiting for results, so having your true supporters on side is hugely important. Can you talk a little bit more about how Cancer Aid helps with that?
Raghav: It is a very isolating time. It’s a time when patients who have a support mechanism, whether that’s a clinician or whether it’s the hospital provided support system, or it’s friends or family. Those patients who have that support mechanism because you need to rely on someone else, is pretty important, pretty helpful/powerful. With the Champion’s component, when we survey patients, a lot of what they didn’t want to do was go around to each one of their supporters and say, “I had pain, I had nausea, I had vomiting” and repeat themselves a multiple amount of times.
They said, can you guys help us voice it, so we just invite people to view what we’re logging, then supporters of mine can come access it and see what I’m logging, and they can provide support. I’ve got pain or nausea, they can say, “I can help you with my appointment, or I can drive you to the clinic, or I can cook diner for you.” Having the ability for a patient to log their feelings, their emotions, as well as their symptoms, and then sharing that with the people they choose the share it with. It’s not that we choose them, we don’t get access to it. They have to invite that person to view those logs. That’s how we’ve created that supportive link.
Joe: Yes, that’s fantastic. What feedback do you see from people, people who are using it? Do they see that friends and family are responding and helping them through it? Is that important to them?
Raghav: 100 percent. We have thousands and thousands of reviews from our patients with comments. Most of them are very positive, the striking majority. There are some which are not so much negative, but they give us some feedback as to how we can improve the app. Actually, those are as valuable as a positive feedback. The positive feedback is great for us to know we’re doing the right thing and creating the right technology. At the same time, the feedback people give us as to how we can constructively improve the app is very valuable to us and we really welcome that. We do a lot of feedback mediation sessions. Always welcome to those comments.
Joe: It’s fantastic that you get feedback and you proactively working it into the app. I think that’s really great. Another question I want to ask you is, with Cancer Aid, really you are at this really interesting intersection between patients and caregivers, medical specialists and researchers. What unique challenges do you see for all of these groups of folks coming together?
Raghav: Yes, so everyone’s challenges are slightly different. Hospital providers have a different challenge to insurers, and even within hospitals, each of the different providers your name, the doctors, the nurses, the researches all have slightly different challenges. Trying to find a solution that fits all of them is not always easy. Personalising it does happen for us, so we try and create personalisation through it. It really depends on what the clinical problem we’re trying to solve is. How is this really going to affect the patient, how’s this going to improve the journey for the patient?
At the same time, what is the commercial use case for doing this? A lot of the time, we need to build a new technology, we have to answer those two questions. Are we really improve the care journey for this patient? Secondly, is this a sustainable model if we’re just doing one build for one person? It doesn’t always make sense.
Joe: Of course, what are some of the biggest challenges for cancer survivors? Does CancerAid help with that side at all?
Raghav: Thankfully, I have not been a cancer survivor, so it’s hard for me to know exactly what the biggest challenges are. From what I hear and from what I see in clinic, patients are often very fearful of recurrence and even after a diagnosis of cancer and finishing treatment, it’s something that is really in their mind. Some patients are looking for clinical trials, some other patients are looking for other patients who have had similar experiences to share their experiences. We provide that, so in our CancerAid community, we’ve got a survivorship page where we talk about nutrition, exercise, how patients can utilize the tools within CancerAid to aid in their recovery.
One of the examples I’ll give you is that in the next few weeks, actually, we’re really excited to launch this, is integrating the step count. Every Apple device counts how many steps you walk. Integrating that into the symptom tracker. When a patient is walking X number of steps, they actually can map that against their symptoms. If they’ve got fatigue and you see the number of steps they’ve walked are lower, that really helps them because what they’ll then know is to understand that my step count is related to my symptoms, and can potentially can improve their step count, increase their activity, and reduce some of those symptoms. Those are some of the tools that we use for survivors within the app that can give them some benefit.
Joe: Yes, from experience, I know that this feature would also be helpful for patients. I know that when I was going throughout chemotherapy, that my oncologist advised me that the best way to deal with fatigue is through exercise. It actually really helped me a lot to build up that habit. That would be helpful for patients, as well, hopefully.
Raghav: I agree, yes, 100 percent. Also, about smaller things, about normalisation, as well. We write articles, potentially about patients returning to work. Not everyone returns to work, some do, some don’t. There’s a difference and it’s not our job to tell people to do or not to, but what we can do is amplify the message with some patients who have chosen to return to work and have us help them, or some patients who have chosen to stay away from work and how they’re coping with that and amplify that story, and be a platform for other patients to resonate to those stories. To say, “Actually, that normalises my experiences” and then they can potentially see that as beneficial to reducing anxiety or if they had any anxiety related to it.
Joe: Yes, exactly. One way or another, it’s the new normal. You’re going back to a very different life to the one you had, that’s not always a bad thing. I think in many cases, you find other benefits, you find a new appreciation for life. I think it’s very important to see, inside Cancer Aid, it’s very important to see stories of people who have made it through to the other side and that they can share their experiences, right?
Raghav: I completely agree with you. It allows patients to read those stories, unless you don’t get access to those stories, quite often. A lot of patients want to share their stories, so we provide the channel to do that. We get a lot of inbound requests from patients who want to write for us, which is really nice, and we love that, and we amplify those stories within our platform.
Joe: In your opinion, what is the best thing about CancerAid?
Raghav: As a technology or as a whole? What do you mean?
Joe: I think about the technology and how it enables outcomes for people?
Raghav: Yes, you hit the nail on the head there. Creating technology that’s scalable instead of just being the doctor in the clinic where I see maybe five or ten or fifteen patients, Cancer Aid is a way to scale better outcomes across the globe. It’s a digital piece of technology, very important that symptom tracking. One of the key messages for us is to get patients to track their symptoms, log their symptoms, understand the rate of change of those symptoms. Then be able to have better communication with their clinicians and realise those improved outcomes.
One of the things I keep saying to our team is, we are building technology that we are privileged to build, and that patients will be using. By using this, we potentially could actually improve their lives and their length of survival. It’s a really powerful position to be in. It’s a really strong rationale as to why we do what we do. We constantly remind ourselves that we’re doing this for those reasons. Yes, we continue to try and create clinical value. At the same time, underlining that by a sustainable business model.
Joe: Yes, that’s great. With all the exciting technology coming our way, like artificial intelligence, what does the future hold for us in your opinion when it comes to digital health?
Raghav: A lot of digital health requires engagement from people. If I simply gave, for example, you or another patient technology, the technology needs to be engaging. There are a lot of fancy words, AI, VR, AR, and so many acronyms. I think they’re all great because they’re all an advance in technology and we embrace advances in technology, even AI, we’ve got plans for how we can utilize AI within Cancer Aid. The key message has to be about how does this improve the engagement of the person using the technology. How do we get them to do the activity that’s going to provide the best benefit?
If you’re able to answer that question, the answer to that question is more sophisticated technology? Then great. If the answer is just having an acronym or one of these novel technologies inside the app just for the sake of it, I don’t think that’s quite the right answer. It has to serve a purpose. For us, that purpose is to really improve patient engagement of our technology.
Joe: That makes a lot of sense. When you talk about engagement, you mean engagement with the oncologist?
Raghav: I mean utilization of the app. For example, symptom logging or personal journal logging requires input from the patient, it’s sometimes an onerous task. Let’s say you have other things on your mind, you have treatment, or you’re not feeling well, the last thing you’re going to do is to feel like you have to log your symptoms. There has to be feedback for the patient by logging, there’s going to be a material benefit to your care and creating those feedback loops and creating that value is challenging. That’s our job.
Joe: How does CancerAid work with those feedback loops at the moment? How does it encourage someone to go in and put in their feedback?
Raghav: Yes, so if someone logs their symptoms with our clinician link, which is the electronic medical record integration. The patient is at home, they log their symptoms, when they go to the clinic, the doctor and nurse have already got on their screen the symptoms that you have logged. We have connected the patient to the doctor digitally, so that the patient can continue to log their symptoms. When they go to clinic, they get to see a graph of those symptoms and how they’ve changed over time and therefore, improve their decision-making.
What the feedback loop is that they log their symptoms, they get advice and management of their illness changes, so they’re more motivated to do it next time. They’re like, “Okay, because I logged my pain, they were able to make a decision on what pain tablets to give me. Let me do it again.” That continues and gives them benefit and gives the clinicians a benefit, too.
Joe: Okay, that’s fantastic. I hope that as many people as possible get to use this app and log their symptoms and hopefully get better outcomes.
Raghav: Yes, no, I agree. Thank you.
Joe: Thanks for your time.
Raghav: Thanks, Joe.