New app offers solutions for 'cancer refugees'

China's rural residents become "cancer refugees" in the big cities due to lack of quality diagnosis and treatment in their regions; one US-developed app is trying to change that. CNN's Matt Rivers profiles two patients to see how the cloud-based app could help.

Posted: Oct 19, 2018 4:38 PM
Updated: Oct 19, 2018 4:38 PM

For Cao Ruizhe, the life or death drama of her fight with cancer plays out in a small windowless room.

Cao and her husband are poor bean farmers from rural China. She didn't trust her local hospital when they told her she had cervical cancer, so she came to Beijing for a diagnosis and treatment.

Like thousands of others each year, they were forced to stay in what locals call "cancer hotels," cheap, dirty rooms across the street from the hospital.

The only furniture in the room is a small TV stand and two small beds. A dumpling steamer and bags of vegetables lie at the foot of her bed. The tiny space costs 2,000 yuan per month, about $300.

"We have to borrow money," Cao said. "What else can we do? I'm so young. How can I give up my life?

The 58-year-old mother of three says she has spent $50,000 on radiation and chemotherapy treatment, collected from relatives and friends. It's a staggering sum for a couple, one that they will probably never be able to pay back, but they have little choice.

They are forced to live in Beijing because like millions of others in China, they cannot receive adequate cancer treatment closer to home, a problem exacerbated in rural provinces such as Anhui, where Cao is from.

While away from home, they are also losing income. It's common for rural farmers to make around $2,000 per year, according to data on Anhui province from the National Bureau of Statistics.

Thousands of patients, one oncologist

China has more cancer diagnoses annually than any other country in the world, with 3.8 million people in 2014 alone, according to the latest figures from China's National Cancer Center.

Given the country's massive population, challenges such as these are inevitable. What is not inevitable, however, is how few doctors there are to treat them.

There are only 29,705 oncologists in China, according to the China National Health Commission's 2017 report, an average of almost 50,000 people per specialist, which can result in wait times stretching for weeks, if not months.

But a new app in China is hoping to remove some of that demand on oncologists by connecting patients with some of the world's best cancer hospitals and researchers.

The app, called Driver, was co-founded by two Harvard trained oncologists and backed financially by Hong Kong billionaire Li Ka Shing, among others.

The creators want to try to help patients get treatment sooner as well as help them find out what their best treatment options are and where those treatments can be found in their respective countries.

But coming at a high price tag, out of the reach of average cancer sufferers, and given the different online environments in the US and China, some experts have questioned how useful the app is at this stage in its development.

An app for cancer

The concept is relatively simple. Patients get a biopsy and send that information to one of two labs that Driver runs, either in the US or in China. Driver analyzes those results and provides what they believe are accurate diagnoses.

"We present to the patient what their standard of care is, and we present to the patient what advanced therapies they're eligible for," said Will Polkinghorn, one of the app's co-founders. The app tells users where they can find those treatments.

The idea is that people like Cao Ruizhe might have been able to find treatment closer to her home in Anhui province, if she was fully aware of all her treatment options and locations.

Polkinghorn says the problem with cancer treatment is that patients are limited by whatever diagnoses and treatment options are presented to them at whatever hospital they choose to go to.

"Any one doctor, any one hospital, by definition, doesn't have all the options," Polkinghorn said. He says the app brings multiple options to patients in one place.

The National Cancer Institute in the US and the National Cancer Center in China have signed up as partners.

"It can help the patient so that some patients don't need to come to big cities for treatment," said Dr. Ma Xioali, deputy director of the Hematology & Oncology Center at Beijing Children's Hospital.

Driver has also created a parallel app for oncologists, called Drive for Clinic, so they can easily access the latest research and treatment options by colleagues around the world.

"Our goal for Drive for Clinic is to become the Bloomberg terminal for the cancer doctor," Polkinghorn said. "Because the doctors are suffering from the dilemma of, what's the best treatment to get for the patient?"

'A good beginning'

But there's a catch: The app will initially be limited to affluent users because of its price tag. The full service costs $3,000, plus a monthly subscription fee of $20.

Additionally, merely providing a list of the best treatment options doesn't solve the problem that those treatment options aren't widely available in China, nor does it reduce the cost.

At this stage, people like Cao Ruizhe can't afford Driver, and even if she could, she'd probably still have to come to Beijing to seek treatment.

Driver's creators say they're trying to bring the cost down as well as provide significantly lower or free access to the app to low-income patients, funded by donations and grants.

They acknowledge the fact that the app can have large-scale impact only if it can be more affordable to the masses.

But they say it's a start and indicative of a broader model, treating cancer by aggregating global oncological knowledge into an app on your smartphone.

Dr. Stephen Chan Lam, associate professor in the Department of Clinical Oncology at the Chinese University of Hong Kong, believes that the app is "a good beginning" but that it hasn't matured enough.

Lam highlights potential legal issues around the app being based in America, including questions around data collection and privacy regulations in other countries.

He said that although the technology is a "smart idea," it will truly end up benefiting only a few patients, not the masses.

"Most of the cancer patients can get standard diagnosis or treatment at local hospitals in China or Hong Kong. The app may help on some rare tumors or be helpful to those patients who have already tried all the standard treatments," he said. "I think only few patients would change their treatments just based on the information provided by this app."

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