New Delhi, Jan. 29: A network of cancer specialists in India has launched a "virtual tumour board" to provide appropriate treatment guidance for patients with complex cancers that often leave doctors divided between surgery, radiation, chemotherapy or some mix of these options.

The board, a body with specialists in surgery, radiation and chemotherapy, will work through the National Cancer Grid (NCG) - a digital network linking about 90 hospitals across the country - to make up for the absence of similar multi-disciplinary oncology teams in some healthcare institutions.

Oncologists estimate that about a quarter of cancers diagnosed each year in the country might fall in what could be labelled a "complex case" where the treatment recommendation is not obvious or straightforward, but needs a discussion by experts across the three specialities.

But, they estimate, treatment decisions for less than 30 per cent of such cases come from multi-disciplinary teams.

"This is unfortunate because medical studies have established without any doubt that the results of treatment are superior when decisions are made by multi-disciplinary teams," said C.S. Pramesh, a surgical oncologist at the Tata Memorial Centre Hospital, Mumbai, and coordinator of the NCG.

Doctors attribute the absence of multi-disciplinary consultations to either the lack of required expertise in some hospitals or the tendency of some doctors to believe that they are doing the best that can be done and additional consultations are unnecessary.

A study in the US about a decade ago illustrated the disagreements that can emerge between doctors in complex cancers.

A group of surgical oncologists, radiation oncologists and medical oncologists were shown a hypothetical case of a complex case of prostate cancer for which the primary therapy is surgery or radiation.

The majority of surgeons prescribed surgery, the majority of radiation specialists prescribed radiation, and the medical oncologists were divided between surgery and radiation.

The NCG, an initiative established five years ago with funds from India's department of atomic energy, will be the platform for the virtual tumour board.

NCG doctors said the board would take up only complex cancers referred by institutions linked to the grid.

The virtual tumour board is more likely to provide evidence-based treatment recommendations than single doctors from individual disciplines, they said.

The board will operate from the Tata Memorial Centre (TMC) with experts drawn from other NCG centres.

The TMC announced the board during a health conference in Mumbai over the weekend.

"Ideally, the course of treatment for every patient with cancer should be discussed by a tumour board," said Ravi Kannan, a surgical oncologist and director of the Cachar Cancer Hospital, Silchar, Assam.

"There may be a subset of breast cancer patients for whom even when surgery is the option, chemotherapy before surgery may give better results," he added.

While most cancer centres in large cities in India already have tumour boards, the virtual board will help patients from smaller towns without access to such expertise.

"The board will throw in fresh ideas, and provide collective decisions from a team rather than from individual doctors," Kannan said.

The NCG had two years ago launched a service that allows patients to seek a "second opinion" by submitting medical details through the digital network to NCG experts.

The experts typically respond within 24 hours of getting the details.

Over 8,000 patients from India and other countries have so far sought second opinions.

The NCG initiatives come at a time when doctors anticipate a rise in the incidence of cancer and mortality across India.

The International Agency for Research in Cancer has estimated that the incidence of cancer in India will rise from about one million in 2012 to 1.7 million in 2035.

The agency has also predicted that the number of cancer deaths in the country may rise from 6.8 lakh in 2012 to 1.2 million by 2035.