Strengthening guideline compliant care delivery in a safety net hospital through artificial intelligence (AI) enabled technology solutions

Background: Concordance with guideline-based cancer care is often low in resource-constrained settings, leading to under- or over-treatment and delays in care. Navya Earthshot is a validated AI-enabled decision support system that matches patient records to standard-of-care cancer treatment guidelines to generate evidence-based recommendations. This study evaluated the implementation of Navya Earthshot at a safety-net hospital in India to assess improvement in concordance with National Cancer Grid (NCG) guidelines and reduction in delays to care. Methods: A prospective pre-post observational study conducted over six months at a safety net cancer center in the public health system of India. Baseline data prior to Navya Earthshot integration were collected for comparison. Key outcomes included concordance of treatment decisions and average number of hospital visits per treatment decision. Navya Earthshot was integrated into routine workflows. The system matched patient-specific information to NCG guidelines to generate treatment options, which were reviewed by treating oncologists and discussed in daily tumor boards. Diagnostic testing was streamlined by eliminating non-mandatory investigations, reinforced through digital care navigation and structured follow-up by lay cancer navigators. Results: During the study period, 892 patients presented to the hospital for a first cancer visit. Among 537 patients requiring active treatment decisions (290 pre-implementation; 247 post-implementation), 411 were evaluable (210 pre; 201 post). Guideline concordance improved from 67% (140/210; 95% CI +/-6%) at baseline to 87% (175/201; 95% CI +/-5%) after Navya Earthshot integration-a 20% absolute increase. Integration of Navya Earthshot, combined with digitally enhanced care navigation, reduced the average number of patient visits before treatment initiation of care from an average 3.45 to 2.5 visits (0.95 visits, 27.5% reduction), primarily due to elimination of non-mandatory report-review visits. Care initiation moved forward from 6 weeks at baseline down to 4 weeks after intervention (2 weeks, 33% reduction). Conclusion: Implementation of Navya Earthshot improved adherence to standard-of-care guidelines and reduced time to treatment in a resource-constrained setting. Integrating validated AI decision support tools into oncology workflows can strengthen cancer care delivery and enable broader adoption of guideline-based treatment in resource-constrained health systems.