Supporting Cancer Research, Patient Care

Fox Chase-Temple Bone Marrow Transplant Program Employs SAS®

For many patients with leukemia, lymphoma and related diseases, bone marrow transplantation represents the only realistic hope for long-term survival. To help ensure their patients achieve the best possible outcomes, physicians at the Fox Chase-Temple Bone Marrow Transplant Program in Philadelphia utilize their Bone Marrow Transplant Information System (BMTIS) to assist in determining optimal treatment options for each patient.

Built entirely with SAS, BMTIS contains detailed data on more than 700 patients who have undergone bone marrow transplantation within the past 15 years. Originally designed to support cancer research, the system is now used to support research, teaching, patient care, clinical decision support, clinical quality management and a variety of administrative functions.

Physicians from the Fox-Chase Temple Bone Marrow Transplant Program consult BMTIS regularly to predict likely outcomes for patients under various treatment options. When the transplant team meets once or twice per week to formally discuss treatment options for both newly referred patients and for current patients who may be encountering problems, they frequently consult the system to determine historical outcomes for similar patients treated on a variety of clinical protocols.

"In a matter of seconds, we can answer questions regarding a wide variety of clinical scenarios and thus provide statistical support for actual patient care decisions on a real-time basis," says Dr. Thomas Klumpp, who serves as both the chief information officer and the assistant director for the Fox Chase-Temple Bone Marrow Transplant Program, as well as associate professor of medicine at Temple University School of Medicine.

Klumpp used SAS to build the original version of the BMTIS in his spare time, in the early 1990's. Since then he has added many features, which have expanded the system's utility far beyond its original purpose of providing clinical research support.

"Choosing SAS was one of the best decisions that our team has made," says Klumpp. "We continue to add new features and new components, and to take advantage of new developments within SAS software itself. Overall, our system has made a very definite positive impact on our ability to perform all of our core missions, which include patient care, teaching, research, clinical quality management and administrative activities."

Administrative, teaching and research support
For most academic cancer centers, providing detailed reviews of treatment and outcomes data to human research review committees can be a very time-consuming activity. Often, a team of full-time research nurses accomplish this task by regularly poring through every patient chart and abstracting information regarding treatment details, adverse events, long-term survival and other outcomes parameters. In contrast, the Fox Chase-Temple Bone Marrow Transplant Program provides detailed reports to the Temple University Human Research Review Committee with just a few keystrokes. Similarly, the team utilizes BMTIS to generate dozens of detailed reports each year for numerous administrators, auditors, insurance companies and accreditation bodies both inside and outside the University.

Insurance companies in particular tend to request outcomes data according to their own categorization schemes, which often do not match the categorization schemes inherent in the raw data. With SAS, however, Klumpp can easily recategorize and analyze the raw data according to the needs of each individual insurance company. He can also save the SAS code that he writes for each company and reuse it for subsequent requests.

The Fox Chase-Temple Bone Marrow Transplant Program also counts on SAS to support Quality Management initiatives. Klumpp has developed a SAS application that continually compares patients' existing conditions to their expected conditions according to clinical protocols in which they are registered. These results are reviewed, discussed and documented at monthly Quality Management meetings. According to Klumpp, the resulting documentation has helped when obtaining accreditation and re-accreditation from various organizations that inspect the team on a regular basis.

Finally, SAS helps enhance training for medical students, interns, residents and post-doctoral fellows. While professors at most medical schools rely primarily on their memories to answer questions posed by medical trainees, the physicians at the Fox Chase-Temple Bone Marrow Transplant Program frequently query BMTIS to provide definitive and highly accurate answers to student's questions regarding the probabilities of adverse events, bone marrow recovery, long-term success rates, duration of hospitalization and more.

SAS is the gold standard
"SAS is clearly the gold standard statistical analysis package in academic medicine," says Klumpp. "According to my recently completed survey of 25 major U.S. academic cancer centers, SAS is more widely utilized than all of the other statistical analysis systems combined."

In addition to praising SAS for its analytic and data manipulation capabilities, Klumpp also commends SAS' technical support staff. "We have always enjoyed excellent technical support from SAS." says Klumpp. "When we encounter technical problems that we cannot solve on our own, we can always contact an appropriate individual from within SAS' technical support team in a very timely fashion. In contrast to certain other software vendors, the SAS technical support team is genuinely committed to making certain that our problem has been adequately addressed regardless of the amount of effort that they may need to contribute."

Looking forward to the future, the Fox Chase-Temple Bone Marrow Transplant Program is in the process of Web-enabling its SAS solution to make patient care and research data more accessible to authorized physicians, nurses and administrators. Klumpp predicts that Web-enabling the system will allow each team member to both contribute data to and draw data from its centralized data warehouse, which will significantly reduce data capturing, data retrieval and data analysis efforts.

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