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Considerations and barriers to starting a new HAI pump program: an international survey of the HAI Consortium Research Network

Published:August 24, 2022DOI:https://doi.org/10.1016/j.hpb.2022.08.008

      Abstract

      Background

      Widespread implementation of HAI pump chemotherapy has been limited by logistic and feasibility concerns. Recent studies demonstrating excellent outcomes have fueled renewed enthusiasm and multiple new programs have emerged. This survey aims to identify barriers critical to establish a successful HAI program.

      Methods

      Using SurveyMonkey™, a 17-question survey assessing factors required for establishing a successful program was developed by 12 HAI Consortium Research Network (HCRN) surgical oncologists. Content analysis was used to code textual responses. Frequency of categories and average rank scores for each choice were calculated.

      Results

      Twenty-eight HCRN members responded to the survey. Implementation time varied, with 15 institutions requiring less than a year. Most programs (n = 17) became active in the past 5 years. Medical and surgical oncology were ranked most important for building a program (average ranking scores: 7.96 and 6.59/8). Administrative or regulatory approval was required at half of the institutions. The top 3 challenges faced when building a program were related to regulatory approval (6.65/9), device/equipment access (6.33/9), and drug (FUDR) access (6.25/9).

      Conclusion

      Development of successful programs outside of historically established centers is feasible and requires a multidisciplinary team. Future collaborative efforts are critical for sustainability of safe/effective new programs.
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      References

        • Bierman H.R.
        • Byron Jr., R.L.
        • Miller E.R.
        • Shimkin M.B.
        Effects of intra-arterial administration of nitrogen mustard.
        Am J Med. 1950; 8: 535
        • Klopp C.T.
        • Alford T.C.
        • Bateman J.
        • Berry G.N.
        • Winship T.
        Fractionated intra-arterial cancer; chemotherapy with methyl bis amine hydrochloride; a preliminary report.
        Ann Surg. 1950; 132: 811-832
        • Anteby R.
        • Kemeny N.E.
        • Kingham T.P.
        • D'Angelica M.I.
        • Wei A.C.
        • Balachandran V.P.
        • et al.
        Getting chemotherapy directly to the liver: the historical evolution of hepatic artery chemotherapy.
        J Am Coll Surg. 2021; 232: 332-338
        • Breedis C.
        • Young G.
        The blood supply of neoplasms in the liver.
        Am J Pathol. 1954; 30: 969-977
        • Ensminger W.D.
        • Rosowsky A.
        • Raso V.
        • Levin D.C.
        • Glode M.
        • Come S.
        • et al.
        A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2'-deoxyuridine and 5-fluorouracil.
        Cancer Res. 1978; 38: 3784-3792
        • Blackshear P.J.
        • Dorman F.D.
        • Blackshear Jr., P.L.
        • Varco R.L.
        • Buchwald H.
        A permanently implantable self-recycling low flow constant rate multipurpose infusion pump of simple design.
        Surg Forum. 1970; 21: 136-137
        • Blackshear P.J.
        • Dorman F.D.
        • Blackshear Jr., P.L.
        • Varco R.L.
        • Buchwald H.
        The design and initial testing of an implantable infusion pump.
        Surg Gynecol Obstet. 1972; 134: 51-56
        • Blackshear P.J.
        • Rohde T.D.
        • Varco R.L.
        • Buchwald H.
        One year of continuous heparinization in the dog using a totally implantable infusion pump.
        Surg Gynecol Obstet. 1975; 141: 176-186
        • Ammori J.B.
        • Kemeny N.E.
        • Fong Y.
        • Cercek A.
        • Dematteo R.P.
        • Allen P.J.
        • et al.
        Conversion to complete resection and/or ablation using hepatic artery infusional chemotherapy in patients with unresectable liver metastases from colorectal cancer: a decade of experience at a single institution.
        Ann Surg Oncol. 2013; 20: 2901-2907
        • Helling T.S.
        • Martin M.
        Cause of death from liver metastases in colorectal cancer.
        Ann Surg Oncol. 2014; 21: 501-506
        • Kemeny N.E.
        • Niedzwiecki D.
        • Hollis D.R.
        • Lenz H.J.
        • Warren R.S.
        • Naughton M.J.
        • et al.
        Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481).
        J Clin Oncol. 2006; 24: 1395-1403
        • Kemeny N.E.
        • Melendez F.D.
        • Capanu M.
        • Paty P.B.
        • Fong Y.
        • Schwartz L.H.
        • et al.
        Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma.
        J Clin Oncol. 2009; 27: 3465-3471
        • Pak L.M.
        • Kemeny N.E.
        • Capanu M.
        • Chou J.F.
        • Boucher T.
        • Cercek A.
        • et al.
        Prospective phase II trial of combination hepatic artery infusion and systemic chemotherapy for unresectable colorectal liver metastases: long term results and curative potential.
        J Surg Oncol. 2018; 117: 634-643
        • Bennouna J.
        • Borg C.
        • Delord J.P.
        • Husseini F.
        • Trillet-Lenoir V.
        • Faroux R.
        • et al.
        Bevacizumab combined with chemotherapy in the second-line treatment of metastatic colorectal cancer: results from the phase II BEVACOLOR study.
        Clin Colorectal Cancer. 2012; 11: 38-44
        • Carneiro B.A.
        • Ramanathan R.K.
        • Fakih M.G.
        • Krishnamurthi S.S.
        • Lembersky B.C.
        • Stoller R.G.
        • et al.
        Phase II study of irinotecan and cetuximab given every 2 weeks as second-line therapy for advanced colorectal cancer.
        Clin Colorectal Cancer. 2012; 11: 53-59
        • Sanoff H.K.
        • Sargent D.J.
        • Campbell M.E.
        • Morton R.F.
        • Fuchs C.S.
        • Ramanathan R.K.
        • et al.
        Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741.
        J Clin Oncol. 2008; 26: 5721-5727
        • Kemeny N.
        • Huang Y.
        • Cohen A.M.
        • Shi W.
        • Conti J.A.
        • Brennan M.F.
        • et al.
        Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.
        N Engl J Med. 1999; 341: 2039-2048
        • Kemeny N.E.
        • Gonen M.
        Hepatic arterial infusion after liver resection.
        N Engl J Med. 2005; 352: 734-735
        • Groot Koerkamp B.
        • Sadot E.
        • Kemeny N.E.
        • Gonen M.
        • Leal J.N.
        • Allen P.J.
        • et al.
        Perioperative hepatic arterial infusion pump chemotherapy is associated with longer survival after resection of colorectal liver metastases: a propensity score analysis.
        J Clin Oncol. 2017; 35: 1938-1944
        • Buisman F.E.
        • Homs M.Y.V.
        • Grünhagen D.J.
        • Filipe W.F.
        • Bennink R.J.
        • Besselink M.G.H.
        • et al.
        Adjuvant hepatic arterial infusion pump chemotherapy and resection versus resection alone in patients with low-risk resectable colorectal liver metastases - the multicenter randomized controlled PUMP trial.
        BMC Cancer. 2019; 19: 327
        • Kemeny N.E.
        • Schwartz L.
        • Gonen M.
        • Yopp A.
        • Gultekin D.
        • D'Angelica M.I.
        • et al.
        Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone: does the addition of systemic bevacizumab improve results?.
        Oncology. 2011; 80: 153-159
        • Cercek A.
        • Boerner T.
        • Tan B.R.
        • Chou J.F.
        • Gonen M.
        • Boucher T.M.
        • et al.
        Assessment of hepatic arterial infusion of floxuridine in combination with systemic gemcitabine and oxaliplatin in patients with unresectable intrahepatic cholangiocarcinoma: a phase 2 clinical trial.
        JAMA Oncol. 2020; 6: 60-67
        • Rossi A.J.
        • Khan T.M.
        • Luna A.J.
        • Cercek A.
        • Jarnagin W.R.
        • Hernandez J.M.
        Hepatic artery infusion pump (HAIP) therapy versus chemotherapy in the first-line setting for patients with unresectable intrahepatic cholangiocarcinoma.
        Ann Surg Oncol. 2022; 29: 35-36https://doi.org/10.1245/s10434-021-10279-5
        • Grady D.
        • Kaplan S.
        A lifesaving pump for cancer patients is being phased out.
        New York Times, 2018
        • Ellis R.J.
        • Angelos P.
        • Jarnagin W.R.
        • Kemeny N.E.
        • Merkow R.P.
        Abrupt discontinuation of the Codman hepatic artery infusion pump: considerations in the era of precision medicine.
        J Am Coll Surg. 2019; 229: 217-219
        • Muaddi H.
        • D'Angelica M.
        • Wiseman J.T.
        • Dillhoff M.
        • Latchana N.
        • Roke R.
        • et al.
        Safety and feasibility of initiating a hepatic artery infusion pump chemotherapy program for unresectable colorectal liver metastases: a multicenter, retrospective cohort study.
        J Surg Oncol. 2021; 123: 252-260
        • Creasy J.M.
        • Napier K.J.
        • Reed S.A.
        • Zani Jr., S.
        • Wong T.Z.
        • Kim C.Y.
        • et al.
        Implementation of a hepatic artery infusion program: initial patient selection and perioperative outcomes of concurrent hepatic artery infusion and systemic chemotherapy for colorectal liver metastases.
        Ann Surg Oncol. 2020; 27: 5086-5095
        • Buisman F.E.
        • Grunhagen D.J.
        • Homs M.Y.V.
        • Grootscholten C.
        • Filipe W.F.
        • Kemeny N.E.
        • et al.
        Adjuvant hepatic arterial infusion pump chemotherapy after resection of colorectal liver metastases: results of a safety and feasibility study in The Netherlands.
        Ann Surg Oncol. 2019; 26: 4599-4607
        • Turley M.C.
        • Moore C.
        • Creasy J.M.
        • Sharib J.
        • Lan B.
        • Thacker J.K.M.
        • et al.
        Combined primary resection with hepatic artery infusion pump implantation is safe for unresectable colorectal liver metastases.
        J Gastrointest Surg. 2021; 26: 764-771https://doi.org/10.1007/s11605-021-05195-8
        • Chakedis J.
        • Beal E.W.
        • Sun S.
        • Galo J.
        • Chafitz A.
        • Davidson G.
        • et al.
        Implementation and early outcomes for a surgeon-directed hepatic arterial infusion pump program for colorectal liver metastases.
        J Surg Oncol. 2018; 118: 1065-1073
        • Dhir M.
        • Jones H.L.
        • Shuai Y.
        • Clifford A.K.
        • Perkins S.
        • Steve J.
        • et al.
        Hepatic arterial infusion in combination with modern systemic chemotherapy is associated with improved survival compared with modern systemic chemotherapy alone in patients with isolated unresectable colorectal liver metastases: a case-control study.
        Ann Surg Oncol. 2017; 24: 150-158
        • Dhir M.
        • Zenati M.S.
        • Padussis J.C.
        • Jones H.L.
        • Perkins S.
        • Clifford A.K.
        • et al.
        Robotic assisted placement of hepatic artery infusion pump is a safe and feasible approach.
        J Surg Oncol. 2016; 114: 342-347
        • Allen P.J.
        • Nissan A.
        • Picon A.I.
        • Kemeny N.
        • Dudrick P.
        • Ben-Porat L.
        • et al.
        Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases.
        J Am Coll Surg. 2005; 201: 57-65