Skip to main content
Download PDF

Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey

BMC Palliative Care volume 21, Article number: 166 (2022) Cite this article

Abstract

Background

Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain.

Methods

A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists.

Results

The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure.

Conclusions

Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.

Peer Review reports

Background

Pain is a common symptom associated with cancer that needs to be controlled or reduced as much as possible. Cancer-related pain decreases the quality of life of patients [1, 2]. Pharmacological management is the basis of cancer pain treatment, and may adequately relieve cancer pain [3, 4]. However, a recent meta-analysis revealed that the proportion of patients with pain remains high, with 66.4% of patients with advanced terminal cancer having pain and 38% of those with cancer of any stage having moderate to severe pain [5].

The pharmacological management of cancer pain in some patients remains insufficient. Refractory cancer pain, which is defined as pain not responding to standard pharmacological treatments [6], may afflict some patients. The limitations of pharmacological therapy include its use for relief of breakthrough pain and side effects of analgesics. The use of individualized pharmacotherapy that considers the timing of treatment, individual characteristics, and non-pharmacological therapies is important for cancer-related pain. Among non-pharmacological therapies, the WHO guidelines [7] strongly recommend radiotherapy. Furthermore, authoritative guidelines [8,9,10] include non-pharmacological therapies such as neural blockade, neuraxial infusion, and cordotomy. Thus, in cancer pain management, an individualized multimodal approach is important [11, 12].

The degree to which interventional procedures for patients with cancer pain are available and utilized remains unclear. Some non-pharmacological therapies, including neural blockade and neuraxial infusion, are effective for cancer pain, and previous studies have reported that they are used to treat 3.8-8% of cancer patients [13,14,15]. However, as there are several barriers to the implementation of these therapies [16,17,18,19,20,21], their limited availability may explain refractory cancer-related pain in some patients with cancer.

Information on the status and availability of neural blockades and neuraxial infusions for cancer pain management or the factors associated with their use are currently limited [13,14,15,16,17,18,19,20,21,22]. Previous questionnaire surveys targeted palliative care physicians, referring physicians, and representatives of facilities at which treatment was provided [16,17,18,19,20, 23]; however, a national survey of the individual professionals who completed these surveys has not yet been performed.

The purpose of the present study was to clarify the availability and number performed by each specialist of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis [CPN], subarachnoid neurolytic block for perineal pain [phenol saddle block], epidural infusions of local anesthetic combined with opioids [Epi], and intrathecal analgesia [IA] for refractory cancer pain) as well as factors related to their implementation using a nationwide survey of specialists. In addition, we aimed to clarify how familiar home hospice physicians (HHPs) and oncologists were with the different interventional procedures available to manage refractory cancer pain.

Methods

Study Design

A cross-sectional study on interventional procedures performed by pain specialists (PSs), interventional radiology (IVR) specialists, HHPs, and oncologists was conducted in Japan.

This survey was part of the “Research on the Construction of Systematic Pain Relief Methods in the Final Stage of Cancer Patients’ Medical Care” program.

Participants and procedures

Between February and March 2020, a questionnaire on interventional procedures for refractory cancer pain was sent to PSs, IVR specialists, HHPs, and oncologists. Eligibility criteria were certificated physicians of each academic society. Exclusion criteria were: 1) not living in Japan, 2) not working at a hospital (regarding PSs and oncologists), and 3) no contact information. To identify subjects, we used lists of certified physicians from websites or certifying societies. A questionnaire was mailed to all certified PSs, IVR specialists, and HHPs who met the eligibility criteria, and to 800 oncologists randomly selected based on prefecture-based population ratios. Double board-certified oncologists who were certified as PSs or palliative care physicians were excluded from the analysis of valid responses.

A letter of purpose, questionnaire, and self-addressed envelope were enclosed and mailed, and a request was made in the letter of purpose to reply within one month of receipt of the questionnaire. A reminder by postcard was sent if when the questionnaire was not returned within this time.

Measurements

In the present study, refractory pain was defined to participants as: pain that patients, family members, or nurses requested the physician to alleviate further, even with appropriate pharmacological therapy. All participants were asked about the following background factors: age, sex, the number of cancer patients seen annually, the number of cancer patients with pain seen annually, the number of cancer patients who died annually, other specialties, facilities at which they work, and their main workplace.

Self-administered questionnaires about the following interventional procedures for refractory cancer pain were conducted: CPN, phenol saddle block, Epi, and IA. We did not distinguish between celiac plexus neurolysis and splanchnic nerve neurolysis from the viewpoint of performing neural blockades for upper abdominal pain, even though the techniques and injection sites of neurolytic agents differ. PSs reported whether they currently perform these four therapies (yes/no), whether they are willing to perform them in the future (a four-point Likert scale consisting of “will perform”, “will probably perform”, “will probably not perform”, and “will never perform”), the number of procedures they performed in the past three years, and background factors and barriers related to the implementation of the four procedures. IVR specialists were asked about CPN only: whether they were currently performing CPN, whether they were willing to perform it in the future, and the number of procedures they had performed in the past 3 years.

Questions were based on those reported in previous studies [16,17,18,19,20,21, 23] and were developed through discussions among members of an expert group. The answers to potential barrier-related questions, such as experience, lack of time, communication with other departments, permission to perform at own facility, and availability of equipment at own facility, were recorded on a seven-point Likert scale with the following available responses: “strongly agree”, “agree”, “somewhat agree”, “neither agree nor disagree (undecided)”, “somewhat disagree”, “disagree”, and “strongly disagree”

Knowledge of these interventional procedures by HHPs and oncologists was also evaluated. HHPs and oncologists reported their knowledge and experience of interventional procedures for cancer pain management using one of four items: “I have performed the interventional procedure by myself”; “Some of my patients have received the interventional procedure from another physician”; “I know the interventional procedure, but have no experience with it”; and “I do not know the interventional procedure”.

Analysis

Analyses were performed on valid responses using descriptive statistics. Responses regarding willingness to perform were divided into two categories: “will perform” and “will perform probably” were categorized as “willing”; and “will probably not perform” and “will never perform” as “not willing”. Responses expressed on a seven-point Likert scale were divided into two categories: “strongly agree” and “agree” were categorized as “agree”; and “somewhat agree”, “neither agree nor disagree (undecided)”, “somewhat disagree”, “disagree”, and “strongly disagree” as “other”. A univariate analysis of the factors and barriers that contribute to the implementation of interventional procedures was conducted using chi-squared test. Multivariate analysis (binomial logistic regression analysis) was performed on variables with a P value of ≤ 0.1 in the univariate analysis. P values < 0.05 were considered to be significant due to the exploratory nature of the present study. Items with missing values of 10% or more were excluded from the analysis. All analyses were conducted using SPSS (version 25, SPSS Inc., Chicago, USA) and R version 4.0.3.

Results

Response rate

Questionnaires were sent to 1,112 out of 1,525 PSs; 1,087 IVR specialists; 308 HHPs; and 800 randomly selected physicians out of 16,717 oncologists. Valid responses were obtained from 545/587 PSs (49.0%) (Fig. 1), 554/572 IVR specialists (51.0%) (Fig. 2), 144/146 HHPs (46.8%), and 399/425 randomly selected physicians (49.9%).

Fig. 1
figure 1

Participant flow (Pain specialist response rate). PSs: Pain specialists

Full size image
Fig. 2
figure 2

Participant flow (Interventional radiology specialist response rate). IVR: Interventional Radiology

Full size image

Characteristics

Participant characteristics are shown in Table 1. The mean ages of PSs, IVR specialists, HHPs, and oncologists were 53.1, 48.2, 47.2, and 46.7 years, respectively. The median numbers of the four types of specialists who saw cancer patients with pain annually were 10, 3, 20, and 10, respectively. The proportions of the four types of specialists working in a designated cancer hospital or university hospital were 59.4, 67.5, 6.3, and 56.1%, respectively.

Table 1 Participant characteristics
Full size table

Implementation of and preferences for interventional procedures

Table 2 shows the implementation of and preferences for interventional procedures. The proportions of PSs who indicated “Currently performing” and “Willing to perform in the future” for the various interventional procedures were as follows: CPN, 49.5 and 60.0%; phenol saddle block, 55.2 and 63.1%; Epi, 75.2 and 67.7%; and IA, 40.9 and 55.2%, respectively. Regarding the frequency of these procedures performed by PSs in the past 3 years, median numbers (interquartile ranges) for the various interventional procedures were as follows: CPN, 0 (0-3); phenol saddle block, 0 (0-1); Epi, 0 (0-3); and IA, 0 (0-0). The numbers of PSs who performed 20 or more procedures were 20 (3.7%), 4 (0.7%), 25 (4.6%), and 4 (0.8%), respectively.

Table 2 Implementation of and preferences for interventional procedures
Full size table

The proportions of IVR specialists who indicated “Currently performing CPN” and “Willing to perform CPN in the future” were 18.1 and 50.2%, respectively. Regarding the frequency of CPN performed by IVR specialists in the past 3 years, the median number (interquartile range) was 0 (0-0), with nearly 90% answering “0”.

In the past 3 years, 545 PSs reported performing 4,591 of the four procedures (CPN, 1547; phenol saddle block, 706; Epi, 1746; and IA, 592), whereas 554 IVR specialists reported performing 202 CPN.

Factors related to the implementation of procedures by PSs

Univariate (Table 3) and multivariate analyses (Table 4) revealed that the number of cancer patients with pain seen annually and difficulty in gaining experience and acquiring skills due to the limited number of cases were associated with the implementation of all four interventional procedures for cancer pain management. Implementation not being permitted at the PSs’ own facility was a barrier to the implementation of CPN, phenol saddle block, and IA. The difficulty of treating patients requiring the procedure due to a lack of time was a barrier to the implementation of CPN and phenol saddle block. Items regarding equipment were excluded from the analysis because they were missing values of 10% or more.

Table 3 Factors related to the implementation of procedures by pain specialists (univariate analysis)
Full size table
Table 4 Factors related to the implementation of procedures by pain specialists (multivariate analysis)
Full size table

Perceptions of interventional procedures by HHPs and oncologists

The proportions of HHPs and oncologists who responded that they did not know each of the four interventional procedures were as follows: CPN, 7.6 and 13.0%; phenol saddle block, 13.9 and 19.0%; Epi, 3.5 and 6.5%; and IA, 11.1 and 27.1%, respectively (Table 5).

Table 5 Number of home hospice physicians and oncologists who responded that they did not know interventional procedures
Full size table

Discussion

The present results clarified the availability, status of implementation, and factors related to the implementation of interventional procedures for refractory pain in patients with cancer using a nationwide survey completed by specialists.

In the present study, the proportions of PSs who responded that they were able to perform CPN, phenol saddle block, Epi, and IA were 49.5, 55.2, 75.2, and 40.9%, respectively. In the past three years, almost 50% reported that they had not performed Epi; furthermore, most responded that they had not performed the three other procedures. Previous surveys on specialist pain services examined the availability of interventional procedures. In the UK, procedures were available at 24.5% (CPN), 24.5% (intrathecal neurolysis), and 85.8% (spinal analgesia; 22% for EPI only, 18% for IA only, and 45% for both) of facilities [16]. In Japan, procedures were available at 66% (CPN), 67.4% (intrathecal neurolysis), 88.2% (Epi), and 54.2% (IA) of facilities [23]. Thus, many pain specialist facilities provide interventional analgesia for cancer patients; however, PSs had few opportunities to perform these procedures.

Based on a previous Japanese study [15], we estimated that 3.3% of the 373,584 patients who died due to cancer in 2018 (approximately 12,000 patients) may have required interventional procedures for cancer pain management. Our survey revealed that 1,530 interventional procedures were performed annually by 545 PSs. Assuming that the 1,112 PSs that responded to our survey performed interventional procedures at the same frequency as the 545 PSs, the expected annual number of interventional procedures was 3,122, which is markedly less than the estimated demand. Thus, interventional procedures do not appear to be sufficiently utilized.

Factors related to the implementation of interventional procedures warrant further study. Previous studies reported the following barriers to the implementation of specialist pain management, such as neural blockade and neuraxial infusion: the underutilization of specialists [16, 17]; access issues/geographical issues [18, 19]; inter-facility issues [19]; inability to get appointments [20]; need for repeating procedures [20]; cost issues [17, 18, 21]; the short survival of patients following referral to palliative care services [21]; time on the part of the specialist for evaluation and discussion [16, 21]; complexity [21]; continuity issues, such as the handling of pumps and catheters, creating a pump, procurement of drugs, and management at home [21]; the inexperience of palliative care physicians [18]; perception issues among palliative care physicians (interest or lack of awareness of potential benefits) [18, 21]; and the lack of training for specialists [21]. In the present study, the number of cancer patients with pain seen annually, difficulty in gaining experience, lack of time, and lack of institutional acceptance were associated with the implementation of procedures, with the first three factors being consistent with previously reported associated factors (involvement of specialists in palliative care [16], time on the part of the specialist for evaluation and discussion [16], and the lack of training for specialists [21]). These factors are important because the results of the present study support previous findings.

The following measures may increase the number of interventional procedures being performed. First, in the present survey, the number of cancer patients with pain seen annually (contributing factor) and difficulty in gaining experience and acquiring skills due to the limited number of cases (barrier) were identified as factors related to implementation. Moreover, previous studies reported the lack of training of experts as a barrier to implementation [21]. Thus, PSs need to increase their experience treating such patients. To increase the experience of PSs, several strategies may be effective, including further specialization for the treatment of cancer pain, a region-wide networking system for identifying potential candidates for interventional procedures, and establishing designated teaching facilities. Second, the effective use of time by PSs to practice palliative medicine may increase the implementation of procedures. In the present study, lack of time was associated with the implementation of two procedures: CPN and phenol saddle block. Moreover, increasing the time spent in palliative medicine practice may compensate for lack of experience. In a 2007 survey of lead anesthetists in UK pain clinics [16], joint consulting arrangements were rare, and only 25% of anesthetists’ job plans had time allocated for palliative medicine referrals; however, there was a positive correlation with the number of referrals. Therefore, promoting opportunities for PSs to be involved in palliative medicine may, in turn, increase the number of interventional procedures performed. Third, efforts are needed to educate palliative care physicians who will serve as bridges. The present survey of HHPs and oncologists revealed that they had knowledge of the implementation of procedures, but no experience or may not be able to refer patients to specialists. Palliative care physicians need to act as a bridge to connect patients to specialists who perform these procedures. Previous studies also reported a lack of experience and awareness among palliative care physicians [18, 21]; thus, further education and awareness on indications for and effects of interventional therapies among palliative care physicians are needed. Fourth, the education of IVR specialists may be important for promoting the implementation of CPN because even though many IVR specialists responded that they are willing to perform CPN, actual implementation rates were low.

Since there are few evidence-based interventional procedures, it may be difficult for specialists to provide a rationale for the procedure; furthermore, palliative care physicians who act as bridges may not be able to propose a procedure with confidence and obtain approval from institutions. Further studies to evaluate the efficacy of these interventional procedures are needed.

Limitations

There are several limitations to the present study. First, although the status of implementation by specialists nationwide was surveyed, we did not obtain information on the implementation status of each facility. A survey of facilities, including designated cancer hospitals, hospitals without designated cancer departments, and home hospices is warranted to obtain more detailed data on interventional procedures for cancer pain management. Second, the valid response rate for each expert, which ranged between 46.8 and 51.5%, may not reflect the overall situation. However, the response rate was sufficient for a survey of individual experts. Third, as Japan has a universal health insurance system, no restrictions on access to medical facilities, and a small geographical area, we considered it unnecessary to ask about geographical distance and cost issues.

Conclusion

PSs surveyed in the present study responded that they implement each of the four procedures to treat patients with cancer pain; however, the actual number appears to be limited and may not meet demands. It is important to take measures to ensure that PSs and IVR physicians are sufficiently utilized to manage refractory cancer pain.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CPN:

Celiac plexus neurolysis/splanchnic nerve neurolysis

PSs:

Pain specialists

IVR:

Interventional radiology

HHPs:

Home hospice physicians

Epi:

Epidural infusions of local anesthetic combined with opioids

IA:

Intrathecal analgesia

References

  1. Kroenke K, Theobald D, Wu J, Loza JK, Carpenter JS, Tu W. The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manag. 2010;40(3):327–41. https://doi.org/10.1016/j.jpainsymman.2009.12.023.

    Article  Google Scholar 

  2. Rustøen T, Moum T, Padilla G, Paul S, Miaskowski C. Predictors of quality of life in oncology outpatients with pain from bone metastasis. J Pain Symptom Manag. 2005;30(3):234–42. https://doi.org/10.1016/j.jpainsymman.2005.04.002.

    Article  Google Scholar 

  3. Ferreira KA, Kimura M, Teixeira MJ. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer. 2006;14(11):1086–93. https://doi.org/10.1007/s00520-006-0086-x.

    Article  Google Scholar 

  4. Wiffen PJ, Wee B, Derry S, Bell RF, Moore RA. Opioids for cancer pain - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;7(7):CD012592. https://doi.org/10.1002/14651858.CD012592.pub2.

    Article  PubMed  Google Scholar 

  5. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manag. 2016;51(6):1070–90. https://doi.org/10.1016/j.jpainsymman.2015.12.340.

    Article  Google Scholar 

  6. Petra VB, Banafsheh A, Phillip G, Paul G, Janet H. Interventional options for the management of refractory cancer painーwhat is the evidence? Support Care Cancer. 2016;24(3):1429–38. https://doi.org/10.1007/s00520-015-3047-4.

  7. World Health Organization. WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. 2018. Available from: https://apps.who.int/iris/handle/10665/279700. Accessed 19 July 2021.

    Google Scholar 

  8. Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(27):3325–45. https://doi.org/10.1200/JCO.2016.68.5206.

  9. Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl 4):iv166–91. https://doi.org/10.1093/annonc/mdy152.

  10. Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, et al. Nesbit S; BCPS, O'Connor N, Rabow MW, Rickerson E, Shatsky R, Sindt J, Urba SG, Youngwerth JM, Hammond LJ, Gurski LA. Adult Cancer Pain, Version 3. 2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2019;17(8):977–1007. https://doi.org/10.6004/jnccn.2019.0038.

  11. Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic pain in the cancer survivor: a new frontier. Pain Med. 2007;8(2):189–98. https://doi.org/10.1111/j.1526-4637.2006.00220.x.

    Article  PubMed  Google Scholar 

  12. van den Beuken-van Everdingen MHJ, van Kuijk SMJ, Janssen DJA, Joosten EA. Treatment of Pain in Cancer: Towards Personalised Medicine. Cancers (Basel). 2018;10(12):502. https://doi.org/10.3390/cancers10120502.

    Article  Google Scholar 

  13. Zech DFJ, Grond S, Lynch J, Hertel D, Lehmann KA. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63(1):65–76. https://doi.org/10.1016/0304-3959(95)00017-M.

    Article  PubMed  Google Scholar 

  14. Grond S, Zech D, Schug SA, Lynch J, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manag. 1991;6(7):411–22. https://doi.org/10.1016/0885-3924(91)90039-7.

    Article  CAS  Google Scholar 

  15. Tei Y, Morita T, Nakaho T, Takigawa C, Higuchi A, Suga A, et al. Treatment efficacy of neural blockade in specialized palliative care services in Japan: a multicenter audit survey. J Pain Symptom Manag. 2008;36(5):461–7. https://doi.org/10.1016/j.jpainsymman.2007.11.009.

  16. Kay S, Husbands E, Antrobus JH, Munday D. Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists. Palliat Med. 2007;21(4):279–84. https://doi.org/10.1177/0269216307078306.

    Article  CAS  PubMed  Google Scholar 

  17. Page ND. Integration of Specialized Pain Control Services in Palliative Care: A Nationwide Web-based Survey. Indian J Palliat Care. 2017;23(2):212–6. https://doi.org/10.4103/0973-1075.204233.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Linklater GT, Leng ME, Tiernan EJ, Lee MA, Chambers WA. Pain management services in palliative care: a national survey. Palliat Med. 2002;16(5):435–9. https://doi.org/10.1191/0269216302pm535oa.

    Article  CAS  PubMed  Google Scholar 

  19. Lovell M, Agar M, Luckett T, Davidson PM, Green A, Clayton J. Australian Survey of Current Practice and Guideline Use in Adult Cancer Pain Assessment and Management: perspectives of palliative care physicians. J Palliat Med. 2013;16(11):1403–9. https://doi.org/10.1089/jpm.2013.0245.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Brown DL, Caswell RE, Wong GY, Nauss LA, Offord KP. Referral of patients with pain from pancreatic cancer for neurolytic celiac plexus block. Mayo Clin Proc. 1997;72(9):831–4. https://doi.org/10.4065/72.9.831.

    Article  CAS  PubMed  Google Scholar 

  21. O'Brien T, Kane CM. Pain services and palliative medicine - an integrated approach to pain management in the cancer patient. Br J Pain. 2014;8(4):163–71. https://doi.org/10.1177/2049463714548768.

    Article  PubMed  PubMed Central  Google Scholar 

  22. De Conno F, Panzeri C, Brunelli C, Saita L, Ripamonti C. Palliative care in a national cancer center: results in 1987 vs. 1993 vs. 2000. J Pain Symptom Manag. 2003;25(6):499–511. https://doi.org/10.1016/s0885-3924(03)00069-1.

    Article  Google Scholar 

  23. Hirakawa N, Nagaro T, Murakawa K, Higuchi H, Iseki M. Current state of interventional treatment for cancer pain in Japan. J Jpn Soc Pain Clin. 2015;22(4):498–506. https://doi.org/10.11321/jjspc.15-0022.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to Dr. Masashi Kato for providing insightful comments and suggestions.

Funding

The present study was funded by the Ministry of Health, Labour and Welfare (Grant Number 19EA1011).

Author information

Authors and Affiliations

  1. Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Yuko Uehara, Yoshihisa Matsumoto, Akio Mizushima & Eriko Satomi

  2. Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Yuko Uehara & Yoshihisa Matsumoto

  3. Department of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yoshihisa Matsumoto

  4. Department of Palliative Care, Saga-ken Medical Centre Koseikan, Saga, Japan; 400 Kasemachinakabaru, Saga, Saga, 840-8571, Japan

    Toshifumi Kosugi

  5. Department of Diagnostic Radiology/Interventional Radiology Center, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Miyuki Sone

  6. Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan; 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Naoki Nakamura

  7. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Mitsunori Miyashita

  8. Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan; 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  9. Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Takuhiro Yamaguchi

  10. Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Eriko Satomi

Authors
  1. Yuko Uehara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihisa Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshifumi Kosugi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miyuki Sone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naoki Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akio Mizushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsunori Miyashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tatsuya Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takuhiro Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eriko Satomi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YU, YM, TM, and ES were responsible for the conception and design of the study. YU, YM, and AM were involved in the preparation of the questionnaire and were responsible for drafting of the manuscript. All authors reviewed and made critical revisions to the manuscript. MM, TM, and TY supervised the study.

Corresponding author

Correspondence to Yoshihisa Matsumoto.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of the National Cancer Center, Japan (6000-021). Formal approval of the study protocol by an ethics committee was not required according to the Japanese national policies. All procedures were performed in accordance with the Declaration of Helsinki. We enclosed a letter explaining the purpose of the survey and explained that responses were voluntary. If the survey was filled out and returned, it was considered as consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uehara, Y., Matsumoto, Y., Kosugi, T. et al. Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey. BMC Palliat Care 21, 166 (2022). https://doi.org/10.1186/s12904-022-01056-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12904-022-01056-6

Keywords

BMC Palliative Care

ISSN: 1472-684X

Contact us