Availability of, Barriers to Performing, and Educational Practices of Interventional Procedures for Refractory Pain in Cancer Patients: A Nationwide Survey of Designated Cancer Hospitals in Japan.

BACKGROUND

Because of the limitations of pharmacological therapy, nonpharmacological therapies including intervention procedures are also important for quality of cancer pain management.

OBJECTIVE

To clarify the availability of, number performed, barriers to performing, and educational practices of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia) in designated cancer hospitals.

DESIGN

Cross-sectional survey.

SETTING

Designated cancer hospitals certified by the Japanese Government.

METHODS

We administered self-administered questionnaires to collect general information about the facility and interventional procedures for refractory cancer pain between January and April 2021.

RESULTS

Questionnaires were sent to 402 facilities, and we received 199 valid responses (49.5%). Regarding availability, 36.7%-59.8% of the designated cancer hospitals reported that each procedure was available. Regarding the frequency of these procedures performed in the past 3 years, medians ranged from 1 to 4 times for each procedure. Among designated cancer hospitals, 44.7-65.8% reported the presence of barriers. Barriers such as "no/few physicians technically able to perform the procedure," "inability to follow-up after the procedure is implemented," and "the facilities to which patients may be referred after implementation are limited" were particularly pronounced. Training and treatment practice were provided by 30.7-55.8% of designated cancer hospitals for the procedures. Moreover, 12.6%-15.6% of designated cancer hospitals educated physicians and nurses responsible for cancer care in the region about pain treatment for the procedures.

CONCLUSIONS

Our findings suggest that designated cancer hospitals need to improve the availability, training, and education of interventional procedures.