Current implementation and perception of palliative interventional radiology procedures for patients with refractory cancer pain among interventional radiologists in Japan: a nationwide survey

Palliative interventional radiology (IR) procedures are effective for managing refractory cancer pain, but their real-world utilization—including procedural volume, physicians’ perceptions, and barriers to implementation—remains unclear. This study aimed to assess the current implementation of these procedures in Japan and to explore IR physicians’ perceptions and barriers. A nationwide cross-sectional survey was conducted among 1,087 board-certified IR physicians in Japan from February to March 2020. A self-administered questionnaire assessed current practice for three procedures (celiac plexus/splanchnic nerve block [nerve block], percutaneous vertebroplasty/osteoplasty [bone augmentation], and transcatheter arterial embolization [TAE]), perceived effectiveness, willingness to perform in the future, and demographics. Barriers to implementation, which were predefined as questionnaire items, were evaluated using univariable and multivariable logistic regression analyses. A total of 554 valid responses were obtained (response rate: 51.1%). Although all respondents were board-certified IR physicians, 52.5% reported diagnostic imaging as their primary practice, and 35.0% were dedicated to IR. Implementation rates were 18.1% for nerve block, 22.6% for bone augmentation, and 51.4% for TAE. Lack of adequate training was the most consistent barrier across all procedures, along with delayed referrals, lack of confidence, limited case volume, time constraints, institutional resource limitations, and insufficient evidence. Perceived effectiveness was high (81.2% for nerve block, 83.1% for bone augmentation, and 62.1% for TAE), whereas willingness to perform was lower (50.2%, 48.4%, and 66.0%). Implementation of palliative IR procedures in Japan remains limited, despite the high perceived effectiveness among IR physicians. Lack of adequate training was the most consistent barrier across all procedures, suggesting that greater availability of training opportunities may help narrow the gap between perceived benefit and actual practice. These findings highlight a clinically important mismatch: procedures viewed as effective for refractory cancer pain are not reaching patients who might benefit from them.