Cancer Pain Procedures Carry Higher Wound Risks With Targeted Therapies

As cancer survival rates climb, a quieter crisis has been growing alongside the victories: cancer-related pain. Roughly a quarter to 40 percent of cancer patients experience pain that resists even high doses of opioids, and about 10 to 20 percent of those who do find relief from medications eventually cut their doses because of intolerable side effects. That gap has pushed pain specialists toward interventional treatments, from steroid injections and sympathetic neurolysis to surgically implanted devices such as spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation, and intrathecal drug delivery systems. But a new retrospective study from a major cancer center suggests that patients on modern targeted cancer therapies may face a substantially elevated risk when the scalpel meets the skin.

The research, published in Cancer Reports, examined periprocedural wound complications in cancer pain patients treated at an academic tertiary-care comprehensive cancer center between March 2016 and January 2024. Investigators identified 195 operative pain procedures in 150 patients, ranging from stimulation trial procedures to full implantations and device revisions or removals. Thirty-nine patients were actively receiving targeted cancer therapy at the time of their procedures, forming the treatment group, while 111 patients served as controls. The team followed Strengthening the Reporting of Observational Studies in Epidemiology guidelines and manually reviewed each record to classify complications within 90 days of surgery.

The results point to a striking difference. Among the 44 procedures in the treatment group, four led to wound-related complications, an absolute rate of 9.1 percent. In the control group of 151 procedures, only three complications occurred, or 2.0 percent. After accounting for repeated procedures within the same patients using a generalized estimating equations model, the treatment group had roughly seven times higher odds of wound complications than controls, with an odds ratio of 7.41 and a 95 percent confidence interval stretching from 1.36 to 40.40. The researchers caution that the wide interval reflects the small number of events, so the estimate is hypothesis-generating rather than definitive.

The specific complications tell their own story. In the treatment group, one patient developed wound dehiscence after spinal cord stimulator implantation, two suffered surgical site infections after stimulation trial procedures, and one experienced a seroma following intrathecal drug delivery system implantation. In the control group, two patients had wound dehiscence after intrathecal device implantation or explantation, and one developed a surgical site infection after implantation. No hematomas were observed in either group. The most common targeted agents in the treatment group were rituximab, a CD20 monoclonal antibody, and pembrolizumab, an immune checkpoint inhibitor targeting PD-1.

Why might these drugs interfere with healing? Targeted cancer therapies work by modulating or enhancing immune activation to destroy cancer cells more effectively. But the same immunological firepower that attacks tumors can also ignite excessive inflammation at a surgical wound site, potentially delaying tissue repair and raising infection risk. Some agents also target vascular endothelial growth factor, a molecule crucial to new blood vessel formation during wound healing. Bevacizumab, lenvatinib, pazopanib, cabozantinib, and regorafenib all appeared in the treatment cohort, each acting on the VEGF pathway through different mechanisms.

Beyond the targeted therapies themselves, the study identified other risk factors that independently predicted wound trouble. Diabetes carried an odds ratio of 7.66 for wound complications, concurrent steroid use an odds ratio of 7.50, and each unit increase in body mass index raised the odds by about 14 percent. Obesity, diabetes, and corticosteroids each impair healing through well-characterized mechanisms, including reduced tissue perfusion, chronic inflammation, altered growth-factor signaling, and greater mechanical stress at surgical sites. Notably, the treatment group had significantly higher average BMI and far higher rates of concurrent steroid use than controls, meaning some of the apparent excess risk attributed to targeted therapy may actually be confounded by these imbalances.

Perhaps the most sobering finding involves what the records did not contain. In 40 of the 44 treatment-group encounters, or 90.9 percent, there was no clear documentation of whether the targeted cancer therapy was held, continued, or adjusted around the time of the procedure. Periprocedural hold recommendations vary considerably by agent, and many drugs lack specific guidance altogether. Existing consensus statements cover infection prevention and anticoagulation management but offer little direction specific to the cancer pain population. Holding cancer treatment carries its own dangers, including the potential for disease progression, making the decision a genuine clinical tightrope.

The investigators emphasize that pain physicians must collaborate closely with oncologists to navigate this periprocedural period safely. Communication between specialists is often inadequate, particularly in outpatient settings where the pain physician and the oncologist may not share the same institution. The study also highlights that interventional pain procedures, while frequently perceived as less invasive than major surgery, nonetheless involve meaningful periprocedural risk, especially in immunocompromised patients. Recognizing these dangers is essential to informed patient selection, interdisciplinary perioperative planning, and shared decision-making with patients who are already battling cancer on multiple fronts.

The researchers acknowledge several limitations. The retrospective design carries unquantifiable sources of bias. Only 39 of 150 patients received targeted therapy, and just seven complications were observed overall, creating wide confidence intervals and a substantial risk of overfitting in the multivariable model. The cohort was also procedurally heterogeneous, pooling interventions that differ substantially in surgical depth, and the composite outcome combined mechanistically distinct events such as seroma and hematoma. Cancer type, disease stage, and prior oncologic therapy varied widely and may independently influence wound healing in ways the study could not fully capture.

Despite these caveats, the findings serve as a wake-up call for a field that has expanded faster than its safety evidence. The authors call for larger, prospective, procedure-stratified studies to more precisely characterize wound-healing risk in cancer pain patients, to compare risks across different classes of cancer treatment, and to assess the safety of periprocedural cancer treatment cessation. Future research should also examine hematologic issues relevant to neuraxial procedures. In the meantime, the study underscores that evidence-based guidelines are urgently needed to protect a growing population of cancer survivors seeking relief from one of the disease’s most disabling symptoms.

Subject of Research: Periprocedural Wound Complication Risks in Cancer Pain Patients Following Targeted Cancer Therapy: A Retrospective Analysis

Article Title: Periprocedural Wound Complication Risks in Cancer Pain Patients Following Targeted Cancer Therapy: A Retrospective Analysis

Article References: Sheen, S., Bansal, V., Sun, X., Wang, J., & Javed, S. (2026). Periprocedural Wound Complication Risks in Cancer Pain Patients Following Targeted Cancer Therapy: A Retrospective Analysis. Cancer Reports, 9(10), Article e70664. https://doi.org/10.1002/cnr2.70664

Image Credits: AI Generated

DOI: 10.1002/cnr2.70664

Keywords: Periprocedural, Wound, Complication, Risks, Cancer, Pain, Patients, Following, Targeted, Therapy, Retrospective, Analysis