Objective: The aim of this study was to investigate the availability and utilization of specialized palliative care services among patients with cancer in Japan. Methods: We conducted a nationwide cross-sectional survey of 828 institutions predicted to provide specialized palliative care services. Results: Responses were received from 751 institutions (response rate, 91%); of these, 541 had specialized palliative care services. Adding the census data of palliative care units, the total estimated number of institutions with specialized palliative care services was 659. Of all the patients with cancer who died in the period from April 2009 to May 2010 in Japan, the estimated proportion who utilized specialized palliative care services was 24%. Conclusions: Usage of specialized palliative care services in Japan have increased explosively in the past decade.