People with lung cancer often feel ashamed and guilty about their illness, British researchers report in a study published in the online edition of BMJ, the British Medical Journal. They interviewed 45 lung cancer patients between the ages of 40 and 90.

Most of the patients felt others were holding them responsible for getting sick because of the link between lung cancer and smoking. About 87% of lung cancer cases are attributable to smoking.

"People automatically think you've brought it on yourself," said one study participant. "People think you're dirty because you smoked."

But even lung cancer patients who never smoked, or who quit decades before, felt this stigma, the researchers from the University of Oxford reported.

The negative feelings caused some patients to conceal their illness, hampering their ability to get support from other people. Others in the study worried about being denied care because of the perception they'd caused their own illness.

Such findings are not surprising, said Jimmie Holland, MD, professor and vice chair of psychiatry at Memorial Sloan-Kettering Cancer Center in New York. Holland was not involved in the current study but has worked with lung cancer support groups for years.

While many cancer patients feel isolated and ashamed after their diagnosis, she said, those feelings are stronger among people with lung cancer. "It hasn't generated the kind of sympathy it does when people have breast cancer," Holland said. "It is a special stigma. The whole thing has been tainted by smoking."

That taint stems in part from a lack of understanding about addiction, Holland said. Many people assume that with enough willpower, a smoker could give up tobacco. Families and friends of smokers with lung cancer may well get angry at the person for not being able to quit. But the high relapse rate among would-be quitters speaks to the difficulty of overcoming tobacco addiction.

Even doctors are not immune to such exasperation, Holland said. "Doctors like to treat people who cooperate and get better," she said.

Some patients in the study -- especially those who were non-smokers -- expressed anger and dismay at the frequency with which they were asked about smoking, by both doctors and other people. Many of the smokers in the study began smoking -- and got addicted -- at a time when smoking was fashionable and its dangers not widely known. Being questioned about the habit increased their feelings of guilt.

Doctors do need to ask lung cancer patients about smoking, but they "shouldn't convey an attitude of disapproval or disgust," Holland said.

"Blaming people isn't helpful for them in coping," she noted. "This is a problem that has to be treated with a certain level of respect and understanding."

Doctors should make an effort to help all their smoking patients quit, Holland said, even if the patient already has lung cancer. Quitting can improve a patient's response to treatment and lower the chances of developing a second cancer.

"I think it makes sense to be reassuring that, even if they smoked, it's important not to smoke more," Holland said. "Help them find the resources they need to quit."

Lung cancer patients who are having trouble coping with negative feelings may find comfort in talking with others with their disease, whether one on one or in support groups, Holland said.