"Given the quality and quantity of cancer support services nationwide, and the positive outcomes of participation shown in the research literature, a high priority should be placed on identifying ways to increase patient use of existing services," say the study?s co-authors, Elizabeth G. Eakin, PhD, and Lisa A. Strycker, MA, of the Oregon Research Institute.

The study includes 368 cancer patients with breast, colon, or prostate cancers who were randomly surveyed from a large Northwestern health-maintenance organization (HMO). The researchers also surveyed 29 health care providers. The results show that 68% of the patients overall were aware of their HMO?s cancer counseling center but only 8% used the center. Of the prostate cancer patients surveyed, 90% were aware of an HMO prostate support group but only 5% made use of the service.

However, providers reported referring 70% of their patients to the cancer center and estimated that 40% actually used the services. The researchers suggest that while more diligent doctors discuss psychosocial concerns with their patients and describe how counseling can help, others may just provide a brochure for the counseling center in a large packet of treatment-related information.

According to the study, the most commonly reported barriers to using counseling services were having adequate support (32%), lack of awareness of the service (25%) and lack of provider referral (13%). The results suggest that in addition to physician referral, education, social support, and spirituality may also influence the use of cancer support services.

The study suggests the need for more systematic ways of educating patients about and providing referrals for counseling to cancer patients. "In addition, the study showed that while oncologists think highly of cancer support services and report recommending them to a large percentage of their patients, few patients actually partake of the services," Eakin says. "And, cancer support services are generally not incorporated into oncology care in a systematic way; thus oncologists don''t realize how few of their patients are using these services," she says.

"It is an interesting study idea in terms of finding out what are the barriers for people to use cancer support services because we obviously want to get beyond that and lower the barriers," says Joy Fincannon, RN, MS, psychiatric clinical nurse specialist and associate medical editor for the American Cancer Society (ACS). Fincannon points out that only 8% used the support services while about 30% of cancer patients are in enough psychosocial distress to benefit from these services. "This disparity is concerning. Obviously we are not reaching all the people in need."

The researchers cite the need for additional research, including more diverse samples and other practice settings, as well as using the information gained to develop more effective patient outreach programs.