The study underscores the importance of finding methods to identify patients who lack a support network or who are severely depressed or anxious, say the authors, who are from University Hospital in Innsbruck, Austria.

Patients'' psychological states can affect their compliance with taking medicine or reporting symptoms, says Frank Baker, PhD, a psychologist and vice president for behavioral research at the American Cancer Society (ACS). Moreover, a growing amount of evidence shows that stress affects the immune system, says Baker. Other research shows that social support -- spouse, family, friends, and belonging to a support group -- protects against some of the stress related to coping with the illness.

"The psychological side of this," he says, "does have some impact on the physical side."

The results carry a message for more open communication between patients and doctors, says the lead author, Wolfgang Söllner, MD, lead author and associate professor in the department of medical psychology and psychotherapy at University Hospital.

"Patients should try to disclose their feelings to their oncologists," Söllner says. "And oncologists should give patients signals that, if they want, they are willing to discuss emotional problems."

The researchers studied 239 patients and eight oncologists in the Radio-oncology Unit of Innsbruck University Hospital, from October 1997 to March 1998.

At the start of radiation therapy, the patients completed several questionnaires that assessed traits such as anxiety, depression, need for psychosocial support, and tendency to minimize problems.

Meanwhile, the patient''s radiation-oncologist completed a short form assessing the patient. In the end, they identified numerous patients with severe problems. The hitch: those patients were often different from the ones actually in distress.

The oncologists accurately tagged only 11 of the 30 patients suffering significant depression, tension, anxiety, and feelings of helplessness. They recommended a social worker for only 58% of the patients whose questionnaires pegged them as having difficulty coping with extreme problems, such as with finances or work.

The disconnection was particularly great with patients from lower social classes (with different communication styles) and patients with cancers of the lung, head, or neck.

The Austrian study fits in with earlier literature on cardiologists and general practitioners, Baker says. "Physicians are not very good at assessing patients? levels of psychological distress," says Baker. Reasons for this, he says, include oncologists? busy schedules, the difficulty of such assessments, and a lack of training in that area -- a matter he believes should be addressed in medical school.

Psychological issues can be difficult to observe, Baker says, and the medical community is learning to turn to patients for self-reports. For example, top cancer centers in the US ask patients to fill out a form describing the level and type of their distress -- be it pain, depression, or a spiritual crisis. Family or friends may need to help complete the form if patients aren?t able. Patients can then be referred for follow-up care.

Söllner agrees that questionnaires are useful. But he also regards them as impersonal and imperfect, with a bias toward over-identifying patients needing specialized therapy. His preference: training oncologists to communicate better and to recognize patient distress.

The ideal, says Söllner, is for oncologists and nurses to serve as a resource to patients with mild or moderate emotional or social needs. Their involvement might require an extra five or 10 minutes; they can offer guidance on joining a self-help group, information on the patients? disease and treatment, or reassurances their feelings are normal, he says.

"Patients want to discuss their psychosocial problems first with oncologists," Söllner says, "and not psychologists." He remains convinced that, while referring to specialists is necessary in severe cases, "too much specialization is not good for patient care." Patients like feeling their doctors are interested in them as a whole person, Söllner says -- not just as a disease.