Objective: To explore Indian cancer patients’ and their primary family caregivers’ (PFC) experiences and expectations of treatment-related communication with their physician while undergoing radiation therapy. Methods: Participants, comprising patient-PFC dyads (n = 32), patients only (n = 33) and PFC only (n = 7), were recruited from one hospital in Mumbai, India. Semi-structured interviews explored participants’ perceived role in cancer-related decision-making, diagnosis and prognosis communication experiences with the physician, communication expectations of their treating physician, and information needs. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. Results: Main themes included: (i) patients’ passive role in treatment communication, (ii) family as an integral part of the medical consultation, and (iii) dyads’ expectations and beliefs about the role of the physician. Conclusion: Indian cancer patients played a passive role in treatment decision-making while physicians were seen as primary medical decision-makers. Further, PFCs provided the final consent for the treatment plan and acted as a mediator/moderator between the patient-physician. Practice implications: These findings suggest the need for (i) interventions such as question prompt lists that may improve patient activation and caregiver preparedness, and (ii) triadic communication training interventions for optimal communication between the three stakeholders (i.e., patient, physician and PFC). © 2022 Elsevier B.V.