Background: Most patients with lung cancer have psychological problems, which has a significant impact on patients' rehabilitation, treatment and quality of life. Through the distress and quality of life assessment, to understand the risk factors of distress, in order to improve the quality of life of lung cancer patients. Methods: The investigation was consisted of 209 lung cancer patients who were treated in Fourth Hospital of Hebei Medical University from February 2014 to December 2015.Patients were assessed through the use of distress thermometer, problem list, quality of life questionnaire. Lung cancer patients were divided into a significant distress group and a non-significant distress group. Chi-square test was used to analyze the relationship between demographic characteristics, disease information and significant distress. Logistic regression analysis was used to analyze risk factors for distress. The Spearman rank correlation was used to analyze the correlation between the significant distress group and each area of the quality of life questionnaire. The test level was significantly different at P< 0.05. Results: The distress of majority lung cancer patients was 0-4 points, 68 cases were significant distress, significant distress rate was 32.5%. Logistic regression showed PS scores, family residence, informed condition were risk factors of significant distress(P< 0.001 < P= 0.035, P= 0.031). Economic problems were the most common cause of psychological distress in lung cancer patients. Other risk factors included the lack of time and energy to take care for the elderly/children, fear, sadness, dizziness and pain. The significant distress of lung cancer patients was negatively correlated with health status, physical function, emotional function, cognitive function, social function, and was positively correlated with symptoms as fatigue, nausea and vomiting, pain, shortness of breath, insomnia, loss of appetite and constipation. Conclusions: The incidence of significant distress in patients with lung cancer is 32.5%. PS score, fully informed, and family residence are the risks of significant distress in patients. The distress of lung cancer patients is significantly related to the quality of life.