--- - |2+ Abstract Objectives Quality of life and psychological well‐being are important patient‐centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low‐income and middle‐income countries remains scarce. We assessed health‐related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle‐income setting. Methods Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed‐up in Malaysia for 1 year. Health‐related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30) and EuroQol‐5 (EQ‐5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses. Results One year after diagnosis, the mean EORTC QLQ‐C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty‐four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high‐income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. Conclusion Cancer survivors in this middle‐income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well‐being is urgently needed in our settings. - Psycho-Oncology, Volume 27, Issue 9, Page 2172-2179, September 2018.