Objectives This study examined both the frequency of appearance‐related symptoms and distress resulting from these symptoms in cancer patients receiving chemotherapy. Methods Self‐report questionnaires were distributed to 753 outpatients receiving ≧4 weeks of treatment at an outpatient chemotherapy center. Valid responses were returned by 638 patients (response rate, 84.7%). Participants were questioned about 57 appearance‐related symptoms (AS) and 23 non‐appearance‐related physical symptoms (non‐AS); psychological well‐being was assessed using a shortened version of the Derriford Appearance Scale 59. Results Questionnaire responses were obtained from 264 male and 374 female patients (mean age, 59.5 years; range, 18–85 years). Most respondents (80.3%) were concerned with changes in appearance resulting from treatment. By sex and disease type, women suffered more than men, and treatment for breast cancer created the greatest distress for women. Conclusion Cancer patients are concerned about a variety of AS, and these may result in greater distress than non‐AS. AS‐related information and care are increasingly being sought in advance of treatment. Copyright © 2013 John Wiley & Sons, Ltd.