The ten most frequently reported pretreatment symptoms on the Rotterdam Symptom Checklist, which was completed by more than 650 patients entering two MRC Lung Cancer Working Party multicentre randomised trials, included general symptoms (tiredness, lack of appetite) and psychological distress (worry, anxiety) in addition to disease-related chest symptoms (cough, shortness of breath). Although the number and severity of symptoms increased with worsening performance status, the commonest symptoms were found to be virtually the same for patients with small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC), and for different grades of performance status. Women with NSCLC reported more psychological symptoms than males, but this difference was much less evident in patients with SCLC. Thus, in order to assess fully the benefit of palliative treatments in patients with lung cancer, account must be taken of all symptoms at presentation, in addition to the traditionally recognised chest symptoms.