Historically, conceptual distinctions have not been made between the components of symptom experience--symptom distress and symptom occurrence--nor has the question of how distressing patients perceive different symptoms to be, irrespective of their current occurrence, been addressed. The aim of this study was to explore the hypothesis that there may be different patterns in discrepancies between how lung cancer patients and their caregivers assess symptom distress and in how they assess symptom occurrence. Thirty-three patient-nurse dyads and 54 patient-family caregiver dyads assessed patients' symptom distress and symptom occurrence. Discrepancies with regard to how patients, nurses, and family caregivers assessed symptom distress and symptom occurrence were identified. Patients and caregivers were more in agreement about which symptoms might cause distress than about current symptom occurrence. Caregivers rated symptom occurrence as greater than patients. The findings highlight the need to further explore what symptom characteristics caregivers address when assessing patients' symptom experiences.