The objective of this study was to examine the agreement between health care professionals' (HCPs) and patients' evaluation of health-related quality of life (HRQOL) issues for cancer patients with bone metastases. A total of 413 patients and 152 HCPs were interviewed across five centres worldwide. Mean scores were almost always higher for HCPs than for patients. Patients and HCPs agreed that four issues affect HRQOL of bone metastases patients profoundly: 'long-term (chronic) pain', 'difficulty in carrying out usual daily tasks', 'able to perform self-care' and 'able to perform role functioning'. A substantial difference was found with respect to the perceived importance of psychosocial and somatic issues. Patients emphasised psychosocial issues with a particular focus on 'worry' about loss of mobility, dependence on others and disease progression, HCPs however rated 'symptom' issues as more important, specifically those related to 'pain'. In conclusion, patients and HCPs agreed that pain and physical/role functioning are important to the HRQOL of cancer patients with bone metastases, but patients also emphasized the importance of psychosocial issues to HRQOL. This information has been an important component in the development of a health-related quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM 22).