Attachment style has been linked to pain, coping, and psychological distress in patients with chronic illness and their caregivers, but little research has focused on patients with lung cancer. The purpose of this study was to investigate how marital attachment style in lung cancer patients and their spouses related to patients’ symptoms, self-efficacy for symptom management, and psychological distress and to their spouses’ levels of caregiver strain and self-efficacy. Participants were 73 early-stage lung cancer patients and their spouses who completed two standardized measures of attachment: marital attachment style and anxious and avoidant marital experiences. Patients completed questionnaires assessing pain, fatigue, self-efficacy for symptom management, anxiety, and depressive symptoms. Caregivers completed questionnaires assessing caregiver strain and self-efficacy for helping patients manage symptoms. Results indicated significant correlations between patient attachment and symptoms, self-efficacy, and psychological distress: Patients with a fearful attachment style (r=.37, p=.002) and those high in anxious (r=.37, p=.002) and avoidant (r=.30, p=.01) marital experiences reported higher levels of fatigue. Patients with a fearful attachment style also reported higher levels of pain (r=.37, p=.002). Anxious marital experiences were negatively associated with self-efficacy for symptom management (r=−.26, p=.03). Fearful, preoccupied, and dismissing attachment styles were significantly associated with anxiety (r=.24-.43, p’s<.05), as were anxious (r=.58, p<.0001) and avoidant (r=.45, p<.0001) marital experiences. Anxious (r=.38, p=.001) and avoidant (r=.40, p=.0005) marital experiences were also associated with depression. Among spouses, those with a preoccupied attachment style (r=.23, p<.05) and anxious (r=.25, p<.04) and avoidant (r=.24, p<.04) marital experiences reported higher levels of caregiver strain. Spouses with a more secure attachment style reported greater self-efficacy (r=.30, p=.01) while those high in avoidant marital experiences reported lower self-efficacy for helping the patient manage symptoms (r=−.24, p=.04). These findings suggest that marital attachment style is related to both patient and spousal adjustment to lung cancer.