Purpose <p>This study addresses key gaps in knowledge regarding two components of body image that impact the emotional well-being of cancer patients: physical appearance and body function. The study examines the interrelationship of anxiety and gender in endorsement of distress related to body function and physical appearance.</p> Methods <p>A retrospective study was conducted involving 1563 patients treated for cancer at City of Hope between 2009 and 2017. Patients completed a biopsychosocial problem-related distress touch-screen instrument before treatment as part of their routine clinical care. Relationships between body image constructs (physical appearance, body function), anxiety, and gender were examined using mixed models. Models controlled demographic (age, marital status, household income, education, and survey language) and clinical variables (cancer type, disease stage).</p> Results <p>An association between anxiety and gender (<i>p</i> &lt; 0.001) was found and was associated with body image distress. With higher levels of anxiety, women were significantly more distressed than men regarding physical appearance (<i>F</i> = 6.94, <i>p</i> = 0.009), while men were significantly more distressed than women regarding body function (<i>F</i> = 4.05, <i>p</i> = 0.044).</p> Conclusion <p>Distress regarding body image is an important factor to consider in patients with cancer. Understanding the impact of anxiety and gender upon physical appearance distress and body function distress can inform individualized medical and psychosocial care.</p>