The burden of lung cancer has several dimensions: the physical symptoms, particularly shortness of breath which is frightening and limits activites; the psychological implications of it as a lethal  cancer (“a death sentence”);and, the social impact of being considered as self-inflicted by virtue of smoking. Each contributes to the burden overall and results in one of the highest levels of depression in patients among all sites of cancer. The power of the anti-tobacco campaign has been so powerful in western countries  that patients with the disease felt abandoned:  the public health concept seemed to them to be “let those with the disease die and concentrate on saving the next generation.” They felt that their cancer  received far less research dollars and there was little emotional support, as if “you got what you deserved”. In the early 1990s, a woman with lung cancer told me, “I sit in clinic and wish I had breast cancer because there is support for them, but nothing for lung cancer patients”. Having worked with patients with lung cancer over 25 years, there is reason for optimism that  the burden is slowly diminishing for several reasons. 1) The target therapies are changing survival in advanced cancer and patients are living longer with better quality of life. 2) The genetics of lung cancer are becoming more evident and the findings of difference in terms of risk and treatment is diminishing the idea that smoking is the only cause. 3) Attitudes are changing as more individuals develop lung cancer who never smoked and hence, society is learning that there are other risk factors. These changes suggest that societal beliefs do change, though slowly. The challenge at a global level is how to reduce tobacco use, especially in developing countries, without stigmatizing those who are being treated for the disease. Lung cancer remains a site of cancer in which patients and their families need  psychological support to cope with the range of challenges they face and their families. Identifying their psychological burden and distress early and addressing can be a major asset in assuring their ability to adhere to treatment regimens.