Despite the importance of empathic communication in cancer patient outcomes, the majority of opportunities to respond empathically to a patient's concern within clinical consultations are "missed" (i.e., 70-90%), or not responded to by physicians. The present study examined the empathic opportunities and responses within clinical consultations of lung cancer patients and how these each are associated with patient-reported outcomes. Results indicate that lung cancer patients (n = 56) most commonly presented empathic opportunities related to emotions, anxiety was significantly associated with empathic opportunity type (p = .011), and physicians are most likely to respond with high empathy to statements around a patient making progress rather than bringing up a challenge or an emotion they felt (p = .031). The present study results highlight the need to train lung cancer physicians to respond with higher empathy to opportunities to respond to negative emotions, including mentions of challenges faced or emotions experienced, as these patients are at the highest risk of experiencing distress and the least likely to receive a high empathic response from physicians.