Purpose
This study was designed to examine both actor and partner effects of perceived marital relationship on quality of life, as well as the mediating effect of holding back cancer-related concerns.

Methods
This was a cross-sectional study in an outpatient setting. Participants were 150 couples consisting of patients with lung cancer and their spouses. Perceived marital relationship, holding back cancer-related concerns, and quality of life were measured with self-report scales. Actor and partner effects on quality of life were analyzed using the actor–partner interdependence mediation model by using structural equation modeling.

Results
A couple's quality of life had a significant direct actor effect on the perceived marital relationship. However, the partner effect and the indirect effect of holding back cancer-related concerns on quality of life was not significant.

Conclusion
When patients with lung cancer and their spouses perceived their marital relationship positively, they assessed their quality of life positively. They were also found to be less hesitant when talking about cancer-related concerns. However, holding back on talking concerns did not have a significant impact on the quality of life (of either oneself or the spouse). Therefore, nurses should first check how they perceive their marital relationship before encouraging communication between patients with lung cancer and their spouses. Nurses can assess these risk factors and intervene if needed, along their cancer trajectory.