Background <p>Sex-related differences in eating-related distress (ERD) experienced by cancer patients have not previously been clarified.</p> Methods <p>We conducted a multicenter survey among advanced cancer patients referred to palliative care. Data on patient characteristics were collected from the electronic medical records, and data on measurement outcomes were obtained from a questionnaire. Patients were categorized into male and female groups. We measured ERD using the Questionnaire for Eating-Related Distress among Patients with advanced cancer (QERD-P). The QERD-P comprises 3 items in each of the 7 factors, for a total of 21 items, and each item is rated on a 7-point Likert scale. High scores indicate worse distress. Comparisons were calculated using the Mann–Whitney <i>U</i> test. To assess associations between sexes and ERD, multivariate logistic regression analysis was performed.</p> Results <p>A total of 192 patients were enrolled and divided into the male (<i>n</i> = 92) and female (<i>n</i> = 100) groups. The total score of the QERD-P was significantly higher in the male group (<i>p</i> = 0.018). The subtotal scores of “reasons why I cannot eat,” “insufficient information,” and “arguments with my family” were significantly higher in the male group (<i>p</i> = 0.035, 0.032, and 0.003, respectively). The male group had significantly higher risks for ERD associated with “arguments with my family” and “time with my family” (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.38–5.24; OR 2.28, 95% CI 1.15–4.53).</p> Conclusions <p>Males had significantly worse ERD and were at higher risk of ERD in family relationships than females.</p>