Purpose <p>The aims of this study were to explore the relationships between dyadic coping (DC) and emotional distress (anxiety and depressive symptoms) in young and middle-aged couples dealing with cancer, from the perspective of gender.</p> Methods <p>This cross-sectional study comprised 275 couples (aged 20–59) in which one partner had a cancer diagnosis. Couples completed the general information questionnaire, the Hospital Anxiety and Depression Scale, and the Dyadic Coping Inventory. The actor-partner interdependence moderated model was used to analyze the dyad data and the moderating role of patient gender.</p> Results <p>No matter whether for patients or spouses, negative DC positively correlated with anxiety and depression symptoms, positive DC negatively correlated with anxiety and depression symptoms. For anxiety symptoms, patients’ gender moderated the actor effect of the pair’s negative DC on their anxiety symptoms and the partner effect of the spouse’s negative DC on the patient’s anxiety symptoms. For depression symptoms, the patient’s gender moderated the actor effect of the spouse negative DC on his or her own depressive symptoms. The relationships between negative DC and emotional distress are stronger among female patients and female spouses.</p> Conclusions <p>This study reveals that patient gender plays a moderating role between negative DC and emotional distress symptoms. It suggests that relevant interventions should focus on reducing negative DC behaviors of patients and spouses, especially for female patients and spouses.</p>