Background: Due to its poor prognosis, a diagnosis of gastric cancer represents a challenging situation for patients and healthcare providers, including psycho-oncological care. There has been little research about the extent to which patients experience distress and their use of support services. Objectives: We aimed to examine (1) the distress and utilization of psychosocial support for patients with gastric cancer compared to other cancer types, (2) the evaluation of psychosocial support services in patients with gastric cancer, and (3) identify predictors of utilization behavior. Methods: The data analysis is based on pooled data of two multicenter research projects. The data of N = 89 gastric cancer patients and N = 1661 patients in the comparison group are analyzed (questionnaires included the distress thermometer with cutoff score ≥ 5 for over-threshold distress and our own questionnaire for the utilization/evaluation of psychosocial support services by patients). In addition to descriptive analysis methods, a binary-logistic regression is carried out to detect predictors of the utilization of psychosocial support. Results: More than 40% of gastric cancer patients reported high levels of distress. Half of them use psychosocial support, most commonly social welfare/services advice and psychological support/psychotherapy. The latter was rated as the most helpful form of support. Younger age was found to be a significant predictor of utilization (odds ratio [OR] = 8.3; p < 0.01). There was weak evidence of an association between increased distress and use of psychosocial support (OR = 2.3; p = 0.19). Conclusion: In the face of high adjustment demands, psychosocial support can help patients with gastric cancer. Currently, this support is used less by older patients, although they report similarly high levels of distress. Providers should therefore make this group of people aware of the availability and content of psychosocial support, thus, facilitating access to psycho-oncological care.