Older adults with cancer use the emergency department (ED) for acute concerns. Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% 95% confidence interval; CI 3.0-7.6;  = 0.005) and hospice (1.3% 95% CI 1.0-3.2;  = 0.52) care and had a higher 30-day mortality rate (8.3%, 95% CI 6.2-10.4). Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.