Patients with pancreatic cancer often face a heavy symptom burden and low quality of life (QoL). Continuing anticancer therapy or extensive hospital service use near the end of life (EOL), as well as delayed initiation of palliative care (PC), may further impair QoL. Early integrated palliative care (EIPC) is recommended but remains underutilized. The aim of this dissertation was to assess EOL care in patients with pancreatic cancer. Studies I and II were retrospective registry-based cohorts that evaluated whether the timing of the formal transition to PC—the PC decision—affected hospital resource use, access to specialized PC (SPC), and the extent to which EIPC was implemented. Study III was a prospective study examining the ability of three QoL questionnaires to monitor symptoms and QoL over a 4-month follow-up period. Across Studies I and II, nearly half of the patients had a PC decision made within the last month of life or not at all. Such late or absent decisions were consistently associated with higher healthcare use in the last month, including more emergency department visits, more hospitalizations, and anticancer therapies being continued closer to death. Late or missing PC decisions were also linked with more deaths in secondary or tertiary hospitals. In contrast, early PC decisions resulted in earlier and more frequent SPC engagement. However, only 36% of patients received PC integrated with ongoing anticancer treatment. In Study III, the short QLQ-C15-PAL provided an efficient overview of well being, while QLQ-PAN26 contributed valuable pancreatic cancer-specific information. No major changes in symptoms or QoL were observed, although missing data, primarily due to non-completion of follow-up questionnaires as patients’ health declined or because of death, increased over time. The most common reported concern was worry about future health. In conclusion, a timely transition to PC is associated with less aggressive EOL care and earlier involvement of PC services. QoL questionnaires offer a practical tool for guiding communication and care in this highly symptomatic patient population.