Despite these recommendations, and probably due to a lack of palliative care teams, patients’ referral to PCT in daily practice is often late (eg: no more therapeutic options, general condition too weak). Recent studies demonstrated the positive impact of PC on aggressiveness of end-of-life care that includes chemotherapy, intensive care unit admission, Emergency Department (ED) visit and acute unit hospitalization, during last month of life. In pancreatic cancer in a retrospective study the positive impact of a PC consultation on these above mentioned end-of-life indicators. These results were confirmed in a prospective multicentric randomized controlled Italian trial including 206 patients with metastatic pancreatic cancer. Recently, the concept of PC has evolved with the issue of the timing of palliative care referral (PCR), and the benefits of an early palliative care.