Goals: The aims of this study were to describe the symptoms, their treatment during the final months of life of terminally ill cancer patients and to assess characteristics of the dying process. Patients and methods: We used a prospective study design. From a representative sample of physicians who participated in a study of end-of-life decision making, we asked whether they were treating a patient with cancer whose treatment was no longer aimed at cure, whose life expectancy was probably longer than 1 week but no longer than 3 months and who would probably continue to be treated by the same physician until their death; 85 physicians completed a monthly questionnaire until patients' deaths. Results: Patients were confronted with an increasing amount of symptoms during the final months of their life. Fatigue, loss of appetite, dependency and feeling unwell were the most prevalent symptoms. Physical symptoms were more often treated than psychosocial symptoms. The number of medical disciplines involved in the patient's care decreased in the period before death, but the number of informal caregivers increased; 73% of patients died peacefully. A peaceful death was impeded by feelings of anxiety and loneliness but promoted by the involvement of children in their patients' care. Conclusion: The results give insight into the nature of suffering and factors related to the dying process of terminally ill cancer patients. Attention to psychosocial well-being and to the need to be with loved ones appears to be essential for patients' quality of life. © Springer-Verlag 2004.