Background: Increasingly, reimbursement models are shifting to bundled payments and pay-for-performance models. While cancer care is often profitable for hospitals in the fee for service model, it is important to monitor outcomes that could influence reimbursement, such as 30-day readmissions; possible indicators of poor quality, such as 30-day mortality admissions; and to utilize longitudinal measures of costs and revenues. Methods: We evaluated trends in the outpatient and inpatient care at an academic cancer center for patients across their last 6 months of life. All-payor hospital claims data were linked to Social Security Death Index data to determine patients’ date of death even if they did not die in-hospital. All utilization at our center was analyzed for the 3,128 cancer patients who died between January 2009 and June 2011. Results: Admissions increased over the final six months, with sharp increases in ICU and total bed days in the final three months. 31% of admissions were 30-day re-admissions; 40% had a negative net margin; and all (1,178) in the final month were 30-day mortality admissions. 63% of hospice referrals occur in the final month. Conclusions: With each month this hospital is increasingly exposed to the risks of 30-day mortality and 30-day readmissions. Are the escalating costs and risks justified in terms of outcomes or quality? These findings reinforce the need for care practices that ensure that care is aligned with patient and family preferences, and that alternate care options are available and presented to patients and families in a timely fashion.