Background: The American Society of Clinical Oncology recommends initiation of palliative care concurrently with active treatment within 8 weeks of advanced cancer diagnoses. We studied the referral practice in our institution. Methods: We reviewed charts of all outpatients seen between June and November 2017 with a diagnosis of leukemia or breast, thoracic, head and neck, pancreas, and prostate malignancies. Data collection included: diagnosis, stage, age, race, gender, deceased/alive, lines of therapy, referral to palliative care, time to referral, reason for referral, time from referral to death, referring provider, inpatient/outpatient, follow up visits, hospitalizations, time from chemotherapy to death, referral for services, social worker referral, and insurance type. Patients with incomplete records were excluded. Fisher’s exact test and Wilcoxon rank-sum test were used to compare groups. Results: Of the 174 eligible patients, 49 (28%) were referred to Palliative Care. Only 22% of patients were referred within 8 weeks of diagnosis. The most common reason for referral was pain management; with the least common being goals of care. Women were more likely to be referred than men, 38% vs 22% (p = 0.035). The mean [SD] age was 63.9[14.7] years. By stage, 96% of patients had stage IV disease and the only stage III patients were those with lung cancer. Amongst stage IV cancers, breast and lung cancer had the highest referral rate, each 50%, with prostate cancer having the lowest at 5% (p < 0.001); despite prostate cancer being the most common diagnosis. There were more referrals to hospice (24% vs 6%; p = 0.002) and home palliative care (16% vs 1%; p < 0.001) in the group referred. The mean [SD] time (weeks) from last chemotherapy to death was shorter in the group referred 6.51[4.19] vs. 16.3 [11.29] (p = 0.037). There was no difference in referral rates to home care (p = 0.192), based on insurance type (p = 0.683) or race (p = 0.647). Conclusions: Referral rates in this analysis did not achieve the recommended guideline standards. Additional educational interventions are planned to identify and overcome barriers to referral.