Background: Outpatient PC facilitates timely referral and improved outcomes for cancer patients. We examined the change in outpatient PC services at US cancer centers over the past decade. Methods: Between April and August 2018, we surveyed all 62 National Cancer Institute designated cancer centers (NCI-CCs) and a random sample of 61 out of 1306 non-NCI-CCs. Two surveys previously used in a national study (Hui et al. JAMA 2010) were sent to each institution: a 22-question executive survey inquired about PC infrastructure and attitudes toward PC and an 82-question PC program leader survey inquired about the PC structures, processes and outcomes in detail. Generalized linear mixed model and logistic regression were used to examine the change in availability of outpatient PC services between 2009 and 2018 among NCI-CCs and non-NCI-CCs, respectively. Results: Among NCI-CCs, 40/62 (65%) executives and 52/61 (85%) program leaders responded. Among non-NCI-CCs, 41/61 (67%) executives and 27/39 (69%) program leaders responded. For NCI-CCs, we observed a significant increase in outpatient PC clinic between 2009 and 2018 (59% v. 95%; OR 13.1, 95% CI 2.6-66.8; P = 0.004) but no significant change in inpatient consultation team (92% v. 90%), PC unit (26% v. 40), nor institute-run hospice (31% v. 18%). For non-NCI-CCs, there was a significant increase in outpatient PC clinics (22% v. 42%; OR 2.51, 95% CI 1.01, 6.26; P = 0.05) and decrease in institute-run hospice (42% v. 22%; P = 0.05) over the past decade but no significant change in inpatient consultation team (56% v. 68%) and PC unit (20% v. 17%). The median (IQR) duration from outpatient referral to death increased from 90 (84, 120) days to 180 (131, 220) days for NCI-CCs and from 41 (28, 54) days to 84 (48, 120) days for non-NCI-CCs, respectively. We also observed significant growth in staffing, service hours, number of referrals, fellowship programs and rotations for oncology fellows, although research activity remains low. Conclusions: Cancer centers reported significant growth in outpatient PC clinics and overall PC infrastructure since 2009. However, major gaps in structures and processes exist, such as the lack of outpatient clinics at non-NCI-CCs, absence of PC units and limited research.