Background: We sought to describe hospital utilization (HU) in patients with advanced-stage cancer who refused treatment and to determine if palliative medicine referral was associated with any changes in HU. Methods: We performed a retrospective chart review of patients diagnosed with advanced-stage malignancies, aged 18-75 years, between 01/01/ 2010 and 12/31/2015, who refused any form of therapy. HU was measured as a sum of emergency department (ED) visits, ED-to-inpatient admissions, and direct inpatient admissions. Results: The study population was composed of 508 patients. The mean age was 63.1 years (standard deviation (σ) 8.1); females composed 39.6% (201/508). HU prevalence was 61.8% (314/508). In female patients, HU occurred in 60.2% (121/201), compared 62.9% (193/307) in male patients (p=0.545). Palliative medicine referral occurred in 17.7% (90/508). When HU was evaluated according to palliative medicine referral, 68.9% (62/90) of patients who were referred to palliative medicine had HU, compared with 60.3% (252/418) who were not referred to palliative medicine (p=0.128). The mean number of hospital visits (NHV) in the population was 1.0 (SD 1.3). In palliative medicine-referred patients, the mean NHV was 1.1 (SD 1.2), and 1.0 (SD 1.3) in patients not referred to palliative medicine (p=0.435). In the total population, ICU admissions occurred in 17.1% (87/508). In patients referred to palliative medicine, ICU admissions occurred in 11.1% (10/90). In patients not referred to palliative medicine, 18.4% (77/418) had ICU admissions (p=0.095). In the total population, the average number of ICU admissions was 0.2 (SD 0.4). In palliative medicine-referred patients, the average number of ICU admissions was 0.1 (SD 0.4). In patients not referred to palliative medicine, the average number of ICU admissions was 0.2 (SD 0.4); p=0.141. Conclusions: Hospital utilization occurred in approximately 60% of patients with advanced-stage cancer who did not accept treatment. Sex was not associated with hospital utilization. The average number of hospital visits remained consistent, whether patients were referred to palliative medicine or not. While a slightly higher prevalence of ICU admissions was observed in patients who were not referred to palliative medicine, this difference did not reach statistical significance, and the number of ICU admissions was comparable regardless of palliative medicine referral. Of note, we did not evaluate if early palliative medicine referral influenced HU compared with later palliative medicine referral.