The value of palliative chemotherapy for hospice patients is difficult to quantify and little is known about outcomes from these treatments. This study examined quality of life and symptom control in hospice patients with cancer receiving chemotherapy and in a control group of hospice patients with cancer who had not received chemotherapy for at least 3 months. Using a case-control study design matching patients by age, gender, race, and cancer diagnosis, patients receiving chemotherapy reported a similar number of symptoms as patients off chemotherapy. Global symptom distress was comparable in both groups as was quality of life. Patients in both groups were similar at the symptom-specific level, however, patients on chemotherapy had better symptom outcomes for urination problems (p=0.03), numbness/tingling (p=0.03), muscle weakness (p=0.07), and pain (p=0.09). Patients on chemotherapy had poorer symptom control involving change in taste (p=0.01) and cough (p=0.01). Patients on chemotherapy were more likely than those off chemotherapy to report that chemotherapy "made them feel better" (p=0.01) and "allowed better symptom control" (p=0.01), indicating that patients taking chemotherapy had more subjective benefit from chemotherapy when compared to those off chemotherapy. The two groups showed no difference in the rate of survival.