Many cancer patients receive inappropriate and costly care before they die. As a result, regional interdisciplinary palliative programs were implemented in Canada. In this study, we determine whether de-institutionalization of healthcare services provided to cancer patients is a cost-effective strategy. A before and after analysis of linked administrative data for 16,283 adults who died of cancer between April 1993 and March 2000 residing in two Canadian jurisdictions. Individual, anonymyzed data from the cancer registry were linked to vital statistics, palliative care program databases, hospital and physician services, medications, nursing home care, and homecare. Age, gender, socioeconomic status, cancer diagnosis, disease burden, geographic and healthcare system variables are used to account for cost variations. Regression techniques are used to evaluate the implications of palliative care services on end-of-life hospital and physician costs. Access to palliative care increased from 45 percent to 81% between 1993 and 2000. Terminally ill cancer patients also spent less time in hospital between 1993 and 2000. Much of this time was spent in palliative home care (3.4%) and residential hospice care (2.4%). Nonetheless, acute care still accounts for most of the cost at the end of life. Two-thirds of $28,093 in services we identified were provided by hospitals to terminally ill cancer patients in their last year of life. Physician (10%), residential hospice care (8%), nursing home care (6%), homecare (6%) and prescription medications (3%) comprised the remainder. Total healthcare costs prior to and post implementation are statistically equivalent. The fact that total healthcare costs have not increased with the addition of a new program suggests that comprehensive, integrated palliative care programs are cost-effective.