Advances in health care and changing demographics worldwide have led to an ageing population whose care at the end of life has become increasingly complicated. Clinicians face a difficult challenge in the effective management of symptoms and suffering of elderly patients with terminal cancer, against a backdrop of complicated family and social structures. We describe the most pertinent features of management of key symptoms, focusing on pain, dyspnoea, constipation, and anorexia–cachexia syndromes. We present a rational approach to nutritional issues along with a description of the psychosocial issues that must be included in the overall management of these patients.