We investigated a possible relationship between levels of endogenous cortisol and severity of different symptoms in patients with advanced cancer. Twenty-three patients with predominantly gastrointestinal cancer, recruited in a palliative care unit, entered the study. Urinary free cortisol (UFC) was measured together with demographic data, blood parameters, tumour burden, concurrent illness, medication, nutritional status and quality of life. Significant positive correlations were found between levels of endogenous cortisol and appetite loss, fatigue and nausea/vomiting. The findings support the view of a chronic stress condition in advanced cancer. Interaction between cytokines and the hypothalamic-pituitary-adrenal (HPA) axis may also be important in the interpretation of the results.