Pancreatic cancer is a rapidly fatal disease with palliation often serving as the main goal of treatment. The end of life is often marked by severe symptoms and poor quality of life (QoL). Several studies presented at the 2012 ASCO Gastrointestinal Cancers Symposium addressed the importance of symptom identification and management for patients with pancreatic cancer: 1) a study evaluating the correlation between patient-reported symptoms, disease burden and treatment duration in patients with advanced pancreatic cancer undergoing gemcitabine-based chemotherapy (Abstract #370); 2) a Japanese study found that patients without worsening of pain or sleep symptoms at one month of chemotherapy had higher frequency of disease control (Abstract #195); and 3) a study showed that fear of cancer recurrence is a substantial problem following resection and should be targeted (Abstract #289). The authors summarize the findings and discuss the importance of QoL in these patients. The results of these studies may facilitate in identifying symptom changes as predictive markers, and improving care and QoL for patients with this devastating disease.