Background:Cancer pain is one of the most common and distressing symptoms in advanced cancer patients. Up to 90% of cancer pain can be controlled by using the World Health Organization guidelines. Objectives:This study was conducted to evaluate the improvement in cancer pain management as indicated by strong opioids’ consumption after the initiation of palliative care (PC) service and to determine factors that may be related to higher opioid consumption by advanced cancer patient. In addition, we aimed to assess the impact of high opioid doses on patient's survival.Patients and Methods:We retrospectively reviewed the medical records of cancer patients referred to a new PC service during six months period. We collected data regarding personal data, disease characteristics, previous cancer treatment, analgesic types and dosage and survival time. Opioid consumption was expressed in oral morphine equivalent (OME) dose. We compared the data of palliative care patients with a control group.Results:One hundred and seventeen patients were enrolled in our study, 61(52.1%) were males and 56(47.9%) females with a median age 53 years (range 17-90). Of 117 adult patients reviewed, 77% were receiving opioid analgesics, with 50% taking strong opioids. Patients with bony metastasis were receiving higher doses of opioids, their mean opioid dose was 145.1 ( 180.5)mg OME/day ( P=0.023). The mean opioid dose in patients pretreated with radiation therapy was 128.2 ( 177.3) mg OME/day ( P=0.004).The mean last prescribed regular opioid among cases was significantly higher among cases compared to controls (132 mg OME/day [ 166.5] vs. 66.2 mg OME/day [ 42], respectively; p= 0.001). The median survival was 209 days for patients treated with high doses of morphine (OME dose ≥ 240 mg), 152 days for those treated with doses 60- <240 mg and was 77 days for those receiving dose <60 mg (P= 0.015).Conclusion:The initiation of palliative care is associated with an increase in opioids consumption which is an indicator of improvement in cancer pain control. We found that the use of higher doses of opioids to control pain in advanced cancer patients is not associated with shorter survival. There is a need to change the current opioid regulations in Egypt to allow the prescription of enough amounts of strong opioids for cancer patients suffering from severe pain.