Objective. To investigate the factors which distinguish the minority of terminally ill cancer patients who receive in-patient hospice care from the majority who do not. Design. Secondary analysis of data from the Regional Study of Care for the Dying, an interview survey of family members or others who knew about the last year of life of a random sample of people who died in 20 English health districts in 1990. Subjects. 2063 people who died from cancer. Sudden deaths were excluded. 342 had been admitted to a hospice in their last year of life. Results. Patients who had hospice inpatient care were more likely than those who did not to have been in pain in the last year of life (OR 2.9), to have been under the age of 85 at death (2.8), to have needed help with between one and seven activities of daily living for between one and six months (1.98), to have had breast cancer (2.24) and to have had constipation (1.60). Conclusion. The results do not demonstrate major differences in pain and symptom experience between cancer patients admitted to hospices in the last year of life and those who are not. Other factors, notably age, dependency level and site of cancer, play a role in determining admission but have limited predictive value. There seems little rationale in why some patients receive this care and others do not. Further research is needed to investigate whether hospice admissions procedures and/or the referral patterns of GPs/hospital doctors lead to some patients being unfairly disadvantaged. The appropriateness (or otherwise) of purchasers and providers of hospice care concentrating upon pain and symptom control rather than on, for instance, nursing care and psychological support will be discussed.