This study examined whether patients who are not fluent in English receive less than optimal palliative care. The subjects were 130 consecutive patients (24 non-English speakers, NE, and 106 English speakers, E) with advanced malignant disease who were admitted to three metropolitan-area hospitals and followed for 6 months or until death. 92% of patients who were unaware of their diagnosis were NE. Control of non-pain symptoms was worse for NE patients than for E patients during their last two months. There was an increased prevalence of mood disturbance in NE patients during their first two months in the study. Of the 102 (83 E, 19 NE) patients who died during the study period, no NE patients died at home. These results suggest that patients not fluent in English received less optimal palliative care. Communication of the diagnosis and prognosis requires the cooperation of the patients' families as well as the use of professional interpreters. Further research is necessary to identify the differences in cultural attitudes that may have contributed to these findings.