Traditionally palliative care has been seen as being provided across the continuum of care, from diagnosis (or even before diagnosis) through to end-of-life care and into bereavement. Yet in many places, palliative care is often reserved for those reaching the end of their life, or for those only in the advanced stage of disease. Much work has been carried out with regards to outcomes of care, with a variety of tools and outcome measures being used to try and measure such outcomes. Despite the emphasis that has been put on outcomes of palliative care in recent years, challenges to the delivery of palliative care remain which impact directly on patient outcomes, such as: accessibility of services, availability of treatment such as radiotherapy, availability of medications such as oral morphine, and late referral to palliative care services. This paper will explore some of these factors, utilising case studies and examples from around the world. Where available, data from patient reported outcome measures (PROMs) will be utilised, looking at outcomes in terms of physical, psychological and existential issues. Following a discussion of the issues, recommendations will be made as to how early referral to palliative care services can be promoted and the implications of this on patient outcomes.