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Background: Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups. Patients and methods: Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000–2006. Results: In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%–17.28%), (ii) frequent emergency room visits (15.69%–20.99%) and >14-day hospital stays (41.48%–46.20%), (iii) admissions to intensive care units (10.04%–12.41%), and (iv) hospital deaths (59.11%–65.40%). Use of cardiopulmonary resuscitation (13.09%–8.41%), intubation (26.01%–21.07%), and mechanical ventilation (27.46%–27.05%) decreased, whereas use of hospice services increased considerably (7.34%–16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates. Conclusions: The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life. [ABSTRACT FROM AUTHOR]