Palliative chemotherapy is defined as treatment in circumstances where the impact of intervention is insufficient to result in major survival advantage, but does affect improvement in terms of tumor-related symptoms, and where the palliation/toxicity trade-off from treatment clearly favors symptom relief. The role of chemotherapy in circumstances where little or no survival benefit is anticipated remains controversial. This is despite the mounting body of evidence in favor of its use for symptom palliation. The notion persists that outcomes other than significant survival benefit are not valid, because of firmly held perceptions of toxicity. Studies of chemotherapeutic palliation using valid measures of quality of life, show that patients may be willing to accept some side effects of treatment, as long as they gain relief from tumor-related symptoms. The aims of this review are to present the case for palliative chemotherapy, to highlight the areas of progress which have made this feasible, and to provide guidance with regard to its appropriate use.