Early palliative care is recommended for patients with advanced cancer but is frequently initiated late. This review evaluates the effects of early vs. late palliative care (PC) initiation on quality of life, survival, healthcare resource use and patient and family satisfaction. A systematic review was conducted according to PRISMA Guidelines. PubMed, Scopus, and the Cochrane Library were searched for studies published from January 2010 onwards comparing early and late PC initiation in adults with advanced cancer. Study selection and data extraction were performed independently by two reviewers. Nineteen studies were included. Early palliative care improved quality of life (QoL) in most studies and was associated with lower use of aggressive healthcare interventions in 4 reports. Survival outcomes were inconsistent. Patient and family satisfaction generally improved with early PC. Early palliative care improves QoL and may reduce high- intensity care, while evidence for other outcomes remains mixed.