Palliative care is an important component of cancer treatment. Advancing palliative care in the developing countries is essential to improving patient care. The issues limiting its practice must be addressed, especially in light of the initiative to adapt the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to the Middle East and North Africa (MENA) region. Palliative care is in its early stage of evolution in the MENA region, and its practice encounters many challenges and barriers. Adaptation of guidelines should take into consideration the situation and conditions in the targeted region to improve the standard of care to an internationally acceptable level. A group of experts in the MENA region reviewed the literature and collaborated to assess the current status of palliative care and recommend modifications to the NCCN Guidelines based on the unique needs of the region.