Introduction: Despite current guidelines, referral to palliative care remains limited in patients with advanced cancer. Currently, no standardized tool exists to timely determine which patients warrant an inpatient palliative care consult. The Supportive & Palliative Care Indicators Tool (SPICT™) tool aims to identify patients with deteriorating health and assess for unmet palliative and supportive needs, but this has not been validated in cancer patients. Methods: This is a single-center, retrospective cohort study analyzing patients with advanced/metastatic cancer admitted between January 1, 2019 to June 30, 2019. Baseline demographics, length of hospital stay, functional status, co-morbidities, cancer type, number of palliative/hospice referrals, 6-month mortality, and a modified SPICT score (m-SPICT) were obtained. Univariate and bivariate analysis were performed using Mann-Whitney U-tests and Chi-square. Results: 227 with advanced/metastatic cancer were included, with majority of patients having lung and gastrointestinal malignancies. Of the 227 patients, 139 (61%) were m-SPICT positive (scores ≥ 2) while 88 (39%) did not meet the cut-off value. M-SPICT positive patients had more co-morbidities (p = 0.009) and a longer hospital length of stay (p = 0.0003). These patients had more inpatient palliative (45% vs 2.3%) and hospice (30% vs 1%) referrals, with resulting changes in code status (p < 0.0001). M-SPICT positive patients had a higher 6-month mortality rate compared to M-SPICT negative patients (58% vs 16%, p < 0.0001). Conclusion: A positive m-SPICT is associated with increased poor clinical outcomes in advanced/metastatic cancer patients and can be used as a tool to trigger early palliative care referral.