Extended survival rates and more diverse and complex cancer trajectories and symptomatology require new approaches to palliative symptom management. Recent research in this field has increasingly recognized the complex and multidimensional nature of mechanisms underpinning symptoms in advanced cancer patients and the need for individualized and tailored approaches to symptom management. There are also important developments in the use of more pragmatic trial designs to better reflect real world complexity. This presentation will illustrate such developments by drawing on examples of research focused on managing nausea in advanced cancer and studies which have examined the implications of multiple co-occurring symptoms in older people with cancer.