As the discipline of Palliative Medicine matures throughout the world, it is becoming more apparent that concepts of adequate palliative care must be expanded in their focus beyond pain and physical symptom control to include psychiatric, psycho-social, existential and spiritual domains of end-of-life care ( Table 1-Breitbart, et al 1995, 1998; Chochinov Et Breitbart, 2000; Rosseau 2000, Puchalski Et Romer, 2000). While pain and physical symptoms are indeed distressing to cancer patients with advanced disease, the fact remains that symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms (Portenoy, et al 1994). Integrating spirituality and issues of meaning and faith into the supportive care of cancer patients with advanced disease is now an essential component of optimal supportive care. This paper reviews the issues of spirituality and meaning in the supportive care of advanced cancer patients and presents a novel psychotherapy intervention based on a meaning-centered approach greatly influenced by work of Viktor Frankl.