Purpose <p>This study evaluated the impact of Palliative Care Consults (PCC) on medicines optimisation in patients with cancer, focusing on deprescribing patterns and associated predictors.</p> Methods <p>This retrospective cohort study reviewed the medical records of patients with cancer admitted to an inpatient hospice unit between January 1 and December 31, 2022. Data were collected at hospice admission, first PCC assessment, and the day of death. Eligible patients had a life expectancy of ≤ six months, a Palliative Performance Scale (PPS) score ≤ 70%, and were prescribed at least one preventive medication at admission. Outcomes included medication burden (preventive medication use and polypharmacy), symptom control medication use, and potentially inappropriate medication (PIMs) use, assessed using OncPal criteria. PIM deprescribing patterns and predictors of successful deprescribing were analysed.</p> Results <p>Among 321 patients (mean age 62.6 years; 60.1% female), the mean number of medications decreased from 7.87 at admission to 7.22 on the day of death (<i>P</i> &lt; 0.001). Preventive medications decreased from 3.53 to 1.25, while symptom control medications increased from 4.34 to 5.98. PCC was associated with a significant PIM reduction (2.11 to 0.52; <i>P</i> &lt; 0.001). Deprescribing was predominantly proactive at the first PCC assessment (61.3%) but reactive in later stages (89.6%). Male gender, absence of polypharmacy, and fewer than three PIMs at admission were significantly associated with successful deprescribing (<i>P</i> &lt; 0.05).</p> Conclusions <p>PCC was associated with improved medicines optimisation, though deprescribing remained reactive. Integration of structured, proactive deprescribing guidelines may enhance hospice care at the end of life.</p>