Background <p>Most patients with pancreatic cancer have advanced disease at the time of diagnosis and a poor prognosis. Therefore, it is important to investigate the symptom burden for these patients, e.g., at the start of specialized palliative care (SPC).</p> Aim <p>To investigate symptoms, problems, and quality of life in patients with pancreatic cancer at the start of SPC and to explore the associations with demographic factors.</p> Method <p>The data sources were the national Danish Palliative Care Database and Danish Pancreatic Cancer Database. Patients with pancreatic and peri-pancreatic cancer, who were diagnosed and died between 2011 and 2018 and admitted to SPC were included. Data about symptoms, problems, and quality of life were collected by EORTC QLQ-C15-PAL (10 scales ranging 0–100). Using ordinal logistic regression analyses, the associations between demographic factors and the symptoms and functions scores and QOL (outcomes) were investigated.</p> Results <p>From 2011–18, 3,497 patients with pancreatic cancer were admitted to SPC and 58% (<i>N</i> = 2028) of these completed the QLQ-C15-PAL. Patients with pancreatic cancer had a high symptom burden regarding fatigue (mean: 76), loss of appetite (mean: 68), and pain (mean: 56), whereas among function scales, low physical function (mean: 35) and low quality of life (mean: 39) were found. Younger patients and patients who had not received any anticancer treatment had a higher symptom burden.</p> Conclusion <p>In this nationally representative study, patients with pancreatic cancer had a high symptom burden and low quality of life at admission to SPC, underlining the need for symptom assessment and palliative care, also before referral to SPC.</p>