Background <p>Poor analgesic compliance often results in persistent pain, impairing quality of life in cancer patients. Mobile health app incorporated health education offers promising strategy to improve medication adherence and support palliative care needs among patients with advanced cancer. The current study aimed to compare the effectiveness of mobile app-based prescription (MABP) with integrated <i>health Education(UPPCHAR App)</i> versus conventional prescription (CP) along with booklet-based education in improving compliance, knowledge and satisfaction among patients with advanced cancer receiving palliative care.</p> Design <p>Randomized Controlled Trial.</p> Setting/participants <p>204 eligible patients, randomly allocated to MABP (<i>n</i> = 102) or CP group (<i>n</i> = 102) using Block randomization. <b>Inclusion Criteria</b>: Patients with advanced cancer (Biopsy proven cancer, stage 3/4; Age &gt; 18 years) receiving palliative care having access to Android phone. <b>Exclusion Criteria</b>: Life expectancy &lt; 6 months, cognitive/psychiatric illness, unable to read English/Hindi, or use smartphone. Data collected at baseline and six months through interviews using demographic and clinical profiles, Adherence to Refills and Medication Scale (ARMS), Knowledge questionnaire (structured) and Patient Satisfaction Questionnaire (PSQ-18).</p> Results <p>Both the groups were comparable in terms of baseline demographic and clinical profile (<i>p</i> &gt; 0.05; χ²/Fisher’s exact test, Two sample t-test; Wilcoxon rank sum Test) except for education and occupation of the patients, surgery done and duration of analgesic intake which were adjusted using ANCOVA. Mean age of patients in MA and CP group was (48.28±13.98) and (50.34±13.89) years respectively. Majority of patients in MA group − 76(74.5%) and CP group 66(64.7%) - were in stage 4 cancer. Both groups had comparable baseline compliance, knowledge and satisfaction. After six months, MABP group demonstrated significantly better medication adherence [MABP:17.79±4.01vsCP:23.99±2.41,<i>p</i> &lt; 0.05,95%CI; unadjusted:6.20(5.28,7.11)adjusted:6.38(5.41,7.34)] and also higher knowledge compared to CP group [MABP:13.41±3.74vsCP:8.90±1.99,<i>p</i> &lt; 0.05,95%CI; unadjusted:4.50(3.68,5.33)adjusted:5.59(5.02,6.15)]. Patient satisfaction, evaluated across multiple domains (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctors, and convenience) was also better in MABP group (<i>p</i> &lt; 0.05) compared to CP group after 6 months.</p> Conclusion <p>UPPCHAR mobile app (mHealth) enhanced medication adherence, knowledge and overall satisfaction among patients with advanced cancer indicating feasibility of using Mobile app to support routine palliative care. Future studies should focus on integrating mobile apps into routine workflows to ensure sustained patient benefit.</p> Trial registration <p>Trial registered prospectively with “Clinical Trial Registry- India” on 12/01/2022 (<b>CTRI/2022/01/039354).</b></p>