Palliative care is now considered an important quality component within cancer care and essential to the continuum of cancer care programs nationwide. American Indian and Alaska Native patients have significant differences in mortality from various cancers, and therefore palliative care is very important while working in parallel towards improved survival overall. In fact, palliative care has in some circumstances even contributed to improved survival (Annual report to the Nation on the status of cancer 1975-2009. DOI:10.1093/jnci/djs491). This article recounts the efforts made over many years to institute quality palliative care programs that are culturally acceptable to Native populations and outlines “next steps”.