BACKGROUND Brain tumor patients have limited survival and suffer from high morbidity requiring specific symptom management. Specialized palliative care (PC) services have been developed to address these symptoms and provide end-of-life treatment. Global utilization patterns of PC in neuro-oncology are unknown. METHODS In a collaborative effort between the Society for Neuro-Oncology (SNO), the European Association of Neuro-Oncology (EANO), and the Asian Society for Neuro-Oncology (ASNO), a 22-question survey was distributed. Wilcoxon 2-sample and Kruskal-Wallis tests were used to assess differences in responses. RESULTS Five hundred fifty-two evaluable responses were received. The most significant differences were found between Asia-Oceania (AO) and Europe as well as AO and United States/Canada (USA-C). USA-C providers had more subspecialty training in neuro-oncology, but most providers had received no or minimal training in palliative care independent of region. Providers in all 3 regions reported referring patients at the onset of symptoms requiring palliation, but USA-C and European responders refer a larger total proportion of patients to PC (P < .001). Physicians in AO and Europe (both 46%) as well as 29% of USA-C providers did not feel comfortable dealing with end-of-life issues. Most USA-C patients (63%) are referred to hospice compared with only 8% and 19% in AO and Europe (P < .001), respectively. CONCLUSIONS This is the first report describing global differences of PC utilization in neuro-oncology. Significant differences in provider training, culture, access, and utilization were mainly found between AO and USA-C or AO and Europe. PC patterns are more similar in Europe and USA-C.