Background: Evidence on the differences in symptom patterns between older palliative cancer and non-cancer patients is lacking. The purpose of the study was to determine the differences in symptoms between older hospitalised palliative cancer and non-cancer patients. Methods: A secondary analysis of two multi-centre cross-sectional studies was performed. A validated instrument was used to assess the frequency and intensity of 40 symptoms in older hospitalised palliative cancer patients (n = 100) and older palliative non-cancer patients (n = 100). The data were collected between March 2013 and June 2015. Differences between groups were measured statistically. Results: Overall, similarities in symptom patterns were observed between cancer and non-cancer patients. Some minor differences were detected between the groups. Non-cancer patients experienced significantly more physical symptoms and functional dependence than cancer patients. Patients with cancer experienced higher levels of frequency and intensity of psychological symptoms compared to non-cancer patients. Conclusions: Healthcare professionals should be aware of the high occurrence of symptoms in both cancer and non-cancer patients, and they should be educated about the systematic assessment of symptoms in multiple domains by accounting for the occurrence of generic symptoms and disease-specific symptoms.