Background <p>Patients with advanced gastrointestinal (GI) cancer experience a high symptom burden which frequently necessitates emergency care. Integration of early home-based specialised palliative care (SPC) with tumour-specific treatments may impact emergency healthcare use.</p> Methods <p>At the initiation of palliative chemotherapy, patients with advanced GI cancer were randomised to early home-based SPC integrated with tumour-specific treatment, or tumour-specific treatment with SPC referral when needed. The aim was to compare quality of life in the two groups. Here we present secondary outcomes; number of emergency department visits, hospitalisations, days of inpatient care, the time from the last chemotherapy treatment to death, and the place of death between the study groups.</p> Results <p>A total of 118 patients were randomised. Patients in the early SPC group had significantly fewer emergency department visits (median 1 versus 3), hospitalisations (median 1 versus 2), and inpatient care days (median 1.5 vs. 11.5) compared to the control group (<i>p</i> &lt; 0.001). There was no significant difference between the study groups in either time between the last chemotherapy treatment and death, inpatient SPC or place of death.</p> Conclusion <p>Early integration of home-based SPC in advanced GI cancer patients significantly reduces emergency healthcare use and hospitalisation.</p> Clinical Trial Registration <p>ClinicalTrials.gov (ref: NCT02246725).</p>