Objective To audit the profile of symptoms related to the anorexia–cachexia syndrome (ACS) in patients with cancer, and current prescribed medication. Setting Cancer patients within both primary and secondary care in north Durham. Method Patients with cancer and symptoms of ACS were referred to the specialist pharmacist. Symptom profile was assessed using the Patient Generated Subjective Global Assessment (PG-SGA) tool and current drug history was recorded. Changes to prescribed medication recommended by the specialist pharmacist were communicated to the responsible clinician. Management strategies were standardised according to the evidence base or best practice in the absence of evidence. Main outcome measure Quantified symptom burden and analysis of patterns of prescribing in this cohort of patients. Results Twenty-three out of thirty-two patients referred were well enough for assessment. Hundred and nineteen active symptoms were identified by the PG-SGA tool in those 23 patients. Patients were prescribed a median of eight drugs, excluding nutritional supplements. Side effects of prescribed medication may have been contributory factors to dry mouth and constipation, reported by 21 (91%) and 12 (52%) patients respectively. Many active symptoms were not managed by prescribed medication, most commonly dry mouth, anorexia and early satiety. Eighty-nine recommended changes to prescribed medication were made by the specialist pharmacist, most frequently treatment of dry mouth and prescription of prokinetic antiemetics. Conclusion ACS in patients with cancer is associated with a significant number of active symptoms, many unmanaged by prescription medication. The potential for standardised assessment and management is raised.