Purpose: To understand the experiences of and difficulties faced by palliative care unit nurses when caring for refractory cachexia. Method: Palliative care nurses completed anonymous self-report postal questionnaires. Factor and multiple regression analyses were then carried out to interpret results. Results: A total of, 169 valid questionnaire responses were received and analyzed. Six factors were identified relating to the difficulties experienced by nurses when caring for refractory cachexia. [A feeling of helplessness and conflict among patients and families faced with decline and death] was considered the most difficult factor experienced by nurses, and typically other difficulties were considered more prominent when this factor was present. [The approach of assessment and perception of refractory cachexia care] differed according to the nurse’s years of experience, degree of involvement in patient care, and learning opportunities previously encountered. [Nurses tended to cope] more easily with the challenges faced if they had been assigned for >3 years. Conclusion: Six factors were identified as difficulties associated with the care of refractory cachexia. These findings suggest the need for thoughtful dialog with patients and their families and the importance of further educational support for nurses.