Background: Patients with advanced cancer often have emotional problems such as inadequate coping, fear of new metastases, or the prospect of enduring physical suffering. Some will need professional emotional support to cope with these problems. Accurately identifying these patients requires a thorough understanding of their characteristics. Aim: To assess the need for emotional supportive care in patients with advanced cancer who have emotional problems, and their associated sociodemographic, disease-related, clinical, and psychosocial characteristics. Design: Prospective multicenter observational study on experienced quality of care and quality of life in patients with advanced cancer and their relatives. Setting/Participants: Baseline data were used of 892 patients with advanced cancer who had emotional problems. Results: In total, 92% of the patients with advanced cancer had emotional problems and 33% of these had emotional supportive care needs. Most patients without emotional supportive care needs had contact with an oncology nurse (70%), while a minority received additional psychosocial support. Our multivariable logistic regression analysis shows that fatigue (odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.82-3.86), pain (OR: 1.50, 95% CI: 1.07-2.12), and less social support (OR: 0.95, 95% CI: 0.91-0.99) were associated with having emotional supportive care needs. Conclusions: One-third of patients with advanced cancer who have emotional problems in the eQuiPe study report emotional supportive care needs. Oncologists and oncology nurses should be aware that emotional supportive care needs are more common in patients with advanced cancer who experience increased pain, fatigue, or decreased social support in addition to their emotional problems. The eQuiPe study is registered as NTR6584 in the Netherlands Trial Register.