OBJECTIVES: This study aims to evaluate differences in healthcare spending during the last year of life among patients with four common cancer types in Germany. METHODS: Costs were analyzed using claims data from a German statutory health insurance fund (AOK PLUS). The study included patients who died between 01/01/2018 and 31/12/2018, with one inpatient diagnosis and/or two confirmed outpatient diagnoses of at least one of four main cancer types [breast (ICD-10 C50), prostate (C61), lung (C33-34), or colorectal (C18-21)] in the 365 days before their death. The CCI score was calculated using two years of continuous claims data preceding the patient’s death. RESULTS: The four cohorts were composed of 1,692 breast cancer (99% female; mean age: 81.39 years; mean CCI: 10.04), 2,103 lung cancer (30% female; 72.86 years; 11.45), 2,175 prostate cancer (0% female; 82.31 years; 10.27), and 2,340 colorectal cancer patients (44% female; 79.51 years; 10.36). Average costs in the last year of life were highest among patients with lung cancer (32.712,80€), followed by colorectal (27.879,55€), prostate (26.817,59€) and breast (24.111,79€) cancers. Across all cohorts, hospitalizations and outpatient prescriptions accounted for the largest share of total spending: 56% and 32% in breast cancer patients, 70% and 21% in lung cancer patients, 58% and 31% in prostate cancer patients, and 66% and 22% in colorectal cancer patients. Spending on outpatient care (5-6%), rehabilitation (0%), and aids and remedies (4-6%) was consistent across all cohorts. CONCLUSIONS: Costs in the last year of life were highest among patients with lung cancer in 2018. Outpatient medications were a cost driver among breast and prostate cancer patients, while lung and colorectal cancer patients faced a higher share of total costs related to hospitalization. Palliative care versus systemic treatment of cancer patients needs to be discussed more intensively, from an ethical, clinical, and health-economic perspective.