OBJECTIVES: To estimate cost associated with informal caregiving in advanced stage Non-Small Cell Lung Cancer (NSCLC) patients, identifying the costs drivers in Italy; to measure symptoms evolution using the LCS subscale of the FACT-L questionnaire. METHODS: 104 patients (55 on second line chemotherapy and 49 in supportive care) were enrolled in 18 Italian oncology departments and followed up for 3 months. Main caregiver workload was assessed monthly by evaluating the number of hours devoted to ten caregiving tasks, presence and activities of other informal or formal caregiver were registered, performance status was evaluated monthly by means of the ECOG scale. Patients completed the LCS symptoms subscale for each visit. Formal caregiving time was valued according to market prices; informal caregiving hours were valued using the wage rate for an equivalent service. The covariance analysis was performed to check for influential factors in assistance need and costs. RESULTS: During the 3-month observational period both ECOG and LCS scores depreciated in the two groups. An equal number of deaths were registered among patients in chemotherapy and in supportive care. Monthly hours of informal caregiving increased from 124.37 to 166.9 for the chemotherapy patients and from 141.92 to 150.97 for supportive care patients. The whole home assistance cost accounted for € 3,159 for chemotherapy and € 4,189 for supportive care patient. The regression analysis highlighted that symptom depreciation is a driver of caregiving time and costs and that the assistance cost increases if the caregiver doesn't live with the patient. CONCLUSIONS: The burden of assistance in NSCLC advanced patients is mainly beard by family members who provide also home health aide. As the population ages and family structure is changing, social intervention targeted at unpaid family caregiver will be needed to ease the economic, psychological and physical burden of caregiving.