OBJECTIVES: Study aim was to compare symptom severity and home assistance burden in advanced non-small-cell-lung cancer (NSCLC) patients with no metastasis (NM), bony and/or cerebral (BCM) metastases and other metastasis localization (OM). METHODS: A total of 104 advanced NSCLC patients were enrolled in 18 Italian oncology departments and followed up for 3 months. Main caregiver workload was assessed monthly by a task scale; activities of other caregivers were also registered and patients completed the LCS symptoms subscale of the FACT-L questionnaire. Formal caregiving time was valued according to market prices; informal caregiving hours were valued using the wage rate for an equivalent service. RESULTS: Mean age of the total sample was 65.5 years, males' prevalence of was over 80%; principal caregiver was patient's spouse living with the patient and non-working in over 70% of cases. Three-monthly mean total per patient assistance costs amounted to €4431 in BCM, to €2617 and €2716 in OM and NM patients. Cerebral and/or bony metastases caused, upon each monthly check, significantly higher assistance costs referred to the main caregiver (p<0.0001). Higher percentages of patients reported symptoms deterioration in the NM and BCM (45% and 43%) respectively, while only 23% of patients referred symptom worsening in OM. CONCLUSION: Home assistance burden was higher in patient with bony and/or cerebral metastases, other metastasis localizations showed no impact on caregiving costs and symptom severity measured by the LCS subscale.