The Ottawa Rapid Palliative Radiotherapy Program (RPRP) was established in 1999 with the goal of facilitating access by family physicians to radiotherapy services for patients with advanced symptomatic cancer. Two years later, an audit revealed that of the 148 patients treated by the program, only 19 had been referred by family physicians.We therefore assessed awareness of the RPRP and perceptions of the effectiveness of palliative radiotherapy on the part of family physicians by surveying a random sample of family physicians in Eastern Ontario.Response rate was 50%. Only 18% of family physicians were aware of the RPRP, although 56% had previously referred patients for palliative radiotherapy. Among responders, 80% regularly provided palliative care, and these physicians were much more likely to be aware of and to refer patients for palliative radiotherapy.Our survey confirms the key role that family physicians play in providing care to patients with advanced cancer. However, significant deficits in family physician awareness of palliative radiotherapy programs and in knowledge of the effectiveness of palliative radiotherapy should be addressed to improve patient care.