To achieve universal health coverage goals, access to quality palliative care must be rapidly scaled up in low and middle-income countries. By 2060, people living with cancer at the end of life will be the major contributors to serious health-related suffering. Major developments have occurred in the science of palliative care research in low- and middle-income countries (LMIC), from the development and validation of outcome measures to the delivery of randomised controlled trials. While the evidence has demonstrated context-specific needs among patients and families facing life-limiting illness, there are also many commonalities. Specific areas of leadership in the field have emerged from LMIC in HIV palliative care and in care for children. These innovations offer enormous potential for adaptation in high income countries. International partnerships in research, founded on mutually beneficial learning and capacity building, are central to achieving universal health coverage goals.