Key PointsQuestionDoes proactive specialist palliative care improve patient-reported outcomes in patients receiving curative-intent surgeries for high morbidity and mortality upper gastrointestinal cancers?FindingsIn this randomized clinical trial across 5 geographically diverse cancer centers that included 356 adults randomized to either surgeon alone or surgeon–palliative care team comanagement, there was no significant difference in postoperative patient-reported outcomes, such as quality of life or mental health. Palliative care was well tolerated by study patient and practitioner participants with no associated harms.MeaningData from this study do not suggest benefits with palliative care for surgical oncology patients with newly diagnosed cancers who were pursuing curative-intent operations; integration of palliative care specialists could possibly be more effectively targeted toward patients with poorer baseline quality of life and functionality.