Many unique issues arise in the end-of-life care of elderly patients with cancer. Although there are similarities with end-of-life care of younger individuals, endof-life care for the elderly cancer patient is complicated by difﬁculties with assessing and managing pain, toxicities of medications, and depression. Furthermore, care of the elderly is sometimes delivered in unique settings such as the nursing home, and special attention must be given toward advance directives that specify levels of care to be provided at the end of life. Properly assessing and managing these issues in the elderly can be difﬁcult in the face of impaired cognitive status, ﬁnancial pressures, or the desire not to be perceived as a burden on the family. In this chapter, we will discuss the issues that surround the end-of-life care of the elderly patient with cancer, as well as the approach toward management.