In 2004, the Oncology Nursing Society published a position paper on cancer in the elderly identifying cancer as a disease of aging. The National Cancer Institute Surveillance Epidemiology End Results data report that more than 50% of all cancers are diagnosed in individuals who are aged 65 or greater. Comorbidities prevalent in the elderly population place them at increased risk of developing side effects and toxicities from cancer treatment. This article presents 2 case studies that demonstrate the complex nature of treatment decisions related to advanced cancer diagnoses. Real and potential nursing problems are identified. Evidence-based practice and interdisciplinary collaboration for the purpose of achieving comprehensive patient- and family-centered care are outlined. Quality-of-life concerns, including decisional capacity, are addressed. The role of the critical care nurse in promoting quality of life in the care of the oncology geriatric patient in the acute care and critical care settings is discussed.