People over the age of 65 years constitute the fastest-growing segment of the US population. Within the next 30 years, this group will comprise over 20% of the total population. Importantly, 50% of all cancers and 70% of cancer mortality occur in this age group. Choosing the correct chemotherapy regimen and dose for the older patient can be extremely difficult because of physiological changes that occur with aging, as well as other comorbidities associated with this age group. Treatment decisions need to be based on a patient's individual performance, functional status and life expectancy. Although there are no accepted algorithms to guide management decisions in elderly cancer patients, data are becoming available that will help guide the use of chemotherapy in the older patient population.