Background: International evidence demonstrates significant negative impact of cancer and its treatment on older people resulting in functional and cognitive decline that effect prognostic outcome. Aim: This study set out to identify and explore reasons for extended length of stay (ELOS) in older cancer patients, to identify opportunities to minimise ELOS and optimise patient outcomes. Sample: Patients aged over 70 years treated at Peter Mac between January 2010 and January 2012. Method: A retrospective medical case note review of inpatient admissions. ELOS was defined as an admission lasting longer than the high boundary for the Australian Refined Diagnostic Related Group (AR-DRG) as defined by the Department of Health and AR-DRG classification. Medical case notes data retrieved included: age, diagnosis, treatment intent, co-morbidities, reason for ELOS, supportive care needs, social support, next of kin, place of residence and outcome post admission. Results: During 2010-2012, there were 2267 new patient registrations of people aged 70 years and over accounting for 1219 inpatient admissions. Mean length of stay ranged from 1 to 162 days with 47 patients recorded as having a LOS over the high boundary for their AR-DRG. The mean age of patients with an ELOS was 81 years (range: 71-97). The mean number of co-morbidities was six (range: 1-14). The top three reasons for ELOS included nutritional and electrolyte imbalance (n=25); complexity of discharge planning (n=19) and; treatment and co-morbidity related complications (n=18) . Discussion: Our data indicate that the introduction of a standardised approach to comprehensive geriatric assessment at point of referral has potential to reduce ELOS for elderly patients. Conclusion and recommendations: Introduction and implementation of evidence based pathways to optimise care of older patients will be implemented at Peter Mac and be evaluated over the next two years.