Background: Over 57% of all new cancer diagnoses in Australia occur in people aged over 65 years. During 2010-2011, 40% of the patient population at Peter MacCallum Cancer Centre (Peter Mac) was aged over 65 years. Aim: To identify opportunities for service improvement from multidisciplinary and consumer perspectives to promote optimal outcomes for older people with cancer. Method: An exploratory, semi-structured interview study. Sample. Thirty four health professionals, 15 patients and their carers/family members took part in audio taped interviews to explore perceptions of current service provision to identify opportunities to improve patient experiences and outcomes. Data analysis: Interview data were transcribed and coded into key themes. Results: Five key categories were identified as barriers to enabling optimal outcomes for older cancer patients: 1) Lack of a coordinated approach to screening and geriatric assessment at point of referral; 2) Lack of a coordinated approach to assessment and management of poly-pharmacy; 3) Lack of timely access to ACAS assessments; 4) Lack of specialist geriatric knowledge to promote optimal outcomes; and 5) Limited knowledge of essential cancer care in residential care facilities and home like care settings. Recommendations: Four key recommendations emerged: 1) Implementation of a sensitive screening tool to promptly identify frail patients 2) Implementation of a standardised approach to identify and assess co-morbid conditions likely to be exacerbated related to treatment; 3) Timely referral and access to ACAS assessments; 4) Implementation of protocols and pathways to support care of elderly cancer patients at Peter Mac and in residential aged care or homelike settings. Conclusion: This study has provided targeted recommendations to inform service improvements for care of older cancer patients at Peter Mac. Optimal models of care provision for older people with cancer are being explored and will be implemented and evaluated over the next two years.