It is more than a decade since the National Service Framework for Older People set the goal of ending age discrimination in the NHS in England; making clear that services should be provided on the basis of clinical need, not age. However, there is growing evidence to show age is a factor in decision making about cancer treatment. Why this should be the case is complex, but it is clear that nurses with expertise in assessing and caring for older people have an important part to play in delivering the solutions.