Cancer elevates the risk for developing depression. Among patients, untreated depression predicts a poorer quality of life, higher medical care costs and excess cancer mortality. Psychosocial care is now considered to be a standard component of quality cancer care. However, there is a limited evidence base and few guidelines for screening and treating depression in elderly cancer patients. In oncology settings, rates of adequate treatment for depression in elderly patients remain strikingly low. Novel approaches are needed to increase access to care, particularly among those with advanced disease.