Currently, there are about 7 million cancer survivors in this country aged 65 and older, and this number is expected to increase rapidly, given trends toward aging and improvements in early detection and treatment. Unfortunately, cancer survivors are at risk for several comorbid conditions and accelerated functional decline. A previous cross-sectional study of 688 older breast and prostate cancer survivors found significant associations between lifestyle practices and levels of physical functioning, with positive associations noted for physical activity and fruit and vegetable consumption and negative associations observed for dietary fat. In a more-recent cross-sectional study of 753 older survivors of breast, prostate, and colorectal cancer, significant associations were also observed between physical function, and physical activity (ρ=0.22, P<.001) and diet quality (ρ=0.07, P=.046), and a significant negative association was also found between physical function and body mass index (ρ=-0.29, P<.001). Therefore, lifestyle interventions may be helpful in positively reorienting the trajectory of functional decline in this vulnerable population, although there are substantial barriers, such as travel, that must be overcome in delivering behavioral interventions to older cancer survivors. Previously reported results from the Pepper Center-funded Leading the Way in Exercise and Diet Project intervention development study suggested that an exercise and diet intervention delivered using telephone counseling and mailed materials was readily accepted and appeared to be of benefit. Larger trials, such as Reach-out to ENhancE Wellness in Older Survivors, have recently produced compelling data. © 2009, The American Geriatrics Society.