Since 2007, the cancer authority in Ontario, Canada has systematically collected symptom scores in cancer out-patients by implementing the Edmonton Symptom Assessment System (ESAS). Our group has conducted a number of studies linking the database containing the screening symptom scores (study cohorts up to 45,000 unique patients) with databases that include: the population-based cancer registry, socio-demographic information, diagnostic and procedure codes from all inpatient and outpatient hospital admissions and the drug benefit database which covers prescription medications for individuals older than 65 years. This presentation will summarize the findings of our studies and outline recent advances, the challenges and gaps in our knowledge and the opportunities to improve symptom managementin older patients with cancer.