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PURPOSE Little is known about the perspectives of older adults (OAs) with newly-diagnosed cancer on their experiences with cancer treatment decision-making. The objective of this study was to explore the factors that were important for accepting or refusing cancer treatment by older adults undergoing chemotherapy and/or radiation therapy. PATIENTS AND METHODS A qualitative study using semi-structured interviews with 20 OAs aged ≥65years with newly diagnosed cancer (<6months) receiving either curative or palliative chemotherapy and/or radiation or who had declined therapy. The COREQ reporting guideline was utilized. RESULTS The majority of patients accepted the recommended cancer treatment. Most OAs followed their oncologist's recommendation, but spoke of making their own decisions and felt confident about their decisions. Second opinions were not commonly sought. Themes emerged can be divided into two categories: 1) pertaining to cancer treatment decision-making, which includes: "Trust in oncologist", "prolong life", "expected outcomes of treatment", "other people's experience", skeptical about going online" and "assertion of independence", and 2) pertaining to oncologist-patient interactions, which includes "communication". CONCLUSION Older patients largely followed their cancer specialists' treatment recommendations. Most patients were satisfied with their treatment decision and were confident in their decisions. Seeking of second opinions was rare. More needs to be done to address the communication gaps and support needs of this population.