“Doc, how long have I got to live anyway if I do nothing?” This is a question from an elderly patient that is familiar to any oncologist. As the proportion of elderly patients continues to increase steadily worldwide, clinicians can expect that this will become an increasingly present scenario in medical offices. In particular, there will be a dramatic increase between 2015 and 2050 in patients currently regarded as the so-called oldest old (those 80 years and older) to more than 440 million worldwide, tripling the current population in this category.1 Whether to subject patients who have already exceeded normal life expectancy to the stressors of major surgery for an aggressive malignant condition is as much an ethical issue as it is a medical one, and clinicians are badly in need of tools to assist patients in shared decision-making. The lay press has caught wind of this issue as well; witness the title to a New York Times article published in June 2019: “The Elderly are Getting Complex Surgeries. Often It Doesn’t End Well.”2