OBJECTIVE : Older adults (OA) are under-represented in cancer clinical trials. We sought to identify the proportion of OA(age > 65) vs. younger adults offered clinical trial and identify reasons patients were not offered a trial. METHODS : Consecutive patients with cancer (n = 503) seen by medical oncology in consultation were included. Oncologists provided reasons for not offering a study to patients who were offered and accepted systemic therapy. Comparison between older and younger adults was done using the Chi square test or Fisher exact test. Logistic regression was used to determine the association between age and being offered clinical trial participation. RESULTS : OA had worse performance status (PS) (ECOG 3+ 15.1% vs 5.2%, p < 0.0001) and more comorbidities (Charlson Comorbidity Index ≥2 24.7% vs 10.0%, p < 0.0001) than younger adults. OA were less likely to be offered systemic treatment (68.3% vs 82.1%, p < 0.001), but were as likely as younger adults to accept (86.6% vs 92.2%, p = 0.07). Of patients who accepted systemic treatment, 24.5% were offered trial enrollment. Taking into account patient factors and stage, increased age by decade was associated with a decreased likelihood of being offered a trial [OR 0.74 (95% CI 0.6-0.9), p < 0.001]. Reasons for not offering a trial included no available trial (75.4%), poor PS (7.8%) and ineligibility (6.3%). Poor PS (11.8% vs 3.9%) was more commonly cited for not offering a study to OA. CONCLUSIONS : Lack of clinical trials is the most common reason patients are not offered a trial. OA remain less likely to be offered a trial than younger adults.