Objective To determine how older adults with cancer, living alone with advanced disease, have distinct experiences, needs and preferences for care, which merit attention.

Design In-depth qualitative interviews with 30 people, half of whom live alone. Participants were recruited from general practices and day hospices in the North West, aged over 75 years; with a documented diagnosis of cancer and professionally determined prognosis of less than 12 months. Baseline face-to-face interviews were followed by telephone contacts at 3 and 6 months. Data were analysed using Framework, a matrix-based approach.

Findings Many of the older adults in this study described substantial networks of intergenerational, spousal and neighbour support, irrespective of living arrangements. Those who lived alone had high levels of functioning and quality of life despite poor health status and practical challenges. The desire to maintain independence in all aspects of their lives was a key theme. Loneliness and social isolation were not common, with few differences observed with living arrangements. Companion animals played an important social role and helped to define the daily routine for some participants who lived alone.

Conclusion Living arrangements are easily observed, and a convenient way of defining a population for study. However, the availability of familial and community support may be a more important influence on older people's end of life experiences. Our findings suggest that the very old living alone with cancer may be a particularly resilient group of people.