Actuality: According to many authors, there is a relationship between aging and the development of cancer. In recent years, the increase in life expectancy, the increase in the number of elderly and senile people in society, the improvement of methods for diagnosing cancer, together with a number of other factors, has led to an increase in the number of people in older age groups who are diagnosed with cancer. Despite the progress made in the treatment of cancer, currently a large number of older people die from this pathology, which is also associated with the presence of concomitant diseases, in particular, metabolic syndrome. In this connection, it is relevant to predict the risks of chemotherapy and to determine the tactics of management of patients with metabolic syndrome in the elderly and senile age in patients who are under dispensary observation for cancer. Objective: To study the features of the geriatric status in patients with metabolic syndrome who have undergone cancer. Materials and methods: The basis of the study was the oncology department of the I. P. Pavlov First Medical State University, St. Petersburg. Concomitant pathology was studied in 216 middle-aged patients, including 107 middle-aged patients without a previous cancer and 109 middle-aged patients with a previous cancer, and in 189 elderly and senile patients, including 91 patients without a previous cancer and 98 patients with a previous cancer. All patients had a metabolic syndrome. Next, we evaluated the geriatric status. The frailty syndrome was detected using the original computer program "Specialized geriatric examination". A multivariate corellian analysis was performed. Based on the obtained data, we developed a modernized management strategy for elderly and senile patients with metabolic syndrome and cancer, which consisted in identifying the frailty syndrome, assessing the prognostic nutritional index (PNI) and geriatric status for choosing chemotherapy methods and determining further treatment approaches. Results: The presence of a previous cancer significantly worsens the geriatric status, to a greater extent in elderly and senile patients. The incidence of age-associated complications of chemotherapy, such as anemia, hypoalbuminemia, electrolyte imbalance (hypokalemia, hyponatremia and hypomagnesemia), as well as the development of drowsiness, anxiety, depression, asthenic syndrome, memory disorders, encephalopathy, weight loss is clearly higher in the group with a low PNI index and even higher in the group with a low PNI index and frailty syndrome, therefore, the frailty syndrome has direct adverse effect on the development of complications of chemotherapy. An additional significant contribution to the development of complications after chemotherapy and the progression of geriatric syndromes in elderly and senile patients with cancer and metabolic syndrome is made by the geriatric status, in particular, the presence of the frailty syndrome and a low Prognostic Nutritional index (PNI), which should be taken into account in the management of such patients. Conclusions: As a result of prevention of the progression of the frailty syndrome in patients with the presence of this syndrome, it was possible to reduce the reference mortality rate for long-term prognosis (5 years) in the elderly and senile age from 6.95 to 14.7, in the group of middle-aged patients and elderly and senile age without the frailty syndrome, the indicators differed slightly (4.32 and 5.06 %), which proves the survival of elderly and senile age patients without frailty syndrome who were treated according to the schemes of middle-aged patients. In patients in groups with the frailty syndrome, a low Prognostic Nutritional Index (The Prognostic Nutritional Index (PNI) is largely associated with poor survival.