Objectives: Chronic kidney disease (CKD) and aging raise cancer risk. However, it is uncertain whether older hemodialysis patients with current cancer or a history of cancer have the same mortality risk as those without disease (HD). Thus, we examined older HD patients with cancer prognoses. Methods: The Korean Society of Geriatric Nephrology retrospective cohort includes 2,085 patients older than 70 who started hemodialysis between 2010 and 2017. Kaplan-Meier survival estimator and Cox proportional hazards regression analysis examined all-cause mortality. Results: At recruitment, 262 (12.6%) had prior cancer and 55 (2.6%) had ongoing cancer. During a median follow-up of 3.2 years, 1357 (65.1%) died. All-cause mortality was greater in the active cancer group (85.5% versus 68.3% vs 64.0%, p < 0.002). All-cause mortality was significantly higher in the active cancer group than in the previous cancer group and the no cancer group (85.5% vs 68.3% vs 64.0%, p<0.002). Kaplan-Meier analysis showed that all-cause mortality differed across the three groups (p < 0.001, log-rank test). After adjusting for clinical variables, multivariate Cox regression indicated a substantial link between active cancer and all-cause death (HR:1.89; 95%CI: 1.362.64; p < 0.001). Previous cancer did not increase overall mortality (HR:1.07; 95%CI: 0.901.28; p = 0.448). Conclusions: Older hemodialysis patients with active malignancy had greater mortality. However, cancer survivors had a comparable mortality risk to non-cancer survivors. Our findings demonstrate that elderly cancer survivors may sustain dialysis.