Recent research in psychosocial oncology has pointed to the traumatic nature of the stress experienced by cancer survivors. Most of this research has focused on children, young adults survivors and their families. This investigation proposes a conceptual model for understanding general psychological distress (anxiety, hostility and depression) and symptoms of posttraumatic stress (hyper-arousal, avoidance and intrusiveness) that may be associated with cancer survivorship among older adults. Findings from a survey of 180 older adult, long-term cancer survivors are used to illustrate the key features of this model. Results of multivariate analysis show that most older adult long-term cancer survivors do not demonstrate clinical levels of posttraumatic stress disorder (PTSD), although over 25% evidence clinical levels of depression. However, many survivors display important symptoms of psychological distress that are related to the continuing effects of cancer and its treatment. Current cancer-related symptoms are the strongest predictors of depression (beta=0.27, p=0.046) and the PTSD sub-dimension of hyper-arousal (beta=0.377, p=0.004). These effects persist even when the effects of other stressors and non-cancer illness symptoms are statistically controlled. Additionally, it appears in this sample that symptoms of PTSD are significantly correlated with traditional measures of psychological distress. Copyright © 2002 John Wiley & Sons, Ltd.