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Logistic regression demonstrated that age ≥ 80 (odds ratio [OR] 1.238, 95% confidence interval [CI] 1.071, 1.431, P = 0.004), more diseases (OR 1.193, 95% CI 1.017, 1.399, P = 0.03), polypharmacy (OR 2.520, 95% CI 2.169, 2.927, P0.001), and irrational use of drugs (OR 1.762, 95% CI 1.408, 2.205, P0.001) were positively associated with PIM use in older outpatients with cancer. The prevalence of PIM use in Chinese older outpatients with cancer and multimorbidity is high in China. The increased prescription complexity caused by can