BACKGROUND: Comprehensive geriatric assessment evaluates key health domains for older adults, focusing on medicine optimisation and medication adherence to improve tolerability and quality of life for older adults on systematic anticancer therapy. The Royal Marsden (RM) Senior Adult Oncology Programme (SAOP) provides multidisciplinary geriatric assessment and interventions for patients ≥ 70 undergoing systematic anticancer therapy. AIM: We designed an ACCESS (eArly identifiCation advanCed gEriatric aSsesSment) tool to enhance efficiency of SAOP outpatient clinics by facilitating geriatric assessment including medications, nutrition, social support, mood, and functional assessments. SETTING: SAOP at RM NHS Foundation Trust, London, UK. DEVELOPMENT: Developed by SAOP pharmacist and clinical nurse specialist with input from SAOP multidisciplinary team, the ACCESS tool includes medication review patient counselling deprescribing, and comorbidity management, aligning with the Royal Pharmaceutical Society Advanced Pharmacy Framework. IMPLEMENTATION: From January to December 2022, ACCESS was implemented in three steps: screening with Senior Adult Oncology Programme v 3 (SAOP3) questionnaire, remote consultation based on results, and medication review and patient counselling for complex medication needs, enhancing patient engagement and treatment understanding. EVALUATION: The practice was audited through the implementation process. Quantitative data from staff and 100 patients who were users of the SAOP service and ACCESS tool revealed higher medication adherence, improved identification of inappropriate medications, and enhanced confidence in managing complex geriatric oncology cases. CONCLUSION: The ACCESS tool, led by clinical pharmacist and clinical nurse specialist has improved outpatient clinic efficiency, patient satisfaction, and healthcare coordination. It allows personalised follow-up plans for older adults with complex health issues on anticancer therapy. Regular multidisciplinary team meetings and digital health records enhance care coordination and decision-making for older adults with cancer.