The ability to perform activities of daily living (ADL) is a crucial factor for independent functioning and living at home. This population-based cross-sectional study examines ADL problems in older cancer survivors compared with an age-matched cancer-free control group. According to both The Cancer Registry of Norway and self-report, 911 individuals > or =70 years had invasive cancer among the participants of The Health Study of Nord-Trøndelag County (HUNT-2) 1995-7. Three age- and gender-matched cancer-free controls for each cancer survivor were drawn from HUNT-2 (N = 2733). Personal- and Instrumental-ADL (P-ADL and I-ADL) problems were self-rated. P-ADL problems addressed activities such as personal hygiene, dressing and eating, while I-ADL problems concerned household activities, managing finances, shopping and administration of medication. Associations among relevant independent variables and P- and I-ADL problems were examined with both descriptive and multivariate statistics. P-ADL problems were present in 10% of the cancer survivors and 8% of the controls (P = 0.02). Correspondingly, 38% of the cancer survivors had I-ADL problems versus 32% of the controls (P < 0.001). Older cancer survivors with co-morbidity showed significantly higher rates of P-ADL and I-ADL problems compared with controls with co-morbidity (14% versus 9%, P = 0.01, and 47% versus 39%, P = 0.02). Cancer survivors with co-morbidity had significantly more P-ADL and I-ADL problems than survivors without co-morbidity (14% versus 8%, P = 0.01 and 47% versus 32%, P < 0.001). This study showed higher incidence of ADL problems among a population of older cancer survivors compared with cancer-free controls. Somatic co-morbidity further increased the prevalence of both P- and I-ADL problems in the cancer survivors. Primary healthcare providers should pay attention to and assess ADL problems in older cancer survivors.