224 Background: Older cancer populations are at higher risks of falls and fall-related injuries undergoing formidable antineoplastic treatment, conditioned to greater physical and functional compromise. While passive risk surveillance and fall prevention strategies often render ineffective, emerging evidence has indicated the benefits of physical activity in reducing risk of falls. This study aimed to explore patient’s awareness and doctor’s advice regarding physical activity in relation to falls among older patients (> 65) under active cancer treatment. Methods: This cross-sectional study was based on the public database from Medicare Health Outcome Survey (MHOS), which derived comprehensive patient-reported outcomes evaluating quality of care provided by Medicare health programs in the United States. Main exposures, including patient’s proactive consultation and doctor’s advice on promoting physical activity, were explored among beneficiaries sampled from 2018 to 2022 diagnosed with cancer and reported undergoing active treatment. Multivariable-adjusted logistic regressions were performed to calculate the risks of falls (Odds ratio, OR) associated with physical activity variables using the latest cohort (2022). Results: Among the total of 14937 (2018), 16927 (2019), 23027 (2020), 23512 (2021), and 21683 (2022) Medicare beneficiaries identified undergoing active cancer treatment, fall incidence sustained at around 30% (median: 30.54%, range 30.17% – 31.26%) of the target population. However, slightly over half of the target populations (median 56.81%, range 53.04% - 56.98%) had proactive consultations regarding physical activity, and even fewer reported receiving doctor’s advice to increase physical activity (median 51.35%, range 48.06% - 52.26%), without significant growth over the 5-year period. In addition, a 21.4% reduction in fall risk (OR=0.786, 95%CI=0.714-0.865) was noted among patients who had physical activity consultations with health professionals. Similarly, a 21.6% risk reduction (OR=0.784, 95%CI=0.713-0.863) was observed among those reported receiving doctor’s advice to increase physical activity level. Notably, the risk of falls associated with these physical variables remained significantly lower in lung (OR=0.667, 95%CI=0.45-0.948), colorectal (OR=0.642, 95%CI=0.436-0.944), and prostate cancer (OR=0.663, 95%CI=0.546-0.804) populations. Conclusions: The study showed an overall lower risk of falls among older cancer patients involved with physical activity, specifically those among lung, colorectal, and prostate cancer subpopulations. Future prospective trials are warranted to provide clinical validations and hence enhance public recognition as to promote the importance of physical activity in minimizing fall risks among older, actively treated cancer patients.