Objective: To analyze the difference in survival associated with anti-cancer treatment (ACT) versus palliative treatment (PT) intention therapy for stage IV non-small-cell lung cancer (NSCLC) in elderly patients. Methods: Tapping the cancer registry database of one medical center in Taiwan, Chi-square and Cox regression were used to analyze differences of treatment intentions and factors predicting survival, and Kaplan-Meier survival analysis to the outcomes of anti-cancer therapies. Results: 333elderlypatientswere diagnosed with NSCLC from 2011 to 2014.Multivariate Cox regression analysis revealed that patients at significantly decreased risk of short survival were those having target therapy only (p=0.008) and having≧2 treatment modalities (p=0.009). Patients at significantly increased risk of short survival were those having poorer performance status (for ECOG 2, 3 and 4, p<0.001, p=0.001, and p<0.001, respectively) and patients of PT group (p<0.001). Kaplan-Meier survival analysis of 236 ECOG 0-2 patients revealed those accepting target therapy only had a median survival 713 days, chemotherapy only 436 days, and two treatment modalities 449 days. Log Rank (Mantel-Cox) test showed no significant difference.(p=0.182) Conclusions: Elderly patients with stage IV NSCLC who can have ACT intention therapy still survived longer than PT intention therapy. The results of this study can be used as reference for treatment planning and shared decision making.