Background: Beyond age and comorbidity, functional status shapes the long-term survival potential of patients with cancer. Accordingly, we explored the relationship between preexisting disability and surgery among older adults with kidney cancer. Methods: Using SEER-Medicare data from 2000–2009, we sampled 28,326 patients ≥66 years old diagnosed with primary kidney cancer. Disability was quantified using function-related indicators (FRI)—claims indicative of patient dysfunction (e.g., mobility-assist devices, falls). We used competing risk regression to assess the relationship between FRI score and non-cancer-related mortality and generalized estimating equations to estimate the probability of surgery according to FRI score, adjusting for patient and tumor stage. Results: We identified 13,619 (48.1%) adults with ≥1 FRI. Disability was associated with older age, greater comorbidity, female gender, unmarried status, lower socioeconomic status, and higher cancer stage (p<0.001). Patients with a FRI score of 1 (SHR 1.10, 95% CI 1.04–1.16) and ≥2 (SHR 1.52, 95% CI 1.44–1.60) had higher likelihoods of non-cancer-related death compared with those with a FRI score of 0. Predicted 10-year incidence of non-cancer-related death was 35, 38, and 48% while the incidence of kidney cancer-related death was 26, 28, and 29% for patients with FRI score of 0, 1, and ≥2, respectively. Patients with FRI of ≥2 received surgical treatment less often than those without disability (OR 0.61, 95% 0.56–0.66), though treatment probabilities remained high for patients with loco-regional disease and low for adults with metastatic cancer (Table). Conclusions: Among older adults with kidney cancer, functional status stands as a significant predictor of long-term survival. Although preexisting disability modulates treatment use to some degree, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient functionality should be considered more heavily when deciding treatment for kidney cancer.