Background: Depression and anxiety are common for cancer survivors, especially those aged 65 years or older, which are negatively associated with quality of life and survival. A few studies have described the average population level of longitudinal change in depression and anxiety, but they may not capture the inter-individual variability of the longitudinal trajectory, especially in older cancer survivors. The aims of the current study were to (1) describe the trajectory patterns of depression and anxiety over time among older cancer survivors; (2) examine the socio-demographic and health-related predictors of different subgroups of trajectories. Methods: We used data from the National Health and Aging Trends Study (NHATS), a nationally representative cohort study. The Generalized Anxiety Disorder-2 scale and Patient Health Questionnaire-2 were used to assess levels of depression and anxiety. The group-based trajectory model was used to identify the distinct trajectories of depression and anxiety from 2015 to 2021. Design-based multinomial logistic regression was used to examine the socio-demographic and health-related predictors of different trajectories. All analyses accounted for the complex sample design (stratification and primary sampling units) and survey weights. Results: A total of 1,766 older cancer survivors were included, and the average prevalence of depression and anxiety from 2015 to 2021 was 27.14%. Four trajectories of depression and anxiety were identified: robust (48.9%), deteriorating (24.1%), meliorating (11.0%), and sustained-high (16.1%). Older cancer survivors were at a sustained-high depression and anxiety trajectory if they were older, female, reported poorer health, had a worse cognitive function, and had more difficulty in activities of daily living (P<0.05). Conclusions: Our findings highlight the heterogeneity and complexity of the depression and anxiety process in older cancer survivors. This study helps identify patients at a high risk of depression and anxiety and develop more individualized strategies to ameliorate the mental health of older cancer survivors.