Background: The benefit of chemotherapy for elderly patients with SCLC in the community setting has not been quantified. The purpose of this retrospective cohort study is to analyze factors associated with the administration of chemotherapy and to examine the impact of chemotherapy on survival. Methods: Patients with SCLC diagnosed between 1992 and 2001 who were at least 65-years old were selected from the SEER-Medicare database. Logistic regression was used to evaluate which covariates influenced receipt of chemotherapy and to construct a propensity score. Cox proportional hazards regression was employed to examine the influence of clinical and demographic variables on survival. Quantile regression was utilized to examine the independent effect of chemotherapy on survival. Results: The final cohort included 10,428 patients. After diagnosis, 67.1% received chemotherapy, 39.1% received radiation, 3.4% received surgery, and 21.8% received no treatment. The most common chemotherapy regimens included etoposide combined with cisplatin or carboplatin. Patients ages 85 and older were less likely to receive chemotherapy compared to patients ages 65 to 69 (OR 0.17, 95% CI 0.14-0.21). Being black was associated with a decreased likelihood of receiving chemotherapy (OR 0.67, 95% CI 0.56-0.81) as was having distant stage disease compared to localized disease (OR 0.56, 95% CI 0.47-0.67). Median survival was 7 months. Factors associated with improved survival were female gender, black race, having localized stage disease, receiving any treatment, and having a lower comorbidity score. Propensity score analysis demonstrated a 6.9-month improvement in median survival for patients who received chemotherapy. Similarly, quantile regression demonstrated that chemotherapy provided a 6.4-month improvement in median survival (95% CI, 6.2–6.6, p<0.001). Conclusions: Statistically significant differences in the receipt of chemotherapy exist among elderly patients with SCLC. Even after extensive adjustments, treatment with chemotherapy is associated with a greater than 6-month improvement in median survival among elderly patients with SCLC.