OBJECTIVES: To consider current trends and future strategies that will bring about change in cancer care delivery for vulnerable populations. DATA SOURCES: Institute of Medicine reports, literature review, clinical practice observations and experiences. CONCLUSION: Vulnerable populations are older adults, both minorities and the underserved, children, and individuals at end of life. These groups pose unique challenges that require health system changes and innovative nursing models to assure access to patient-centered care in the future. IMPLICATIONS FOR NURSING PRACTICE: In the future, attention to the needs of vulnerable populations, the growing aging cancer population and the improved outcomes in the pediatric and adolescent cancer population will all require new nursing services and models of care. System changes where nursing roles are critical to support the transition to earlier palliative care are projected.