Lay abstract This study assessed how US physicians have been treating a common type of esophageal cancer, known as squamous cell carcinoma, which has spread from the esophagus to other parts of the body (advanced/metastatic cancer). We looked at information from US cancer registry data on 756 people who were 66 years and older and diagnosed between 2010 and 2015. Only 14% of people received a second kind of chemotherapy after their first chemotherapy was stopped. People received their second chemotherapy for a short period (approximately 6 weeks) and lived for approximately 6 months on average from start of treatment. This research highlights that more effective treatments are needed for older people with advanced/metastatic esophageal squamous cell carcinoma. Aim: To characterize real-world patterns of second-line treatment and outcomes in older patients with advanced/metastatic esophageal squamous cell carcinoma (ESCC). Patients and methods: Patients aged >= 66 years diagnosed with advanced/metastatic ESCC between 2010 and 2015 and followed through 2016 were included in this retrospective analysis using SEER-Medicare data. Results: Of 756 patients with advanced/metastatic ESCC, 104 (14%) received second-line therapy; median duration of treatment was 1.5 months. Median overall survival was 5.7 months for all patients receiving second-line treatment, and 4.5, 5.6 and 8.5 months, respectively, for patients receiving taxane monotherapy, taxane combination therapy and nontaxane therapy. Conclusion: A small proportion of patients with advanced/metastatic ESCC received second-line therapy, which was associated with short duration of treatment and poor overall survival.