Objective <p>To systematically evaluate the effects of aerobic exercise (AE), resistance exercise (RE), mind-body exercise (MBE), and multimodal exercise (ME) on quality of life, depressive symptoms, and anxiety symptoms in older adults with cancer, and to compare the relative efficacy of different exercise types using network meta-analysis (NMA).</p> Methods <p>A systematic search was conducted in PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials published from database inception to April 5, 2026. Inclusion criteria were studies with participants having a mean age ≥ 65 years diagnosed with any type of cancer; interventions involving structured exercise training; and outcomes including quality of life, depression, or anxiety. Stata 17 was used for NMA, with standardized mean difference as the effect size. The surface under the cumulative ranking curve (SUCRA) was used to rank the efficacy of exercise types.</p> Results <p>A total of 27 randomized controlled trials involving 2,573 older adults with cancer were included. SUCRA ranking showed that for improving quality of life, AE showed the highest-ranking probability (81.5%), followed by ME (76.3%), MBE (62.0%), and RE (53.1%). For improving depression, MBE showed the highest-ranking probability (98.6%), followed by ME (73.5%), AE (66.3%), and RE (31.2%). For improving anxiety, MBE also showed the highest-ranking probability (95.8%), followed by RE (75.7%), ME (62.0%), and AE (50.9%).</p> Conclusion <p>The effects of different exercise types on psychological outcomes in older adults with cancer may vary. AE showed a higher-ranking probability for improving quality of life, while MBE demonstrated a higher-ranking probability for alleviating depression and anxiety. These findings should be interpreted cautiously considering the limitations of the evidence and may serve as a reference for clinical decision-making and future research.</p>