Purpose <p>This study aimed to evaluate the prevalence and predictors of frailty and the association between frailty and neurocognitive impairments among Chinese survivors of childhood cancer.</p> Methods <p>A total of 185 survivors of childhood cancer were recruited from a long-term follow-up clinic in Hong Kong (response rate: 94.4%; 48.1% female; mean age 28.9&#xa0;years, standard deviation = 6.7&#xa0;years). Frailty was assessed using the Fried frailty criteria. Neurocognitive outcomes were evaluated using a performance-based test. Multivariable logistic regression was used to identify the predictors of frailty. Multivariable generalized linear models were used to explore the associations between frailty and cognitive outcomes.</p> Results <p>The proportions of survivors with frailty and pre-frailty were 22.7% and 27.0%, respectively. “Frail” survivors were more likely to be diagnosed with cancer at a younger age (odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.87–0.99, <i>P</i> = 0.041) and to have coexisting chronic health conditions (OR = 4.63, 95% CI: 1.68–12.80, <i>P</i> = 0.003) than “non-frail” and “pre-frail” survivors. Survivors with frailty exhibited worse attention detectability (unstandardized point estimate [Est] = 4.57, standard error [SE] = 1.69, <i>P</i> = 0.007), omissions (Est = 3.68, SE = 1.15, <i>P</i> = 0.001), and cognitive flexibility (Est = 8.08, SE = 3.08, <i>P</i> = 0.009) than “non-frail” and “pre-frail” survivors.</p> Conclusions <p>More than one fifth of the participating Chinese survivors of childhood cancer were identified as phenotypically frail. Frailty was associated with worse performance in attention and executive function.</p> Implications for Cancer Survivors <p>The findings highlight the needs for regular monitoring and early interventions that can modify the aging pathway in the cancer continuum, to mitigate frailty and improve psychosocial outcomes during long-term cancer survivorship.</p>