Objective To investigate the effects of empowerment theory-based behavioral transformation nursing on symptom distress, psychological resilience, and coping styles in elderly oncology patients. Methods Eighty elderly patients hospitalized in the oncology department of The Third People’s Hospital of Bengbu from January with internal 2021 to April 2024 were selected. With SPSS software to generate a random number table, patients were randomly divided into a control group and an observation group in a 1:1 ratio, with 40 cases in each group. The control group received routine nursing care, while the observation group received additional empowerment theory-based behavioral change transformation intervention on top of routine care. The intervention period was 3 months for both groups. The changes in symptom distress (MSAS score), psychological resilience (CD-RISC score), and coping styles (MCMQ score) were observed and compared between the two groups before and after intervention. Results After intervention, symptom distress scores in both groups decreased significantly compared with pre-intervention [control group (2.15±0.38) points vs (1.22 ±0.16) points; observation group (2.13 ±0.42) points vs (0.78 ±0.09) points, both P <0.001]. The observation group showed significantly lower scores in total distress index [(0.78±0.09) points vs (1.22±0.16) points], physical symptoms [(1.08 ±0.14) points vs (1.66±0.21) points], and psychological symptoms [(0.92 ±0.12) points vs (1.54±0.21) points] compared with the control group (all P<0.001). Regarding psychological resilience, the observation group demonstrated significantly higher scores in optimism [(13.45±1.87) points vs (11.62±1.59) points], tenacity [(35.85±4.96) points vs (32.06 ±4.45) points], and strength [(25.72 ±3.55) points vs (22.35 ±3.09) points] compared with the control group (all P<0.001). In terms of coping styles, the observation group showed significantly higher scores in confrontation [(16.24±2.24) points vs (13.73±1.89) points, P<0.001] and significantly lower scores in avoidance [(14.03±1.94) points vs (17.45±2.42) points] and submission [(10.16±1.41) points vs (14.02±1.94) points] compared with the control group (all P<0.001). Conclusion Empowerment theory-based behavioral transformation nursing can effectively alleviate symptom distress, enhance psychological resilience, and promote the formation of positive coping styles in elderly oncology patients.