Volume 224 - Published ahead of Issue 8
Uneven Ground: Survival Differences Among Victorian Lung Cancer Patients by Location of Residence (2011–2023): A Retrospective Cohort Study
Authors: Evangeline Samuel, Eldho Paul, Mike Lloyd, Sanuki Tissera, Craig Underhill, Sagun Parakh, Phillip Parente, Inger Olesen, Javier Torres, Katharine See, Gavin M. Wright, David Langton, Thomas John, Matthew Conron, James Bartlett, Nicola Atkin, Nikolajs Zeps, Susan V. Harden, Wasek Faisal, John R. Zalcberg, Rob G. Stirling
Correspondence: evangeline.samuel@monash.edu
Med J Aust 2026 || doi: 10.5694/mja2.70268
Published online: 18 August 2026
Published online: 18 August 2026
Abstract
Objectives
Patients in regional and rural areas consistently experience poorer lung cancer survival rates compared with those in metropolitan centres, but the reasons remain unclear. This study examined survival differences in non-small cell lung cancer (NSCLC) across Victoria and identified key prognostic factors contributing to these differences.
Design
Retrospective cohort study.
Setting and Participants
NSCLC patients diagnosed between 1 July 2011 and 22 May 2023 identified from the Victorian Lung Cancer Registry (VLCR).
Main Outcome Measures
Residential address and treatment institution were classified using the Modified Monash Model (MMM): Modified Monash (MM) category 1 (MM1) as metropolitan, MM2 as regional and MM3–MM7 as rural/remote. Demographic, socio-economic and cancer-specific factors were analysed as potential predictors of all-cause mortality.
Results
Among 13,548 patients, 4244 (31%) lived in regional or rural/remote areas. Compared with metropolitan patients, these groups had higher smoking prevalence (metropolitan, 2848/9304 [31%] vs. regional, 366/1083 [34%] vs. rural, 1148/3161 [37%]) and were more likely to be Australian-born (metropolitan, 4919/9304 [53%] vs. regional, 873/1083 [81%] vs. rural, 2603/3161 [82%]; p < 0.001). Comorbidity burden was similar across groups (median, 1; interquartile range, 0.0–1.0; p = 0.19). Socio-economic disadvantage was more marked in regional and rural patients (median Index of Relative Socio-Economic Advantage and Disadvantage [IRSAD] deciles: metropolitan, 8.0 vs. regional, 5.0 vs. rural, 3.0; p < 0.001), and average travel times to treatment were longer (metropolitan, 0.4 vs. regional, 1.9 vs. rural, 2.8 h, respectively). Patients treated at regional institutions had poorer survival (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.19–1.35; p < 0.001). This difference persisted after adjustment for age, stage, performance status, smoking and comorbidities (HR, 1.11; 95% CI, 1.04–1.18; p = 0.001).
Conclusions
Regional, rural and remote patients with NSCLC face greater socio-economic disadvantage and travel burdens, and experience poorer survival even after accounting for clinical and demographic factors. These findings highlight enduring inequities in lung cancer care and emphasise the need for targeted interventions to strengthen access, treatment equity and outcomes for non-metropolitan populations.
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Savio G. Barreto, Christos S. Karapetis, Shahid Ullah, Matthew Burge, Susan Caird, Angus Campbell, Azim Jalali, Ross Jennens, Muhammad A. Khattak, Belinda Lee, Stephanie H. Lim, Shehara Mendis, Louise Nott, Timothy J. Price, Jeremy D. Shapiro, Jeanne Tie, Javier Torres, Colin Williams, Rachel Wong, Vanessa Wong, Peter Gibbs
Australian Pathways for Specialist Pain Management and Early Palliative Care for People With Pancreatic Cancer: Developed Using a Community Consensus Approach
Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy
Program Guidelines for the National Lung Cancer Screening Program: Targeted Lung Cancer Screening in High-Risk Individuals in Australia
Nicole M. Rankin, Rebecca Zosel, Lisa J. Whop, Raglan Maddox, Annette McWilliams, Miranda Siemienowicz, Jon Emery, Maria A. R. Lantin, Georgia Bartlett, Mikayla Wolfe, Abbey Diaz, Katrina Anderson, Lillian Liu, Cindy Toms, Sarah McDermott, Peter Bligh, Jeremy Chalke, Stephen Melsom, Claire E. Nightingale, Alison Brown, Sam Pope, Julia Brotherton, Anne Fidler, Michel Itel, Mark Brooke, Diane M. Pascoe, Fraser Brims, Tracy L. Leong, Emily Stone, Dorothy Keefe, Vivienne Milch
Beyond Mammography: Sovereignty and Relational Breast Care With Aboriginal and Torres Strait Islander Women
Devaleena Das, Jessica Gildersleeve, Amy Thomson, Aunty Gracelyn Smallwood, Lorelle Holland
Striving for Racial Equity in Oral Cancer Research: A Case Study
Sneha Sethi, Simon Naylor, Catherine Leane (Dharug/Gabrigal), Gail Garvey (Kamilaroi), Joanne Hedges (Yamatji), Lisa M. Jamieson, Nicolas Reid (Dharug/Gabrigal)
Treatment and Survival Outcomes for Indigenous and Non-Indigenous Australians Within the Victorian Lung Cancer Registry: A Retrospective Cross-Sectional Cohort Study
Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling