The Medical journal of Australia · 2026
Uneven Ground: Survival Differences Among Victorian Lung Cancer Patients by Location of Residence (2011-2023): A Retrospective Cohort Study.
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Samuel Evangeline, Paul Eldho, Lloyd Mike, Tissera Sanuki, Underhill Craig, Parakh Sagun, Parente Phillip, Olesen Inger, Torres Javier, See Katharine, Wright Gavin M, Langton David, John Thomas, Conron Matthew, Bartlett James, Atkin Nicola, Zeps Nikolajs, Harden Susan V, Faisal Wasek, Zalcberg John R, Stirling Rob G
Аннотация
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.
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.