Aims: The aim of this study was to explore the potential survival differences for advanced cancer patients treated in metropolitan Perth and rural WA.

Methods: Retrospective data was collected for advanced cancer patients treated between 1st Jan 2007 and 31st Dec 2011 through the Medical Oncology Department at Royal Perth Hospital. Patients were divided into two groups: country and metropolitan Perth based on residential postcodes. Survival analysis was carried out for advanced breast, colorectal, lung, pancreatic, esophageal/gastric, melanoma and prostate cancer.

Results: 1602 patients were identified. Survival data was available for 1581 patients, 408 country and 1173 metro dwelling. Median survivals for country and metro patients respectively were: whole group: 7.6m vs. 8.3m (p=0.06, HR 0.89), breast: 21.3m vs. 22.1m (p=0.18), colorectal: 16.4m vs. 13.1m (p=0.32), lung: 3.1m vs. 5.1m (p=0.17), upper GI (esophageal/gastric): 7.2m vs. 5.6m (p=0.63), pancreatic: 3m vs. 4.5m (p=0.02), melanoma: 10.5m vs. 10.4m (p=0.95) & prostate: 15.3m vs. 28.6m (p=0.17). Country patients received fewer lines of anti-cancer therapy compared to metro patients for breast cancer (> 2lines: 37% vs. 61%) & pancreatic cancer (≥ 1line: 42% vs. 60%; ≥ 2lines: 19% vs. 35%). On multivariate analysis performance status (p <0.0001) & treatment site (p=0.02) were major prognostic factors.

Conclusions: Our findings suggest a trend towards inferior survival outcome for rural cancer patients. Treatment outcomes for rural patients have improved over last decade due to specialist-lead rural oncology clinics but further measures are needed to close the treatment gap.