Rapid Fire Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Geographic variation in symptoms at palliative care admission among Australian cancer patients (142160)

Jared Tang 1 , Anumut Ayalew 2 , Sabina Clapham 2 , Melissa Loorham 3 , Natasha Michael 3 4 5
  1. School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW, Australia
  2. Palliative Care Outcomes Collaboration, Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
  3. Bendigo Health, Bendigo , VIC, Australia
  4. Institute of Health Research, University of Notre Dame, Sydney, NSW, Australia
  5. Plunkett Centre for Ethics, Australian Catholic Univeristy, Darlinghurst, NSW, Australia

Purpose: Nearly one-third of Australians live outside metropolitan areas, where they experience persistent disadvantage from education and employment to access to healthcare. Our aim was to quantify the extent to which geographic variation is associated with an increased symptom burden among patients with cancer at the initiation of palliative care.

Methods: A nationwide retrospective cohort study of 169,322 patients which included all adults who received palliative care for a cancer diagnosis from services registered with the Palliative Care Outcomes Collaboration between 1 January 2020 and 31 December 2024. Symptom burden was assessed using the Symptom Assessment Scale (SAS), Australia-modified Karnofsky Performance Status (AKPS), Resource Utilisation Group-Activities of Daily Living (RUG-ADL). The MMM was used to define geographical remoteness. Binary logistic regression models were fitted to examine the association between geographical remoteness and each symptom burden. A separate model was fitted for each symptom, and Statistical significance was set at p < 0.05.

Results: Lung cancer was the most common diagnosis (20.3%), followed by colorectal cancer (10.2%). Patients from regional and rural/remote areas exhibited a higher prevalence of moderate‑to‑severe symptoms than their metropolitan counterparts for all SAS domains. The greatest differences were seen between metropolitan and regional populations for all symptoms with fatigue and pain displaying the greatest prevalence. After adjustment, patients from regional and rural/remote areas had significantly higher odds of moderate‑to‑severe in all SAS domains. The strongest associations were observed for insomnia (regional aOR 1.45, 95% CI 1.38–1.52; rural/remote 1.35, 1.29–1.43) and nausea (regional 1.35, 1.28–1.42; rural/remote 1.23, 1.16–1.30).

Conclusion: This study provides compelling evidence of inequitable cancer-related symptom burden at the point of entry into specialist palliative care across geographic regions in Australia, reflecting gaps in access, workforce, and services. This underscores the need for targeted interventions to enhance timely access to palliative care in rural Australia.