IARC 60th Anniversary - 19-21 May 2026
Session : Global Advances in Transforming towards Resilient and Equitable Health System
Equitable cancer care in rural and remote Australia: A mixed methods study to identify solutions for reducing time to diagnosis and treatment
MARSHALL S. 1, YOONG S. 1, UGALDE A. 1, CHAPMAN A. 1, ANDERSON A. 1, WRIGHT C. 1, CRAWFORD-WILLIAMS F. 2, JONGEBLOED H. 1, RODI H. 1, RIVA S. 1, WONG SHEE A. 1, SHORT C. 3, HART N. 4, GUNN K. 5, ARAS D. 6, BERGIN R. 1, BOLTONG A. 7, KARIKIOS D. 9, RHEE J. 9, KISS N. 1, LEIGH L. 10, GAO L. 1
1 Deakin University, Burwood, Australia; 2 McGrath Foundation, Sydney, Australia; 3 University of Melbourne, Parkville, Australia; 4 University of Technology Sydney, Sydney, Australia; 5 Adelaide University, Adelaide, Australia; 6 Western Alliance, Warrnambool, Australia; 7 Monash University, Melbourne, Australia; 8 University of Sydney, Sydney, Australia; 9 University of New South Wales, Sydney, Australia; 10 Hunter Medical Research Institute, Newcastle, Australia
?Background: People with cancer in rural and remote areas experience poorer cancer outcomes compared with people living in urban areas, in part due to delays in diagnosis and treatment commencement. In Australia, the Optimal Care Pathways (OCPs) are nationally endorsed guides outlining best practice cancer care. The ECORRA (Equitable Cancer Outcomes across Rural and Remote Australia) trial aims to codesign and test an implementation package to support rural and remote healthcare services in delivering care aligned with the OCPs.
Objectives: We report on the first phase of this project, to understand current cancer care practices in rural and remote areas of Australia, and barriers and facilitators of timely cancer care.
Methods: A mixed-methods study guided by the Theoretical Domains Framework (TDF) to explore determinants of practice, and Levesque’s framework for healthcare access. Purposive sampling recruited health professionals involved in rural cancer care delivery, and people with lived experience of cancer residing in rural Australia. Participants completed a pre-interview online survey followed by a semi-structured interview. Quantitative data were analysed descriptively and qualitative data were thematically analysed and mapped to TDF or Levesque domains. Participants were asked about awareness and use of OCPs, and consumers were asked about barriers and facilitators to accessing care.
Results: Of the 135 consenting participants, 112 completed the survey and 96 participated in an interview, including 74 health professionals (76% female; 35% medical, 45% nursing), and 22 consumers (91% female, 82% patients, 18% carers). Approximately a quarter of health professionals had good or excellent awareness of the OCPs (28%), with variation across states. Just over half of professionals (51%) felt equipped to deliver OCP concordant care, and 77% had not received any OCP- specific training. While most professionals (71%) agreed that cancer framework adherence improves outcomes, confidence in meeting the diagnostic and treatment timelines outlined in the OCPs across the sample was moderate (43%). Professional interviews highlighted system-level and resource barriers that impact on diagnostic and treatment timelines, including limited diagnostic and treatment equipment, specialist shortages, and poor interoperability of IT systems. Consumers highlighted service scarcity, long travel distances, financial burdens, and challenges navigating complex health systems as major access barriers that may affect diagnostic and treatment timelines.
Several solutions for increasing timeliness of cancer care to people in rural areas were identified. These include regional hubs within tertiary services, rapid-access clinics to fast-track care, dedicated care coordination, telehealth, outreach, strong collegial relationships, leadership support, a collaborative health professional culture, constructive auditing, routine audit and feedback, and guiding decisions with multidisciplinary meetings.
Conclusions/Implications: Key determinants affecting the timeliness of cancer diagnosis and treatment commencement across rural and remote settings were identified. The next phase of this work is to operationalise the solutions with rural health service partners through co-design. Findings will inform the design of theory-driven, equity-focused implementation strategies to support delivery of optimal, timely cancer care across Australia. These findings present a roadmap of solutions to reduce rural inequities, relevant to policy development, health service initiatives and research programs globally.