30 May 2025

A new study suggests that liver cancer patients in rural areas have lower survival than metropolitan patients, with patients in rural areas passing away 2.53 years after diagnosis, compared to 4.7 years for patients in metropolitan areas.

The research, featured in this month’s Internal Medicine Journal from the Royal Australasian College of Physicians, highlights the health inequities faced by rural patients wanting to access specialist care and the dire need to address them.

Senior author, Dr Tim Mitchell, says that despite similar treatment plans for metropolitan and rural patients, rural patients still experienced significantly lower overall survival than metropolitan patients.

“Rural patients seem to have fewer years with their loved ones after being diagnosed with hepatocellular carcinoma, the most common form of primary liver cancer, than people in the cities.

“Of the 400 patients we included in our study, 305 were from urban areas and 95 were rural, 76.2% and 23.8% respectively.

“Patients presented with similarly staged disease, and we offered all patients similar curative treatment plans.

“We also observed that rural patients had a lower rate of post-treatment surveillance adherence, which meant they were less likely to stick to their post-treatment scans and care.

“Our hospital has a remote catchment that covers the Northern reaches of Western Australia. This means patients who don’t live in Perth have to travel a long way to see a liver specialist. There currently isn’t an MRI in the Kimberley and post-treatment liver MRI scans are not covered by the MBS so they need to be performed on a hospital scanner to avoid a cost to the patient.

“When patients have to travel hundreds, if not thousands of kilometres just to get a scan, and all the time and cost associated with that, it’s easy to see why people may deprioritise continuing their care, once the immediate threat has passed.

“Liver cancer is a very complex disease that requires routine medical checks by specialists, and being able to access that treatment is a timely fashion is absolutely necessary for good health outcomes.

“We also observed that regardless of whether patients were metropolitan or rural, a majority of our patients’ treatment – almost two-thirds – was not delivered within an optimal timeframe, which suggests system-related issues may be impacting liver cancer treatment.

“We need to improve the way we deliver healthcare to everyone – whether you’re in the bustling cities or in the bush.

“Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality globally as it is often diagnosed at a late stage. In Australia the incidence rates are increasing each year.

“To improve health outcomes for liver cancer patients, state and federal governments need to be investing in technology and supports we know our patients need: improving the awareness and diagnosis of chronic liver disease, services that address the underlying cause of liver disease, for example addiction medicine, and accessibility of medical technology.

“We also need investment in research to optimise liver cancer surveillance, ideally using a blood test rather than a scan, which is critical to improve access and timeliness of diagnosis and treatment.

“While this study has its limitations, being a small study within a single hospital network in WA, our findings do support what we’ve been seeing on the ground – rural patients appear worse off than their metropolitan counterparts.

“Given the retrospective study design, we were unable to determine the specific cause of death for patients and there may have been several factors affecting our results, including a lower prevalence of cirrhosis in our patients compared to historical data. It is also possible that patients with very advanced disease at diagnosis were not referred to us, so we didn’t capture those people either.

“We have not come up with a solution for this problem but hope our findings will be a point of conversation for doctors around the country, particularly in rural and remote areas, to highlight the need for better access for patients who need it most,” says Dr Mitchell.