Medical Journal of Australia最新文献

{"title":"Gabapentinoid Poisoning Presentations to Victorian Emergency Departments: A 15-Year Trend Analysis","authors":"Bishaal Tej Gurung,&nbsp;Amy McNeilage,&nbsp;Angus Skeen,&nbsp;Tina Lam,&nbsp;Joanna F. Dipnall,&nbsp;Jane Hayman,&nbsp;Suzanne Nielsen,&nbsp;Ting Xia","doi":"10.5694/mja2.70275","DOIUrl":"https://doi.org/10.5694/mja2.70275","url":null,"abstract":"<p>This study identified and characterised 1207 emergency department presentations related to gabapentinoid overdose in Victoria from 2009–2010 to 2023–2024. Presentation rates increased substantially since 2009–2010, and about half (49.5%; 597/1207) of all presentations were classified as intentional. Co-ingestants were common, although 36.2% (437/1207) of presentations were reported to involve gabapentinoids alone.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Safety of Concomitant Meningococcal B and National Immunisation Program Vaccines in Infants Aged < 15 Months: A Survey-Based Surveillance Study.","authors":"Thuy Nguyen, Evelyn C S Tay, Michael Dymock, Thomas L Snelling, Lucy Dawes, Julie Marsh, Yue Wu, Alan Leeb, Nicholas Wood, Lucy Deng","doi":"10.5694/mja2.70297","DOIUrl":"10.5694/mja2.70297","url":null,"abstract":"<p><strong>Objective: </strong>To examine short-term safety outcomes following vaccination at 2-, 4-, 6- and 12-month timepoints, comparing infants receiving meningococcal B (MenB) vaccines concomitantly with National Immunisation Program (NIP) vaccines to those receiving vaccines at separate visits.</p><p><strong>Study type: </strong>Observational cohort survey study.</p><p><strong>Setting, participants: </strong>Online surveys via AusVaxSafety were sent 3 days post-immunisation to collect reports of adverse events following immunisation (AEFIs). Infants aged < 15 months were included if, between 1 April 2022 and 31 March 2025, they received NIP and MenB vaccines concomitantly or separately at schedule timepoints, and their carer completed an AusVaxSafety survey.</p><p><strong>Main outcome measures: </strong>Bayesian multinomial logistic regression estimated the risk of reporting any AEFI, medical review and impact on daily activities following each vaccination strategy.</p><p><strong>Results: </strong>Of 45,215 infants receiving NIP and MenB vaccines at the 2-, 4-, 6- and 12-month timepoints (with or without other vaccines), 72% (32,751/45,215) received concomitant vaccination. Excluding those with additional vaccines, 10,959 were included in the analysis. The adjusted model showed the cumulative risk of any AEFI was lower under the concomitant strategy compared with the separate strategy at 2 months (29% [95% credible interval (CrI), 26% to 31%] vs. 35% [95% CrI, 31% to 40%], risk difference -6.7 [95% CrI, -11.5 to -2.2]) and similar at 4 months (45% [95% CrI, 43% to 48%] vs. 47% [95% CrI, 43% to 52%]), 6 months (45% [95% CrI, 42% to 49%] vs. 44% [95% CrI, 38% to 50%]) and 12 months (47% [95% CrI, 45% to 50%] vs. 52% [95% CrI, 48% to 56%]). Medical review within 3 days was lower at 12 months in the concomitant group (4.1% [95% CrI, 3.4% to 5.0%] vs. separate 6.3% [95% CrI, 4.7% to 8.3%], risk difference -2.2 [-4.3 to -0.4]) and comparable across earlier time points (concomitant 2.3%-4.2% vs. separate 3.6%-3.9%). Impact on daily activities was low (concomitant 1.1%-8.5% vs. separate 1.6%-8.3%) with no differences observed between strategies.</p><p><strong>Conclusions: </strong>Separating MenB vaccines from routine NIP vaccines does not reduce, and may increase, the cumulative reaction burden across visits. Findings support concomitant administration.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":"e70297"},"PeriodicalIF":6.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"They Brought the Hospital to Me","authors":"Hugh N. Burrill","doi":"10.5694/mja2.70281","DOIUrl":"https://doi.org/10.5694/mja2.70281","url":null,"abstract":"<p>I collapsed at the gym when a massive pulmonary embolism caused my heart to stop. Unbelievably I survived thanks to a clinical trial delivering an extracorporeal membrane oxygenation (ECMO) heart–lung bypass machine directly to me at the gym. Hopefully out-of-hospital ECMO becomes an accepted emergency strategy to save more lives.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Changing Indications for Adult Liver Transplantation in Australia: A Narrative Review","authors":"Fadak Mohammadi,&nbsp;Alan J. Wigg,&nbsp;Ken Liu,&nbsp;Simone I. Strasser","doi":"10.5694/mja2.70276","DOIUrl":"10.5694/mja2.70276","url":null,"abstract":"<div>\u0000 \u0000 <p>Adult liver transplantation practice in Australia and New Zealand has changed substantially over the past decade in response to shifting liver disease epidemiology and advances in donor organ preservation. Alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease have become leading indications for adult liver transplantation in Australia and New Zealand. Transplant recipients are increasingly older and medically complex, necessitating multi-disciplinary assessment including evaluation of frailty. Indications for liver transplantation have expanded to include selected patients with severe alcohol-related hepatitis, acute-on-chronic liver failure, extended-criteria hepatocellular carcinoma and other highly selected non-resectable liver malignancies including colorectal liver metastases and cholangiocarcinoma. In parallel, donor utilisation has evolved, with increasing use of expanded-criteria donors and donation after circulatory determination of death. Machine perfusion technologies are increasingly used in Australia to optimise marginal liver grafts and minimise waitlist mortality. Having an awareness of these evolving indications, recipient complexity and donor optimisation strategies is essential to support timely liver transplantation referral, improve inter-disciplinary understanding, allow equitable access and provide appropriate stewardship of limited donor organs.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in Preterm Birth Associated With Hypertensive Disorders of Pregnancy in Victoria, Australia: A Population-Based Interrupted Time-Series Study","authors":"Melvin Marzan,&nbsp;Heng Jiang,&nbsp;Daniel Lorber Rolnik,&nbsp;Joanne M. Said,&nbsp;Lisa Hui","doi":"10.5694/mja2.70267","DOIUrl":"10.5694/mja2.70267","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Hypertensive disorders of pregnancy (HDP) are a leading reason for medically indicated preterm birth (PTB), yet their contribution to population-level PTB trends is poorly understood. We examined temporal trends in PTB overall and HDP-associated PTB in Victoria over an 11-year period spanning the COVID-19 pandemic, and distinguished changes in HDP prevalence from changes in preterm delivery among affected pregnancies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Type&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Population-based interrupted time-series study using seasonal autoregressive integrated moving average (SARIMA) models, with July 2018 (launch of a national preterm birth prevention program) pre-specified as a temporal reference point.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;All hospitals in Victoria, Australia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;779,325 singleton births at ≥ 20 weeks' gestation between 1 January 2012 and 31 March 2022.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Monthly rates (per 1000 singleton births) of overall PTB, HDP and HDP-associated PTB. Decomposition analyses separated changes in HDP prevalence from changes in preterm delivery among affected pregnancies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Overall PTB was lower after July 2018 (5.8%–5.6%), while HDP prevalence increased (6.4%–7.0%). HDP-associated PTB increased before mid-2018 (+0.75 per 1000 births per month; 95% confidence interval [CI], 0.50–1.00) but declined thereafter (−1.12 per 1000 births per month; 95% CI, −1.88 to −0.36). This reversal was driven predominantly by reduced iatrogenic PTB with HDP; spontaneous PTB with HDP showed no significant change. Despite rising HDP prevalence, decomposition analyses estimated 89 fewer HDP-associated PTB cases than expected under pre-2018 patterns, reflecting a decline in the proportion of HDP pregnancies delivered preterm. PTB without HDP showed no significant temporal change.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;PTB among HDP-complicated pregnancies declined despite increasing HDP prevalence, consistent with a shift towards later gestational age at delivery rather than reduced disease incidence. These findings may reflect improvements in care and demonstrate that ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linguistic Manoeuvres: Obstetric Violence Camouflages Harm and Loss of Consent From Birth","authors":"Liz Sutton,&nbsp;Harsha Ananthram,&nbsp;Rebecca Matthews","doi":"10.5694/mja2.70265","DOIUrl":"https://doi.org/10.5694/mja2.70265","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linguistic Manoeuvres: Obstetric Violence Camouflages Harm and Loss of Consent From Birth","authors":"Wendy Pollock,&nbsp;Alissa Fleming,&nbsp;Ensieh Fooladi,&nbsp;Joy Kloester,&nbsp;Anne Tremayne,&nbsp;Yasmin Zisin,&nbsp;Bethany Carr,&nbsp;Kym Davey,&nbsp;Suzanne Willey,&nbsp;Jenny Gamble","doi":"10.5694/mja2.70264","DOIUrl":"https://doi.org/10.5694/mja2.70264","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linguistic Manoeuvres: Obstetric Violence Camouflages Harm and Loss of Consent From Birth","authors":"Bashi Kumar-Hazard,&nbsp;Andrew M. Bisits,&nbsp;Sharon L. Settecasse,&nbsp;Jenny Gamble,&nbsp;Hazel Keedle,&nbsp;Hannah G. Dahlen","doi":"10.5694/mja2.70263","DOIUrl":"https://doi.org/10.5694/mja2.70263","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Onset Colorectal Cancer With Liver-Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real-World Clinical and Molecular Data From an Australian National Database (2009–2024) to Guide Treatment Planning","authors":"Savio G. Barreto,&nbsp;Christos S. Karapetis,&nbsp;Shahid Ullah,&nbsp;Matthew Burge,&nbsp;Susan Caird,&nbsp;Angus Campbell,&nbsp;Azim Jalali,&nbsp;Ross Jennens,&nbsp;Muhammad A. Khattak,&nbsp;Belinda Lee,&nbsp;Stephanie H. Lim,&nbsp;Shehara Mendis,&nbsp;Louise Nott,&nbsp;Timothy J. Price,&nbsp;Jeremy D. Shapiro,&nbsp;Jeanne Tie,&nbsp;Javier Torres,&nbsp;Colin Williams,&nbsp;Rachel Wong,&nbsp;Vanessa Wong,&nbsp;Peter Gibbs","doi":"10.5694/mja2.70266","DOIUrl":"https://doi.org/10.5694/mja2.70266","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To leverage the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry (an Australian cancer database) to explore the ideal timing and sequence of therapies and the factors influencing these decisions in colorectal cancer (CRC) patients with liver-only metastases to inform contemporary decision-making and future trials.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Type&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective registry-based cohort study using the TRACC registry.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting and Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Consecutive patients with liver-only metastatic CRC enrolled in the TRACC registry.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early-onset CRC (EOCRC) (≤ 50 years) and late-onset CRC (LOCRC) (&gt; 50 years) patients with liver-only metastases from a real-world perspective.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between 14 January 2009 and 2 September 2024, 1691 patients with liver-only metastatic CRC were enrolled in TRACC. These included 276 EOCRC patients (16.3%) and 1415 LOCRC patients (83.7%). In the EOCRC subset, there were more females (48.2% vs. 34.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), more left-sided primaries (76.1% vs. 65.7%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), more synchronous disease (53.3% vs. 42.1%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and &lt;i&gt;BRAF&lt;/i&gt; V600E mutations (13.9% vs. 8.1%; &lt;i&gt;p&lt;/i&gt; = 0.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38 years, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99 years in EOCRC patients and 5.88 years in LOCRC patients. For all patients and for those undergoing resection, respectively, B-Raf proto-oncogene, serine/threonine kinase (&lt;i&gt;BRAF&lt;/i&gt;) (hazard ratio, 1.97 [&lt;i&gt;p&lt;/i&gt; &lt; 0.001] and hazard ratio, 2.25 [&lt;i&gt;p&lt;/i&gt; &lt; 0.001]) and Kirsten rat sarcoma viral oncogene homologue (&lt;i&gt;KRAS&lt;/i&gt;) mutations were associated with worse outcomes (hazard ratio, 1.29 [&lt;i&gt;p&lt;/i&gt; &lt; 0.001] and hazard ratio, 1.34 [&lt;i&gt;p&lt;/i&gt; = 0.003]).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Differences in sex distribution, &lt;i&gt;BRAF&lt;/i&gt; mutation rates, primary tumour site and over","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uneven Ground: Survival Differences Among Victorian Lung Cancer Patients by Location of Residence (2011–2023): A Retrospective Cohort Study","authors":"Evangeline Samuel,&nbsp;Eldho Paul,&nbsp;Mike Lloyd,&nbsp;Sanuki Tissera,&nbsp;Craig Underhill,&nbsp;Sagun Parakh,&nbsp;Phillip Parente,&nbsp;Inger Olesen,&nbsp;Javier Torres,&nbsp;Katharine See,&nbsp;Gavin M. Wright,&nbsp;David Langton,&nbsp;Thomas John,&nbsp;Matthew Conron,&nbsp;James Bartlett,&nbsp;Nicola Atkin,&nbsp;Nikolajs Zeps,&nbsp;Susan V. Harden,&nbsp;Wasek Faisal,&nbsp;John R. Zalcberg,&nbsp;Rob G. Stirling","doi":"10.5694/mja2.70268","DOIUrl":"https://doi.org/10.5694/mja2.70268","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective cohort study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting and Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;NSCLC patients diagnosed between 1 July 2011 and 22 May 2023 identified from the Victorian Lung Cancer Registry (VLCR).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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%]; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Comorbidity burden was similar across groups (median, 1; interquartile range, 0.0–1.0; &lt;i&gt;p&lt;/i&gt; = 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; &lt;i&gt;p&lt;/i&gt; &lt; 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; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). This difference persisted after adjustment for age, stage, performance status, smoking and comorbidities (HR, 1.11; 95% CI, 1.04–1.18; &lt;i&gt;p&lt;/i&gt; = 0.001).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Regional, rural and remote patients with NSCLC face greater socio-economic disadvantage and travel burdens, and experie","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 8","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}