MCG and AD were supported by the National Institute download the handbook for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. CPRD

has received funding from the MHRA, Wellcome Trust, Medical Research Council, NIHR Health Technology Assessment programme, Innovative Medicine Initiative, UK Department of Health, Technology Strategy Board, Seventh Framework Programme EU, various universities, contract research organisations and pharmaceutical companies. Competing interests: None. Ethics approval: The study obtained ethical approval from the South West London Research and Ethics Committee (09/H0806/81) and was approved by the CPRD Independent Scientific Advisory Committee (ISAC protocol 08_083). Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
Multiple studies have explored the preferences of patients living with cancer towards preventative screening programmes, adjuvant therapies and information giving in palliative care.1–4 For example, a recent review of 23 papers published between 1987 and 2003 evaluating patients’ preferences

towards adjuvant therapy in cancer found that there were four important determinants of their choices.4 These included the benefits and toxicities of treatment, experience of the treatment and whether they had dependants at home. However, their results were limited by the small sample sizes of the studies included in the review and the lack of data about psychological characteristics and specialist-related factors. There are limited contemporary data about how patients living with cancer in metropolitan and rural areas make their cancer-related decisions relating to diagnosis, investigations and treatments. Identified determinants of the health-seeking behaviour of patients with cancer include personality and cultural factors,5 6 access to healthcare,7 their socioeconomic status8 and geographical location.9 A large American study5 using data from the 2007 Health Information National Trends Survey (n=1482 rural and 6192 urban residents) found that rural

patients were more likely to have fatalistic beliefs, which led to the lower likelihood that they would seek medical care. A study of patients with prostate cancer in rural Southwest Georgia10 also showed that rural patients who had a Dacomitinib poor therapeutic relationship with their doctors were less likely to receive treatment after 6 months compared with urban patients. There are reported deficiencies in the provision of certain healthcare services to rural areas in Australia.7 Rural patients are more likely to travel long distances to access healthcare services at an inconvenient time and incur additional out-of-pocket expenses.11 Their cancer-related decisions may be suboptimal and could result in worse survival outcomes in rural-remote patients across Australia.