© 2015 National Rural Health Alliance Inc. Objective: To investigate whether any survival differences existed between advanced cancer patients treated in metropolitan Perth and those treated in regional Western Australia (WA). Design: Retrospective study. Setting: Advanced cancer patients treated through medical oncology clinics at Royal Perth Hospital and regional cancer centres (Kalgoorlie, Albany, Geraldton and Northam). Participants: Patients diagnosed with advanced melanoma, breast, colorectal, gastro-oesophageal, prostate, lung and pancreatic cancers between 1 January 2007 and 31 December 2011. Interventions: Nil. Main outcome measure: Median survival. Results: Data were available for 1581 patients with 75% living in a metropolitan setting and 25% in rural WA. Median overall survival was 8.3 months for metropolitan patients and 7.6 months for regional patients (P=0.06, HR 0.89; 95% CI, 0.78-1.01). There was no statistically significant difference in median survival for different tumour types except pancreatic cancer: breast 22.1 months versus 21.3 months, colorectal 13.1 months versus 16.4 months, lung5.1 months versus 3.1 months, upper GI 5.6 months versus 7.2 months, pancreatic4.5 months versus 3 months (P=0.02, HR 0.57; 95% CI, 0.32-0.99), melanoma 10.4 months versus 10.5 months, prostate28.6 months versus 15.3 months. Rural cancer patients with breast and pancreatic cancers received fewer lines of anti-cancer therapy compared to metropolitan patients. The three-year survival rates for metropolitan compared to rural breast cancer patients were 34 and 23%, respectively (not statistically significant). Conclusion: Our findings suggest a trend towards inferior survival for regional cancer patients in WA compared with metropolitan-based patients.