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Background Aboriginal Australians have higher cancer mortality than non‐Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this. Aims To investigate demographic, clinical and access factors associated with lung, breast and bowel cancer treatment for Aboriginal people compared with non‐Aboriginal people in New South Wales, Australia. Methods Population‐based cohort study using linked routinely collected datasets, including all diagnoses of primary lung, breast or bowel cancer from January 2009 to June 2012. Treatment (surgery, radiotherapy or chemotherapy) within 6 months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer‐specific multidisciplinary team, visit to a specialist and possession of private health insurance. Logistic regression modelling was employed. Results There were 587 Aboriginal and 34 015 non‐Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non‐Aboriginal people received surgery (odds ratio 0.46, 95% confidence interval 0.29–0.73, P < 0.001) or any treatment (surgery, chemotherapy or radiotherapy; odds ratio 0.64, 95% confidence interval 0.47–0.88, P = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 vs 33.3%, 2865/8597, P = 0.04) compared with non‐Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non‐Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities. Conclusion Aboriginal people were significantly less likely to receive surgery for lung cancer than non‐Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways.

International clinical guidelines recommend long-or short-course neoadjuvant radiotherapy for locally advanced rectal cancer. This study aims to examine variation in the use of neoadjuvant radiotherapy for rectal cancer and identify patient and hospital factors that underpin this variation. Methods and Materials:We conducted a retrospective, consecutive cohort study using statewide hospitalisation and radiotherapy data from New South Wales, Australia, 2013-2018. Included participants had a primary rectal adenocarcinoma and underwent surgical resection. Factors associated with the use or not of any neoadjuvant radiotherapy, and short versus long-course were explored using multilevel logistic regression models.Results: Of the 2912 people included in the study, 43% received neoadjuvant radiotherapy. There was significant variation in the use of neoadjuvant radiotherapy depending on geographic location. Abdominoperineal excision (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.53-2.28) and having surgery in a public hospital (OR = 2.34, 95% CI = 1.92-2.87) were both predictors of use. Among those receiving neoadjuvant radiotherapy, 17% received short-course therapy, with shortcourse declining over the study period.Conclusions: The use of neoadjuvant radiotherapy for rectal cancer is highly variable, with differences only partially explained by assessable patient-or hospital-level factors. Understanding neoadjuvant radiotherapy utilisation patterns may assist in identifying barriers and opportunities to improve adherence to clinical guidelines.