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To investigate self‐reported out‐of‐pocket health care expenses, both overall and by cost type, for a large population‐based sample of Australians, by cancer status and socio‐demographic and medical characteristics. Cross‐sectional study. New South Wales residents participating in the 45 and Up Study (recruited aged 45 years or older during 2005–2009) who completed the 2020 follow‐up questionnaire; survey responses linked with New South Wales Cancer Registry data. Proportions of respondents who reported that out‐of‐pocket health care expenses during the preceding twelve months exceeded $1000 or $10 000; adjusted odds ratios (aORs) for associations with socio‐demographic and medical characteristics. Of the 267 357 recruited 45 and Up Study participants, 45 061 completed the 2020 survey (response rate, 53%); 42.7% (95% confidence interval [CI], 42.2–43.1%) reported that overall out‐of‐pocket health care expenses during the previous year exceeded $1000, including 55.4% (52.1–58.7%) of participants diagnosed in the preceding two years and 44.9% (43.7–46.1%) of participants diagnosed with cancer more than two years ago. After adjustment for socio‐demographic factors, out‐of‐pocket expenses greater than $1000 were more likely to be reported by participants with cancer than by those without cancer (diagnosis in past two years: aOR, 2.06 [95% CI, 1.77–2.40]; diagnosis more than two years ago: aOR, 1.22 [95% CI, 1.15–1.29]). The odds of out‐of‐pocket expenses exceeding $1000 increased with area‐based socio‐economic advantage and household income, and were higher for people with private health insurance (vpeople with Medicare coverage only: aOR, 1.64; 95% CI, 1.53–1.75). Out‐of‐pocket expenses exceeding $10 000 were also more likely for participants diagnosed with cancer during the past two years (vno cancer: aOR, 3.30; 95% CI, 2.56–4.26). People diagnosed with cancer during the past two years were much more likely than people without cancer to report twelve‐month out‐of‐pocket health care expenses that exceeded $1000. Out‐of‐pocket expenses for people with cancer can exacerbate financial strain at a time of vulnerability, and affect health care equity because some people cannot pay for all available treatments.

To describe patterns of care in New South Wales for men with prostate cancer, and to ascertain factors associated with receiving different types of treatment. Individual patient data record linkage study. 4003 New South Wales men aged 45 years or more enrolled in the population‐based 45 and Up Study in whom prostate cancer was first diagnosed during 2006–2013. Prostate cancer treatment type received; factors statistically associated with treatment received; proportions of patients who consulted radiation oncologists prior to treatment. In total, 1619 of 4003 patients underwent radical prostatectomy (40%), 893 external beam radiotherapy (EBRT) (22%), 183 brachytherapy (5%), 87 chemotherapy (2%), 373 androgen deprivation therapy alone (9%), and 848 no active treatment (21%). 205 of 1628 patients who had radical prostatectomies (13%) had radiation oncology consultations prior to surgery. Radical prostatectomy was more likely for patients aged 45–59 years, with regional stage disease, living 100 km or more from the nearest radiotherapy centre, having partners, or having private health insurance, while lower physical functioning, obesity, and living in areas of greater socio‐economic disadvantage reduced the likelihood. EBRT was more likely for patients aged 70–79 years, with non‐localised or unknown stage disease, living less than 100 km from the nearest radiotherapy centre, or not having private health insurance, while the likelihood was lower for patients aged 45–59 years or more than 80 years and for those who had several comorbid conditions. Men with prostate cancer were twice as likely to have radical prostatectomy as to receive EBRT, and fewer than one in seven had consulted radiation oncologists prior to prostatectomy. The treatment received was influenced by several socio‐demographic factors. Given the treatment‐specific side effects and costs, policies that affect access to different treatments for prostate cancer should be reviewed.