Victims of child sex abuse and their families are angry at Cardinal George Pell's delay in giving evidence to the Royal Commission into Institutional Responses to Child Sexual Abuse.

Key points: Cardinal Pell cancels appearance scheduled for next week at child sex abuse royal commision

Cardinal Pell cancels appearance scheduled for next week at child sex abuse royal commision His office says his cardiologist has advised him against making the trip from Rome due to a heart condition

His office says his cardiologist has advised him against making the trip from Rome due to a heart condition Some abuse survivors angered by decision

Some abuse survivors angered by decision Cardinal Pell will be called again to appear in February

Cardinal Pell's long-awaited appearance at the inquiry has been delayed after his lawyers said he was suffering from a heart condition which made him too sick to travel to Australia.

Allan Myers QC applied for Cardinal Pell, who is based in Rome, to give his testimony via video link instead, a request which was denied by the inquiry's chair, Justice Peter McClellan.

Justice McClellan said he would call Cardinal Pell to give evidence before the inquiry in Ballarat, a diocese that has been described by victims as being a "centre of sex crimes against children", in February.

"It is preferable that his evidence be given in person in Australia," Justice McClellan said.

"The commission had already determined to sit in Ballarat to take further evidence in relation to the Ballarat matter, that having been listed for February of next year.

"In the hope that the Cardinal's health will improve, rather than take video evidence this week we will defer his evidence to the Ballarat sitting.

"If the Cardinal's health has not sufficiently improved by then to enable him to travel we will further consider the position, which may include further delaying his evidence to a date when he can travel safely to Australia."

He also noted there were technical difficulties when Cardinal Pell appeared via video link from Rome last year.

Justice McClellan's comments were met by a round of applause from the audience at the hearing.

"Cardinal Pell deeply regrets this, and has been preparing himself for this journey for some time, but the circumstances in which he finds himself are the circumstances that exist now," Mr Myers told the commission.

"He doesn't wish to delay the hearing of his evidence before the commission, he wishes it to be received in the ordinary course that's been organised by the commission."

A statement from Cardinal Pell's office said the 74-year-old, who is Australia's most senior Catholic, suffered from a heart condition and had been advised by a cardiologist that it was not safe to undertake long-haul flights.

Survivor 'furious' at no-show

Abuse victim David Ridsdale said he was "furious" Cardinal Pell would not be giving evidence next week.

Mr Ridsdale suffered years of abuse at the hands of his uncle, notorious convicted paedophile Gerald Ridsdale.

He told the commission in May that Cardinal Pell tried to bribe him to stay quiet about the abuse, a claim which Cardinal Pell denied.

"It's fairly simple, he needs to come and answer some questions. It's not that difficult," Mr Ridsdale said.

"If I can make the flight and I was only premium economy, not first class like he was ... I would implore Cardinal Pell to come and face the music like all of us men have had to do for all these years."

"I'm not disappointed, I'm furious. But having him come to Ballarat may not be the result he was expecting, so I'm pleased the commission responded as they did."

Anthony Foster, whose daughter Emma was serially abused by a priest while in primary school, said Cardinal Pell's absence did not come as a complete surprise.

"We're shocked, disappointed, [but], in a strange way, not surprised," he said.

"This is a very, very late call for a supposedly serious ailment. I find that unlikely."

Cardinal Pell was an assistant priest in Ballarat East from 1973 to 1983. The diocese has been described by victims as being a "centre of sex crimes against children".

He later set up the Melbourne Response to handle abuse complaints when he became Melbourne Archbishop in 1996, before becoming the Archbishop of Sydney.

He now oversees the Vatican's finances.

Cardinal Pell has previously acknowledged his mistakes and apologised for the Catholic Church's handling of sexual abuse cases.

Ballarat victims have long called on Pell to give his evidence in the regional city.

'Unsafe' for Pell to fly long haul

A statement from Cardinal Pell's office issued later on Friday said while some may question his decision to stay in Rome, it would be "unwise for him not to heed medical advice".

The statement said:

The Cardinal had booked his travel back to Melbourne and until the middle of this week was determined to return to give evidence in person. The Cardinal has suffered from a heart condition for some time but his symptoms have recently worsened, with a specialist cardiologist in Rome advising only a few days ago that it is not safe for him to undertake long haul flights in his current condition. Cardinal Pell strongly supports the work of the royal commission and wanted to keep his commitment to give evidence from 16 December.

It said his health would continued to be monitored.

Cardinal Pell was called to appear by the commission in June.

"I want to make it absolutely clear that I am willing to give evidence should the commission request this, be it by statement, appearance by video link, or by attending personally," he said in a statement at the time.

The commission has previously heard harrowing evidence about allegations of child abuse at the hands of priests, involving dozens of victims, particularly in the Ballarat area, in Victoria's west.

It was also revealed a number of senior clergy did not act when told of abuse, and many dismissed allegations made by victims at the time.