Timeliness of Colorectal Cancer Care in Veterans: The Role of Travel Distance.

BACKGROUND

Rural patients experience healthcare disparities due to multiple factors including travel distance. However, the impact on colorectal cancer (CRC) care for Veterans remains undefined.

AIMS: We aimed to describe the association between distance and timeliness of care for Veterans with CRC.

METHODS AND

RESULTS

We assembled a retrospective cohort of Veterans with Stage I-III CRC who underwent resection at a Veterans Affairs Medical Center (VAMC) between 2001 and 2018. Time from diagnosis to initiation of treatment, length of stay, 30-day readmissions and mortality were compared based on distance (≤ 40 mi; 41-100 mi, and > 100 mi). Among 375 patients, the median travel distance was 67.9 mi and median time to treatment initiation was 33 days. In a multivariable linear regression adjusted for age, stage, year of surgery, race and co-morbidities, the time to initial treatment was 11.8 days longer for patients > 100 mi away compared to those who live within 40 mi (CI 1.4-22.1, p = 0.026). No significant difference was observed for patients within 40 mi vs. 41-100 mi away (0.13 days, CI -9.4 to 9.8, 0.98). Common contributors to delays > 60 days included transitions from non-VAMC care, cardiac optimization and additional testing or treatment. There were no associations between distance and surgical length of stay, 30-day readmissions, or mortality.

CONCLUSION

Travel distance > 100 mi was associated with timeliness of care for Veterans, though no differences in clinical outcomes were observed. Distance-related outcome disparities may be mitigated through integrated, high-volume VA care system.