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.