This retrospective cohort study examined the relationship between travel distance and timeliness of care for Veterans diagnosed with Stage I–III colorectal cancer who underwent surgical resection at a Veterans Affairs Medical Center (VAMC). The study period spanned 2001 to 2018. A total of 375 Veterans met inclusion criteria. The median travel distance from patients’ residence to the treating VAMC was 67.9 miles.
Across the cohort the median interval from cancer diagnosis to initiation of treatment was 33 days. The investigators categorized travel distance into three groups for analysis: ≤ 40 miles, 41–100 miles, and > 100 miles. These categories were used to compare timeliness metrics and short-term surgical outcomes.
To estimate the independent association between travel distance and time to initial treatment, the authors performed a multivariable linear regression model adjusted for age, cancer stage, year of surgery, race, and comorbidities. In this adjusted analysis, Veterans living more than 100 miles from the VAMC experienced a mean delay of 11.8 days to treatment initiation compared with those living within 40 miles (95% CI 1.4–22.1; p = 0.026). By contrast, there was no significant difference in time to treatment between Veterans living 41–100 miles and those living ≤ 40 miles (difference 0.13 days; 95% CI −9.4 to 9.8; p = 0.98).
The findings indicate a threshold effect in which the greatest delays occurred for the cohort traveling beyond 100 miles. The study adjusted for key clinical and demographic variables, suggesting that distance itself contributed to prolonged time to starting treatment independent of measured confounders.
Among cases with delays longer than 60 days, common documented contributors included: transitions from non-VAMC care (for example, referrals or care coordination issues when patients moved from community health systems to the VA system), preoperative cardiac optimization, and the need for additional diagnostic testing or interim treatments prior to definitive surgical management. The report attributes these factors as frequent practical causes of extended intervals before operative treatment.
The authors evaluated several short-term surgical outcome measures across the distance categories: length of hospital stay after resection, 30-day readmission rates, and 30-day mortality. No statistically significant associations were observed between travel distance and these outcomes. In other words, despite the observed delay in time to treatment for Veterans living >100 miles away, there was no detected difference in immediate postoperative length of stay, early readmissions, or short-term mortality in this cohort.
In this cohort of 375 Veterans with Stage I–III colorectal cancer treated at a VAMC between 2001 and 2018, greater travel distance—specifically distances exceeding 100 miles—was associated with a modest but statistically significant increase in time from diagnosis to initiation of treatment (mean 11.8 days longer) after adjustment for age, stage, year, race, and comorbidities. Veterans living 41–100 miles away did not show a meaningful increase in time to treatment compared with those living within 40 miles.
Common operational contributors to delays beyond 60 days included care transitions from non-VA systems, cardiac optimization needs, and additional testing or treatment prior to surgery. Despite delays linked to distance, there were no observed differences in short-term surgical outcomes (length of stay, 30-day readmissions, or mortality), which the authors suggest may reflect mitigating effects of the integrated, high-volume VA care system.
Limitations specific to the dataset and any additional subgroup or long-term survival analyses were not described in detail in the abstract. The authors conclude that while travel distance >100 miles is associated with decreased timeliness of care, integrated VA systems may help buffer distance-related disparities in immediate postoperative outcomes.
Keywords: Veteran's health; access to care; colorectal cancer; timeliness of care; travel distance.