---
title: "Travel Distance and Timeliness of Colorectal Cancer Care in Veterans"
id: "pubmed-42675007"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42675007"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42675007/"
doi: "10.1002/cnr2.70663"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Travel Distance and Timeliness of Colorectal Cancer Care in Veterans
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42675007
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42675007/)
- **DOI:** [10.1002/cnr2.70663](https://doi.org/10.1002%2Fcnr2.70663)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cohort study evaluated how **travel distance** affected timeliness of care for Veterans with Stage I–III **colorectal cancer** who underwent surgical resection at a Veterans Affairs Medical Center between 2001 and 2018. - The cohort included 375 Veterans; the median travel distance was 67.9 miles and the median time from diagnosis to treatment initiation was 33 days. - In multivariable linear regression adjusted for age, stage, year of surgery, race, and comorbidities, Veterans living >100 miles from the treating VAMC experienced a mean delay of **11.8 days** to treatment start compared with those living ≤40 miles (95% CI 1.4–22.1; p = 0.026). - No meaningful difference in time to treatment was observed between Veterans living 41–100 miles and those ≤40 miles (0.13 days; 95% CI −9.4 to 9.8; p = 0.98). - Common contributors to delays exceeding 60 days included transitions from non-VA care, need for cardiac optimization, and requirement for additional testing or treatment prior to surgery. - There were no detected associations between travel distance and surgical length of stay, 30-day readmissions, or mortality. - Authors conclude that travel distance >100 miles is associated with delays in care timing but not with short-term surgical outcomes, and suggest that integrated, high-volume VA care may mitigate distance-related disparities.
## Clinical Analysis & Structured Key Points
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Timeliness of Colorectal Cancer Care in Veterans: The Role of Travel Distance [Emma M Bradley](https://pubmed.ncbi.nlm.nih.gov/?term=Bradley+EM&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Megan Shroder](https://pubmed.ncbi.nlm.nih.gov/?term=Shroder+M&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Gretchen Edwards](https://pubmed.ncbi.nlm.nih.gov/?term=Edwards+G&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Shannon McChesney](https://pubmed.ncbi.nlm.nih.gov/?term=McChesney+S&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-3 "Division of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA."), [Colleen Kiernan](https://pubmed.ncbi.nlm.nih.gov/?term=Kiernan+C&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-4 "Division of Surgical Oncology, Department of General Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA."), [Robert S Dittus](https://pubmed.ncbi.nlm.nih.gov/?term=Dittus+RS&cauthor_id=42675007)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-5 "Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA."), [Christianne L Roumie](https://pubmed.ncbi.nlm.nih.gov/?term=Roumie+CL&cauthor_id=42675007)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#full-view-affiliation-5 "Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.") Affiliations Expand ### Affiliations * 1 Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA. * 2 Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA. * 3 Division of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA. * 4 Division of Surgical Oncology, Department of General Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA. * 5 Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. * PMID: **42675007** * DOI: [ 10.1002/cnr2.70663 ](https://doi.org/10.1002/cnr2.70663) Item in Clipboard # Timeliness of Colorectal Cancer Care in Veterans: The Role of Travel Distance Emma M Bradley et al. Cancer Rep (Hoboken). 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Cancer Rep (Hoboken) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Rep+%28Hoboken%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cancer+Rep+%28Hoboken%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42675007/) . 2026 Sep;9(9):e70663. doi: 10.1002/cnr2.70663. ### Authors [Emma M Bradley](https://pubmed.ncbi.nlm.nih.gov/?term=Bradley+EM&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Megan Shroder](https://pubmed.ncbi.nlm.nih.gov/?term=Shroder+M&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Gretchen Edwards](https://pubmed.ncbi.nlm.nih.gov/?term=Edwards+G&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA."), [Shannon McChesney](https://pubmed.ncbi.nlm.nih.gov/?term=McChesney+S&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-3 "Division of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA."), [Colleen Kiernan](https://pubmed.ncbi.nlm.nih.gov/?term=Kiernan+C&cauthor_id=42675007)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-1 "Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-4 "Division of Surgical Oncology, Department of General Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA."), [Robert S Dittus](https://pubmed.ncbi.nlm.nih.gov/?term=Dittus+RS&cauthor_id=42675007)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-5 "Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA."), [Christianne L Roumie](https://pubmed.ncbi.nlm.nih.gov/?term=Roumie+CL&cauthor_id=42675007)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-2 "Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42675007/#short-view-affiliation-5 "Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.") ### Affiliations * 1 Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System-Medical Center North, Nashville, Tennessee, USA. * 2 Geriatric Research Education and Clinical Center, and the VETWISE- LHS Center of Innovation, Tennessee Valley Healthcare System-Veterans Health Administration, Nashville, Tennessee, USA. * 3 Division of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA. * 4 Division of Surgical Oncology, Department of General Surgery, Vanderbilt University Medical Center-Medical Center North, Nashville, Tennessee, USA. * 5 Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. * PMID: **42675007** * DOI: [ 10.1002/cnr2.70663 ](https://doi.org/10.1002/cnr2.70663) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **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. **Keywords:** Veteran's health; access to care; colorectal cancer; timeliness of care; travel distance. © 2026 The Author(s). Cancer Reports published by Wiley Periodicals LLC. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. R. L. Siegel, A. N. Giaquinto, and A. Jemal, “Cancer Statistics, 2024,” CA: A Cancer Journal for Clinicians 74, no. 1 (2024): 12–49, . 2. 1. L. L. Zullig, K. J. Sims, R. McNeil, et al., “Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update,” Military Medicine 182, no. 7 (2017): e1883–e1891, [https://doi.org/10.7205/MILMED‐D‐16‐00371](https://doi.org/10.7205/MILMED%E2%80%90D%E2%80%9016%E2%80%9000371). 3. 1. G. L. Jackson, L. D. Melton, D. H. Abbott, et al., “Quality of Nonmetastatic Colorectal Cancer Care in the Department of Veterans Affairs,” Journal of Clinical Oncology 28 (2010): 3176–3181. 4. 1. T. P. Hanna, W. D. King, S. Thibodeau, et al., “Mortality due to Cancer Treatment Delay: Systematic Review and Meta‐Analysis,” BMJ 371 (2020): m4087, . 5. 1. Y. H. Lee, P. T. Kung, Y. H. Wang, W. Y. Kuo, S. L. Kao, and W. C. Tsai, “Effect of Length of Time From Diagnosis to Treatment on Colorectal Cancer Survival: A Population‐Based Study,” PLoS One 4, no. 1 (2019): e0210465, . Show all 55 references ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42675007/) * Colorectal Neoplasms* / diagnosis Actions * [ Search in PubMed ](https://
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