NASHVILLE, TN—For many rural patients, receiving timely, quality cancer care remains difficult. Challenges include transportation hurdles, financial constraints, a lack of providers, and minimal access to clinical trials. As a result, while cancer incidence rates are lower in rural areas, cancer mortality rates are higher.

Nearly 25% of veterans live in rural parts of the United States. In the last five years, Congress enacted the VA Budget and Choice Improvement Act and VA Mission Act to make timely access to care easier for veterans who live further from VA facilities by enabling them to tap into community services. The acts allowed cancer patients to use community oncology practices for care.

Researchers at the VHA Tennessee Valley Health System (TVHS) and Vanderbilt Hematology Oncology, both in Nashville, TN, and MD Anderson Cancer Center in Houston, TX, investigated whether rural veterans received timely care for metastatic colorectal cancer before the new legislation expanded access. Their study was published in conjunction with the 2020 ASCO Annual Meeting held May 29-31.1

The team reviewed the records of 1,107 veterans who had colorectal surgery between January 1, 2000 and December 31, 2015 at TVHS and found 170 patients at high-risk stage 2 or stage 3 colorectal cancer. The researchers excluded patients over age 80 or more than age 75 with a prior year hospitalization for a major comorbidity, or who died or went to hospice within 30 days of surgery.

Of the 170 patients, 121 had colon cancer and 59 had rectal cancer. The majority of patients were male (96%) and white (79%). The median age was 64 years.

The median number of days to chemotherapy varied substantially based on distance from the TVHS but did not increase smoothly. Veterans who lived less than 50 miles from the center received chemotherapy at a median of 62.5 days from surgery, while those who lived 50 to 99 miles away began chemotherapy sooner, at a median of 58.5 days. Patients who resided more than 100 miles from the center waited a median of 84 days to initiate chemotherapy.

In colorectal cancer, timely care is usually defined as starting chemotherapy within 56 days of surgery. Using that metric, only 41% of the closest group, 48% of those living 50-99 miles away, and just 32% of those who had to travel more than 100 miles met the standard for timely care. After adjusting for known correlates, the researchers determined that the time to chemotherapy was 10.6 days longer for patients living more than 100 miles from the center compared to those living within 50 miles of the TVHS.

“Distance to care may influence timeliness of chemotherapy among Southeast regional veterans,” the researchers concluded, but “[g]iven the observed overall low rate of timely chemotherapy, understanding modifiable health system factors associated with omissions and delays, as well as the impact of recent VA legislation merits further exploration.”

  1. Martin RL, Edwards GC, Samuels LR, Eng C, Roumie CL. “Impact of travel distance on timeliness of adjuvant chemotherapy in veterans with colorectal cancer.” Abstract e19159. 2020 ASCO Annual Meeting. May 29-31, 2020.