PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.
BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.
METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.
DATA ANALYSIS : We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.
RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.
IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.