Purpose: To investigate whether traveling long distances to a cancer treatment facility increases self-reported distress among veterans with head and neck cancer.
Background: Veterans within VISN 20 receive radiation therapy for head and neck cancer in Portland, Oregon, or Seattle, Washington. Given the geography, many travel and stay in lodging for the duration of treatment. As they cannot access usual sources of support within their communities, these veterans may be at risk for greater distress while undergoing cancer treatment.
Methods: The National Comprehensive Cancer Network Distress Thermometer (DT) is a validated tool for self-reported distress by cancer patients. Respondents report distress on a 0 to 10 scale and answer 28 questions regarding physical, emotional, and practical problems. In Seattle, the DT is completed shortly before starting treatment. Patient demographics, treatment plan (chemoradiation vs radiation alone), and DT data for veterans with head and neck cancer were abstracted from the Computerized Patient Record System. A DT score of 7 or higher was considered significant distress. Distance to the VA was calculated by zip code from the veteran’s address. Data were analyzed with logistic regression to control for possible effects of cancer stage, age category, or treatment plan.
Results: Sixty veterans with head and neck cancer completed the DT between April 2014 and April 2015. The average age was 65.4 years (range 39-91), all were male, 77% were white, 77% had stage III or IV cancer at diagnosis, and 47% traveled > 50 miles. The average DT score was 5.4. Veterans traveling > 50 miles were more likely to report significant distress compared with those who traveled < 50 miles (odds ratio (OR) = 1.6, P = .02). Sleep was the only problem significantly more likely for veterans traveling > 50 miles (OR = 1.71, P = .01).
Implications: Veterans with head and neck cancer traveling > 50 miles for cancer care are more likely to report significant distress or distress related to sleep. This small study suggests travel burden may be an underappreciated source of distress for veterans with cancer. Further research is warranted to better understand how travel burden affects distress and identify opportunities for intervention
