Travel Burden and Distress in Veterans with Head and Neck Cancer

Background: Rural cancer patients often travel long distances to access specialty care. The time and cost of travel and spending an extended period of time away from home can be a significant burden. In addition, usual support networks of friends, family, and community may be unavailable throughout treatment.

Objective: The objective of this analysis was to investigate whether traveling long distances to a cancer treatment facility increased self-reported distress among veterans treated for head and neck cancer.

Methods: Veterans with head and neck cancer referred for radiation or chemoradiation, a 5- to 6-week course of treatment requiring daily appointments, were included in this analysis. Distance to the VA was calculated by zip code from the veteran’s address. A distance of >50 miles was chosen to define a “traveling.”

The National Comprehensive Cancer Network Distress Thermometer (DT) captures self-reported distress on a 0 to 10 scale, along with 28 physical, emotional, and practical problems. At the VA, the DT is completed by a nurse shortly before starting treatment, and results are recorded in the medical record.

Patient demographics, treatment plan (chemoradiation vs radiation alone) and DT data for veterans with head and neck cancer were abstracted from the medical record. A DT score of 7 or higher was considered significant distress. Logistic regression was used to measure the effect of travel on distress while controlling 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 years), all were male, 77% were white, 77% had stage III or IV cancer at diagnosis, and 47% traveled more than 50 miles.

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).

Conclusions: Veterans with head and neck cancer traveling >50 miles for cancer care are more likely to report significant distress and distress related to sleep. There was a trend toward greater distress in other symptom reports, but statistical significance was limited by sample size.

This study suggests travel burden may be an underappreciated source of distress for patients with cancer. Patient navigation should be used to support patients traveling for care and include distress assessment and management.

Note: This abstract was presented as a poster at the 2015 Association of VA Hematology/Oncology Meeting, September 2015.