title: Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer?
abstract: BACKGROUND
  Patients must have transportation to the treatment site before they can access appropriate cancer care. This article describes factors associated with patients experiencing transportation-related barriers to accessing cancer care.
  
  
  METHODS
  The Cancer Care Assessment & Responsive Evaluation Studies (C-CARES) questionnaire was mailed to Veterans Affairs (VA) patients with colorectal cancer (CRC) during the fall of 2009. Eligible patients were diagnosed at any VA facility in 2008, they were men, and alive at the time of the mailing. A total of 1409 surveys were returned (approximately 67% response rate). To assess transportation barriers, patients were asked how often it was difficult to get transportation to or from treatment. Symptoms were assessed using validated Patient-Reported Outcomes Measurement Information System (PROMIS) scales for fatigue, pain, and depression. Multivariate logistic regression was used to examine determinants of transportation barriers.
  
  
  RESULTS
  A minority of respondents (19%) reported transportation barriers. Patients experiencing pain (OR, 1.04; 95% CI, 1.02-1.06) had greater odds of transportation barriers than patients without this symptom. Patients who reported no primary social support (OR, 6.13; 95% CI, 3.10-12.14) or nonspousal support (OR, 2.00; 95% CI, 1.40-2.87) were more likely to experience transportation barriers than patients whose spouses provided social support.
  
  
  CONCLUSIONS
  Patients with uncontrolled pain or less social support have greater odds of transportation barriers. The directional association between social support, symptoms, and transportation cannot be determined in this data.
  
  
  CONCLUSIONS
  Inquiring about accessible transportation should become a routine part of cancer care, particularly for patients with known risk factors.
authors.affiliation: Durham Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, NC 27705, USA. leah.zullig@va.gov
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.forename: Joan M
authors.initials: JM
authors.lastname: Griffin
authors.forename: Sean
authors.initials: S
authors.lastname: Phelan
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000628:therapy*; D005221:Fatigue; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D011379:Prognosis; D012944:Social Support; D011795:Surveys and Questionnaires; D014187:Transportation of Patients; D014728:Veterans