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Background: In our recent study, advanced disease stage and nonreceipt of surgery were the most important mediators of the racial disparity in breast cancer survival. The purpose of this study was to quantify the racial disparity in these two intermediate outcomes and investigate mediation by the more proximal mediators of insurance status and neighborhood poverty. Methods: This was a cross‐sectional study of non‐Hispanic Black and non‐Hispanic White women diagnosed with first primary invasive breast cancer in Florida between 2004 and 2015. Log‐binomial regression was used to obtain prevalence ratios (PR) with 95% confidence intervals (CIs). Multiple mediation analysis was used to assess the role of having Medicaid/being uninsured and living in high‐poverty neighborhoods on the race effect. Results: There were 101,872 women in the study (87.0% White, 13.0% Black). Black women were 55% more likely to be diagnosed with advanced disease stage at diagnosis (PR, 1.55; 95% CI, 1.50–1.60) and nearly twofold more likely to not receive surgery (PR, 1.97; 95% CI, 1.90–2.04). Insurance status and neighborhood poverty explained 17.6% and 5.3% of the racial disparity in advanced disease stage at diagnosis, respectively; 64.3% remained unexplained. For nonreceipt of surgery, insurance status explained 6.8% while neighborhood poverty explained 3.2%; 52.1% was unexplained. Conclusions: Insurance status and neighborhood poverty were significant mediators of the racial disparity in advanced disease stage at diagnosis with a smaller impact on nonreceipt of surgery. However, interventions designed to improve breast cancer screening and receipt of high‐quality cancer treatment must address additional barriers for Black women with breast cancer. [ABSTRACT FROM AUTHOR]

• Lung cancer outcomes are related to neighborhood context. • Low segregation/high deprivation predicts receiving surgery for white patients. • High segregation/ low deprivation predicts receiving surgery for black patients. • Living in rural areas increased risk of death for black and white patients. • High Hispanic segregation/high deprivation increased risk of death for black patients. The purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age. This was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation. White patients who lived in low black segregation/high deprivation areas had 15 % lower odds of receiving surgery (95 % CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14 % (95 % CI: 1.05–1.24) and 26 % (95 % CI: 1.08–1.46), respectively. Living in rural areas increased the risk of death for black patients by 54 % r (SHR = 1.54 [1.19–2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas. This study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period., Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes., Results: Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women., Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities., Impact: These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women., (©2021 American Association for Cancer Research.)

Objectives: To compare the learning needs of women undergoing robotic versus open (laparotomy) gynecologic surgery for benign and cancerous conditions., Design: Descriptive exploratory study., Setting: A tertiary care hospital in Orlando, Florida., Participants: Women undergoing gynecologic surgery (N = 226; n = 71 laparotomy and n = 155 robotic)., Methods: All consenting procedures and data collection occurred in two study visits. Instruments included a demographics questionnaire and the Patient Learning Needs Scale. Bivariable sociodemographic and clinical differences between surgical groups were assessed with Pearson's chi-square test. Multiple linear regression was used to assess differences in total Patient Learning Needs Scale scores and subscores between surgical groups and to evaluate the association of demographic and clinical variables with total Patient Learning Needs Scale scores within surgical groups., Results: White and non-Hispanic women were more likely to receive robotic surgery. Women who underwent robotic surgery were more likely to ambulate and have their first oral intake on the day of surgery. Women in the robotic surgery group were also significantly more likely to have a hospital length of stay of 1 day or less (90.3% vs. 4.2%, p < .001). At discharge, participants in the robotic surgery group had significantly more learning needs overall (179.67 vs. 159.66, p < .001) and for the subscales of Medication, Activities of Daily Living, Feelings Related to Condition, Treatment/Complications, Quality of Life, and Skin Care than participants in the laparotomy group. For women in the robotic surgery group, those with a hospital length of stay longer than 1 day had significantly greater learning needs. For women in the laparotomy group, Asian women had greater learning needs than White women., Conclusion: Participants who underwent robotic gynecologic surgery had greater learning needs than those who underwent laparotomy. Nurses and other health care providers may perceive robotic surgery as a less invasive procedure with fewer adverse effects, shorter length of stay, and faster recovery that requires fewer postoperative care instructions., (Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: Although the colorectal cancer (CRC) mortality rate has significantly improved over the past several decades, many patients will have a recurrence following curative treatment. Despite this high risk of recurrence, adherence to CRC surveillance testing guidelines is poor which increases cancer-related morbidity and potentially, mortality. Several randomised controlled trials (RCTs) with varying surveillance strategies have yielded conflicting evidence regarding the survival benefit associated with surveillance testing. However, due to differences in study protocols and limitations of sample size and length of follow-up, the RCT may not be the best study design to evaluate this relationship. An observational comparative effectiveness research study can overcome the sample size/follow-up limitations of RCT designs while assessing real-world variability in receipt of surveillance testing to provide much needed evidence on this important clinical issue. The gap in knowledge that this study will address concerns whether adherence to National Comprehensive Cancer Network CRC surveillance guidelines improves survival., Methods and Analysis: Patients with colon and rectal cancer aged 66-84 years, who have been diagnosed between 2002 and 2008 and have been included in the Surveillance, Epidemiology, and End Results-Medicare database, are eligible for this retrospective cohort study. To minimise bias, patients had to survive at least 12 months following the completion of treatment. Adherence to surveillance testing up to 5 years post-treatment will be assessed in each year of follow-up and overall. Binomial regression will be used to assess the association between patients' characteristics and adherence. Survival analysis will be conducted to assess the association between adherence and 5-year survival., Ethics and Dissemination: This study was approved by the National Cancer Institute and the Institutional Review Board of the University of Central Florida. The results of this study will be disseminated by publishing in the peer-reviewed scientific literature, presentation at national/international scientific conferences and posting through social media., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)