title: Associations between education and physical functioning and pain in adult Danish cancer survivors.
abstract: BACKGROUND
  Late effects after cancer diagnosis and treatment are common, but only few studies have examined the role of social factors in developing these late effects. The aim of this study was to examine the association between educational level and physical function and pain among cancer survivors two years after diagnosis.
  
  
  METHODS
  The study population consisted of adult Danish patients with a first-time cancer diagnosis who were sent a questionnaire in 2010 and followed up in 2012. In total, 4346 returned the first questionnaire shortly after diagnosis and 2568 returned the follow-up questionnaire. After exclusion of 177 due to missing information, we included 2391 cancer survivors in the analyses. Physical function and pain were measured using the EORTC QLQ-C30. Linear regression analyses were conducted separately for men and women, and adjusted for demographic and clinical characteristics. Additionally, analyses were stratified on comorbidity.
  
  
  RESULTS
  Differences in mean scores according to educational level were small. Physical function was better in women with medium (2.8; 95% CI 0.1;5.4) and higher education (3.4; 95% CI 0.9;5.9) compared to women with short education. In contrast, men with medium education reported lower physical function (-2.9; 95% CI -5.7;-0.1) than men with short education. Compared to women with short education, we found lower pain scores among women with medium (-5.0; 95% CI -8.7;-1.4) and higher education (-3.4; 95% CI -6.7;0.0). Similarly, men with higher education experienced lower pain score (-3.4; 95% CI -6.9;0.1) than men with short education. The role of educational level differed between those with and without comorbidity.
  
  
  CONCLUSIONS
  Educational level is slightly associated with physical function and pain among cancer survivors. However, mean differences in this study were small and below what is considered clinically relevant.
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Winther
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Tina K
authors.initials: TK
authors.lastname: Nygaard
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Trine A
authors.initials: TA
authors.lastname: Horsbøl
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Trille
authors.initials: T
authors.lastname: Kjær
authors.affiliation: b Research Centre for Cancer Diagnosis in Primary Care, Aarhus University , Aarhus , Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: c Centre for Psychological Cross-disciplinary and Applied Research, Department of Psychology , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Hanna B
authors.initials: HB
authors.lastname: Hovaldt
authors.affiliation: d Documentation and Quality, Danish Cancer Society , Copenhagen , Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Sandager
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000368:Aged; D000072716:Cancer Pain / Q000503:physiopathology*; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D017741:Survivors