What is known and what is still unknown within chronic musculoskeletal pain? A systematic evidence and gap map.

ABSTRACT: Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no EGMs within the broad domain of chronic musculoskeletal (MSK) pain in adults. The aim of this study was to create a contemporary EGM of interventions and outcomes used for research investigating chronic MSK pain. This EGM was based on systematic reviews of interventions published in scientific journals within the past 20 years. Embase, PubMed, the Cochrane Library, and PsycINFO were used to retrieve studies for inclusion. The quality of the included reviews was assessed using AMSTAR-II. Interventions were categorised as either physical, psychological, pharmacological, education/advice, interdisciplinary, or others. Outcomes were categorised using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Of 4299 systematic reviews, 457 were included. Of these, 50% were rated critically low quality, 25% low quality, 10% moderate quality, and 15% rated high quality. Physical interventions (eg, exercise therapy) and education were the most common interventions reported in 80% and 20% of the studies, respectively. Pain (97%) and physical functioning (87%) were the most reported outcomes in the systematic reviews. Few systematic reviews used interdisciplinary interventions (3%) and economic-related outcomes (2%). This contemporary EGM revealed a low proportion of high-quality evidence within chronic MSK pain. This EGM clearly outlines the lack of high-quality research and the need for increased focus on interventions encompassing the entire biopsychosocial perspective.

Patient Responses to the Term Pain Catastrophizing: Thematic Analysis of Cross-sectional International Data.

Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, advocates and patients have reported stigmatizing effects of the term in clinical settings and the media. We conducted an international study to investigate patient perspectives on the term pain catastrophizing. Open-ended electronic patient and caregiver proxy surveys were promoted internationally by collaborator stakeholders and through social media. 3,521 surveys were received from 47 countries (77.3% from the U.S.). The sample was mainly female (82.1%), with a mean age of 41.62 (SD 12.03) years; 95% reported ongoing pain and pain duration > 10 years (68.4%). Forty-five percent (n = 1,295) had heard of the term pain catastrophizing; 12% (n = 349) reported being described as a 'pain catastrophizer' by a clinician with associated high levels of feeling blamed, judged, and dismissed. We present qualitative thematic data analytics for responses to open-ended questions, with 32% of responses highlighting the problematic nature of the term. We present the patients' perspective on the term pain catastrophizing, its material effect on clinical experiences, and associations with negative gender stereotypes. Use of patient-centered terminology may be important for favorably shaping the social context of patients' experience of pain and pain care. PERSPECTIVE: Our international patient survey found that 45% had heard of the term pain catastrophizing, about one-third spontaneously rated the term as problematic, and 12% reported the term was applied to them with most stating this was a negative experience. Clinician education on patient-centered terminology may improve care and reduce stigma.

Participatory research: a Priority Setting Partnership for chronic musculoskeletal pain in Denmark.

OBJECTIVES: Patient and stakeholder engagements in research have increasingly gained attention in healthcare and healthcare-related research. A common and rigorous approach to establish research priorities based on input from people and stakeholders is the James Lind Alliance Priority Setting Partnership (JLA-PSP). The aim of this study was to establish research priorities for chronic musculoskeletal (MSK) pain by engaging with people living with chronic MSK pain, relatives to people living with chronic MSK pain, healthcare professionals (HCP), and researchers working with chronic MSK pain. METHODS: This JLA-PSP included a nation-wide survey in Denmark, an interim prioritisation, and an online consensus building workshop. The information gained from this was the basis for developing the final list of specific research priorities within chronic MSK pain. RESULTS: In the initial survey, 1010 respondents (91% people living with chronic MSK pain/relatives, 9% HCPs/researchers) submitted 3121 potential questions. These were summarised into 19 main themes and 36 sub-themes. In the interim prioritisation exercise, 51% people living with pain/relatives and 49% HCPs/researchers reduced the list to 33 research questions prior to the final priority setting workshop. 23 participants attended the online workshop (12 people/relatives, 10 HCPs, and 1 researcher) who reached consensus for the most important research priorities after two rounds of discussion of each question. CONCLUSIONS: This study identified several specific research questions generated by people living with chronic MSK pain, relatives, HCPs, and researchers. The stakeholders proposed prioritization of the healthcare system's ability to support patients, focus on developing coherent pathways between sectors and education for both patients and HCP. These research questions can form the basis for future studies, funders, and be used to align research with end-users' priorities.

[Non-pharmacological treatment of migraine and tension-type headache].

Migraine and tension-type headache are among the most frequent diseases of the world. As pharmacological treatment often is associated with distinct side effects, there is an increasing need for non-pharmacological treatment options. However, there has been a striking lack of evidence with regards to the efficacy of the huge variety of non-pharmacological interventions. In this review, we present the available evidence for the most common non-pharmacological treatment options with focus on the national clinical guideline for non-pharmacological treatment of headache disorders published in 2021.

Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education in migraine treatment. A systematic review and meta-analysis.

BACKGROUND: Many people suffering from migraine combine pharmacological and non-pharmacological treatments. The purpose of this systematic review is to provide an updated guideline for some widely used non-pharmacological treatment options for migraine. METHODS: We conducted a systematic literature review of randomized studies of adults with migraine treated with manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education. The main outcomes measured were days with headache and quality of life. Recommendations were formulated based on the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) approach including patient preferences based on expert opinion and questionnaire data. RESULTS: The overall level of certainty of the evidence was low to very low. Manual therapy techniques and psychological treatment did not change the studied outcomes. Supervised physical activity might have a positive impact on quality of life, acupuncture on headache frequency, intensity, quality of life and the use of attack-medicine. Patient education might improve self-rated health and quality of life and increase the number of well-informed patients. CONCLUSION: Based on observed effects, the lack of serious adverse events, and patients' preferences, we make weak recommendations for considering the investigated interventions as a supplement to standard treatment.Protocol registration: Prospero CRD42020220132.

Mental well-being, health, and locus of control in Danish adults before and during COVID-19.

AIM: The aim of this study was to investigate the possible impact of the Covid-19 pandemic on general health, mental well-being, and experiences of control compared to pre-pandemic populations. Our hypotheses were that we would observe a significantly lower level of psychological well-being and general health in the 2020 sample compared to the pre-pandemic samples, and that we would observe younger age groups to be the most affected. METHOD: Two representative Danish populations (2016, n = 1656) and (2017, n = 3366) were compared to a representative Danish population (2020, n = 1538) sampled during the first lockdown in May 2020. Two-tailed tests of proportions were used to investigate possible differences between samples in proportions reporting poorer mental well-being measured by 5-item World Health Organization Well-Being Index, general health, and internal locus of control. RESULTS: Younger men (aged 18-24) and younger women (aged 18-44) as well as elderly women (aged 65-74) reported lower mental well-being during the early phase of the pandemic compared to the population from 2016. Both women and men in 2020 reported significantly lower levels of internal locus of control compared to the 2017 sample. This was especially true for younger men and women. There were no statistically significant differences in general health between populations. DISCUSSION: This study partly supports the hypothesis that the Covid-19 pandemic affected mental well-being negatively among younger persons. However, longitudinal studies are needed to investigate possible long-term effects of the pandemic on mental health and well-being. Further, qualitative studies are needed to investigate the in-depth consequences of Covid-19.

Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis.

BACKGROUND: Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement or an alternative to medical treatment. However, the evidence for their effects are limited. Therefore, the aim of this study was to review the evidence for manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education as treatments for TTH on the effect of headache frequency and quality of life. METHODS: A systematic literature search was conducted from February to July 2020 for clinical guidelines, systematic reviews, and individual randomised controlled trials (RCT). The primary outcomes measured were days with headache and quality of life at the end of treatment along with a number of secondary outcomes. Meta-analyses were performed on eligible RCTs and pooled estimates of effects were calculated using the random-effect model. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). In addition, patient preferences were included in the evaluation. RESULTS: In all, 13 RCTs were included. Acupuncture might have positive effects on both primary outcomes. Supervised physical activity might have a positive effect on pain intensity at the end of treatment and headache frequency at follow-up. Manual joint mobilisation techniques might have a positive effect on headache frequency and quality of life at follow-up. Psychological treatment might have a positive effect on stress symptoms at the end of treatment. No relevant RCTs were identified for patient education. The overall certainty of evidence was downgraded to low and very low. No serious adverse events were reported. A consensus recommendation was made for patient education and weak recommendations for the other interventions. CONCLUSION: Based on identified benefits, certainty of evidence, and patient preferences, manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture, and patient education can be considered as non-pharmacological treatment approaches for TTH. Some positive effects were shown on headache frequency, quality of life, pain intensity and stress symptoms. Few studies and low sample sizes posed a challenge in drawing solid conclusions. Therefore, high-quality RCTs are warranted.

Personality as a predictor of well-being in a randomized trial of a mindfulness-based stress reduction of Danish women with breast cancer.

Purpose: Many clinical interventions have been designed to improve psychological well-being in women with breast cancer; however, there are individual differences in the extent of benefit across participants. Mindfulness-Based Stress Reduction (MBSR) is a structured 8-week intervention that has been shown to reduce depression and anxiety for patients with breast cancer. Personality factors may influence which participants benefit more from various psychological interventions, including MBSR.Design: In a secondary analysis, we examined whether personality factors accounted for variability in response to an MBSR intervention for women with breast cancer.Sample: Two hundred eighty Danish women with breast cancer who completed the Mindfulness and Cancer Mamma trial were included in this analysis.Methods: Using multiple regression analyses, we investigated whether personality factors, measured by the NEO-PI-R, contribute independently or interact with treatment to predict depressive symptoms at 2, 6, and 12-month follow-up.Findings: The interaction between low conscientiousness and MBSR, as well as high neuroticism and MBSR each predicted significantly lower levels of distress at 12-month follow-up compared to women who higher in conscientious or lower in neuroticism.Conclusions: Personality factors may contribute to the impact of psychosocial interventions, such as MBSR, on psychological well-being.Implications for Psychosocial Providers: Utilizing personality measures may assist providers in identifying which patients may benefit from mindfulness therapies.

Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study.

PURPOSE: The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories. METHODS: A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories. RESULTS: The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated. CONCLUSIONS: A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories. IMPLICATIONS FOR CANCER SURVIVORS: In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.

Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: Results of a randomized controlled trial.

BACKGROUND: Women with breast cancer experience different symptoms related to surgical or adjuvant therapy. Previous findings and theoretical models of mind-body interactions suggest that psychological wellbeing, i.e. levels of distress, influence the subjective evaluation of symptoms, which influences or determines functioning. The eight-week mindfulness-based stress reduction (MBSR) program significantly reduced anxiety and depression in breast cancer patients in a randomized controlled trial (NCT00990977). In this study we tested the effect of MBSR on the burden of breast cancer related somatic symptoms, distress, mindfulness and spiritual wellbeing and evaluated possible effect modification by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing. MATERIAL AND METHODS: A population-based sample of 336 women Danish women operated for breast cancer stages I-III were randomized to MBSR or usual care and were followed up for somatic symptoms, distress, mindfulness skills and spiritual wellbeing post-intervention and after six and 12 months. Effect was tested by general linear regression models post-intervention, and after six and 12 months follow-up and by mixed effects models for repeated measures of continuous outcomes. Effect size (Cohen's d) was calculated to explore clinical significance of effects among intervention group. Finally, modification of effect of MBSR on burden of somatic symptoms after 12 months' follow-up by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing were estimated. RESULTS: General linear regression showed a significant effect of MBSR on the burden of somatic symptoms post-intervention and after 6 months' follow-up. After 12 months' follow-up, no significant effect of MBSR on the burden of somatic symptoms was found in mixed effect models. A statistically significant effect of MBSR on distress was found at all time-points and in the mixed effect models. Significant effects on mindfulness were seen after six and 12 months and no significant effect was observed for spiritual wellbeing. No significant modification of MBSR effect on somatic symptom burden was identified. CONCLUSION: This first report from a randomized clinical trial on the long-term effect of MBSR finds an effect on somatic symptom burden related to breast cancer after six but not 12 months follow-up providing support for MBSR in this patient group.

What to listen for in the consultation. Breast cancer patients' own focus on talking about acceptance-based psychological coping predicts decreased psychological distress and depression.

OBJECTIVE: To analyze whether qualitative themes in breast cancer patients' self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process. METHODS: Ninety-seven breast cancer patients gave unstructured, 10-min self-presentations at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the symptom check-list 90-revised (SCL-90-R) and the center for epidemiological studies depression scale (CES-D). RESULTS: Among the qualitative themes, only the percentage of words spent on talking about 'Acceptance-based psychological coping' was related to symptoms. In regression models controlling for age, education and time since diagnosis, a stronger focus on acceptance-based coping predicted less psychological distress and depression, respectively. A cross-validation including only the first few minutes of speech per patient confirmed these results and supported their practical utility in health consultations. CONCLUSION: Patients' focus on acceptance-based coping significantly predicted decreased psychological distress and depression, respectively. No other qualitative themes predicted symptoms. Doctor-patient studies may benefit from combined qualitative-quantitative methods. PRACTICE IMPLICATIONS: While quantitative symptom assessment is important for a consultation, health care providers may improve their understanding of patients by attending to patients' presentations of acceptance-based psychological coping.

Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients.

UNLABELLED: The prevalence of sleep disturbance is high among cancer patients, and the sleep problems tend to last for years after the end of treatment. As part of a large randomized controlled clinical trial (the MICA trial, NCT00990977) of the effect of mindfulness-based stress reduction (MBSR) on psychological and somatic symptoms among breast cancer patients, the aim of the current study was to evaluate the effect of MBSR on the secondary outcome, 'sleep quality'. MATERIAL AND METHODS: A total of 336 women operated on for breast cancer stage I-III 3-18 months previously were randomized to MBSR (n = 168) or treatment as usual (n = 168); both groups received standard clinical care. The intervention consisted of an eight-week MBSR program (psycho-education, meditation and gentle yoga). Sleep quality was assessed on the Medical Outcome Study sleep scale at baseline, after the intervention and at six- and 12-months' follow-up. RESULTS: The mean sleep problem scores were significantly lower in the MBSR group than in controls immediately after the intervention. Quantile regression analyses showed that the effect was statistically significant only for the participants represented by the lower percentile of change between baseline and post-intervention, i.e. those who had more sleep problems; the MBSR group had a significantly smaller increase in sleep problems than the control group. After the 12-month follow-up, there was no significant between-group effect of MBSR on sleep quality in intention-to-treat analyses. CONCLUSION: MBSR had a statistically significant effect on sleep quality just after the intervention but no long-term effect among breast cancer patients. Future trials in which participation is restricted to patients with significant sleep problems are recommended for evaluating the effect of MBSR on sleep quality.

Who participates in a randomized trial of mindfulness-based stress reduction (MBSR) after breast cancer? A study of factors associated with enrollment among Danish breast cancer patients.

BACKGROUND: Discussion regarding the necessity to identify patients with both the need and motivation for psychosocial intervention is ongoing. Evidence for an effect of mindfulness-based interventions among cancer patients is based on few studies with no systematic enrollment. METHODS: We used Danish population-based registries and clinical databases to determine differences in demographics, breast cancer and co-morbidity among 1208 women eligible for a randomized controlled trial (www.clinicaltrials.gov identifier: NCT00990977) of mindfulness-based stress reduction MBSR. RESULTS: Participants (N = 336) were found to be younger (p < 0.001) and have a less recent diagnosis at invitation than decliners (N = 872; p < 0.001). After adjustment for age and time since diagnosis at invitation, a statistically significant difference was also found between the two groups in use of psychologist sessions (p < 0.05), whereas neither breast cancer variables nor co-morbidity was significantly different. Self-reported data obtained by use of validated psychometric scales from 169 decliners and 336 women who agreed to enroll in the trial showed statistically significant differences in level of education, distress, anxiety, depression, well being and symptom burden. No differences were observed with regard to marital status, children living at home, affiliation to the work market, psychiatric caseness or any lifestyle measure. CONCLUSION: Our findings indicate that participants are younger, have a less recent diagnosis and have a higher level of education than those who refuse. This should be taken into account in designing and evaluating trials of psychosocial interventions and in planning mindfulness-based interventions.

Mindfulness significantly reduces self-reported levels of anxiety and depression: results of a randomised controlled trial among 336 Danish women treated for stage I-III breast cancer.

INTRODUCTION: As the incidence of and survival from breast cancer continue to raise, interventions to reduce anxiety and depression before, during and after treatment are needed. Previous studies have reported positive effects of a structured 8-week group mindfulness-based stress reduction program (MBSR) among patients with cancer and other conditions. PURPOSE: To test the effect of such a programme on anxiety and depression among women with breast cancer in a population-based randomised controlled study. METHODS: A total of 336 women who had been operated on for breast cancer (stage I-III) were randomised to usual care or MBSR+usual care. Questionnaires including the Symptom Checklist-90r anxiety and depression subscales and the Center for Epidemiological Studies-Depression scale were administered before randomisation and immediately, 6 and 12 months after the intervention. RESULTS: Intention-to-treat analyses showed differences between groups in levels of anxiety (p=0.0002) and depression (SCL-90r, p<0.0001; CES-D, p=0.0367) after 12 months. Graphical comparisons of participants with higher levels of anxiety and depression at baseline showed a significantly greater decrease in the intervention group throughout follow-up and no differences among least affected participants. Medium-to-large effects were found for all outcomes in the intervention group in analyses of change scores after 12 months' follow-up. CONCLUSION: The 8-week group based MBSR intervention had clinically meaningful, statistically significant effects on depression and anxiety after 12 months' follow-up, and medium-to-large effect sizes. Our findings support the dissemination of MBSR among women with breast cancer. (Clintrials.gov No.: NCT00990977).

All-cause mortality among men whose cohabiting partner has been diagnosed with cancer.

BACKGROUND: Previous studies suggest that spouses of cancer patients are at increased risk for several chronic diseases. We investigated mortality in relation to cancer morbidity in the stable female partner. METHODS: We established a national retrospective cohort study of 1,422,131 men who had lived continuously with the same partner for at least 5 years and used Cox regression analysis to assess the association between experiencing cancer in a cohabiting partner and all-cause mortality. RESULTS: The risk for death was only slightly elevated among men whose partner had cancer than for men whose partner remained free of cancer (hazard ratio = 1.03; 95% confidence interval = 1.01-1.05). CONCLUSIONS: Although a cancer diagnosis in a spouse might be associated with considerable distress, our study indicates that the risk for death differs only slightly between men living with a partner with cancer and those living with a partner without cancer.

The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis.

OBJECTIVE: The use of mindfulness-based therapy (MBT) in oncology settings has become increasingly popular, and research in the field has rapidly expanded. The objective was by means of a systematic review and meta-analysis to evaluate the current evidence for the effect of MBT on symptoms of anxiety and depression in adult cancer patients and survivors. METHOD: Electronic databases were searched, and researchers were contacted for further relevant studies. Twenty-two independent studies with a total of 1,403 participants were included. Studies were coded for quality (range: 0-4), and overall effect size analyses were performed separately for nonrandomized studies (K = 13, n = 448) and randomized controlled trials (RCTs; K = 9, n = 955). Effect sizes were combined using the random-effects model. RESULTS: In the aggregated sample of nonrandomized studies (average quality score: 0.5), MBT was associated with significantly reduced symptoms of anxiety and depression from pre- to posttreatment corresponding to moderate effect sizes (Hedges\'s g) of 0.60 and 0.42, respectively. The pooled controlled effect sizes (Hedges\'s g) of RCTs (average quality score: 2.9) were 0.37 for anxiety symptoms (p < .001) and 0.44 for symptoms of depression (p < .001). These effect sizes appeared robust. Furthermore, in RCTs, MBT significantly improved mindfulness skills (Hedges\'s g = 0.39). CONCLUSION: While the overall quality of existing clinical trials varies considerably, there appears to be some positive evidence from relatively high-quality RCTs to support the use of MBT for cancer patients and survivors with symptoms of anxiety and depression.

No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial.

OBJECTIVE: Rehabilitation programmes are intended to help cancer patients achieve optimal functioning and live independently. We evaluated whether a psychosocial rehabilitation course was effective in relieving cancer patients' distress and improving their well-being. METHODS: Patients with breast, prostate or colorectal cancer diagnosed within 2 years who had finished primary treatment were randomised to usual care or a 6-day residential course of lectures, discussions and peer groups on issues related to treatment and living with cancer. Changes in self-reported distress (POMS-Sf) and quality of life (EORTC QLQ-C30) from baseline to 1 and 6 months' follow-up were measured. Analyses were adjusted for baseline scores of outcome, cancer site, time since diagnosis, gender, age and education. RESULTS: Of 507 patients, 452 were included in the analyses, 404 completed the 1-month and 394 the 6-month assessment. Patients in the control group showed greater decreases in total mood disturbance and subscales of the POMS-Sf and showed more improvement in emotional, cognitive and social functioning at both 1 and 6 months and in role functioning at 6 months than the intervention group. A similar pattern was observed in analyses of breast cancer patients only. CONCLUSION: A 6-day residential rehabilitation course did not relieve cancer patients' distress or improve their well-being.

Social inequality and incidence of and survival from cancers of the oesophagus, stomach and pancreas in a population-based study in Denmark, 1994-2003.

We investigated the effect of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the oesophagus, stomach and pancreas diagnosed during 1994-2003 with follow-up through 2006 in Denmark using information from nationwide registers. The analyses were based on data on 2075 patients with cancer of the oesophagus, 2673 with stomach cancer and 3657 with pancreatic cancer in a cohort of 3.22 million persons born between 1925 and 1973 and aged >or=30 years. Overall, we found decreasing incidence rates of all three gastrointestinal cancers with increasing social advantage; this was most pronounced for oesophageal cancer and least for pancreatic cancer. The effect of socioeconomic position on survival after these cancers was less clear, perhaps due to the poor relative survival from these cancers and the fact that all three cancers are relatively rare in Denmark.