{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:25:21Z","timestamp":1787135121686,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000038","name":"National Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["410020557"],"award-info":[{"award-number":["410020557"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["410021687"],"award-info":[{"award-number":["410021687"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"award":["410021687"],"award-info":[{"award-number":["410021687"]}],"id":[{"id":"https:\/\/ror.org\/01gavpb45","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008363","name":"Danish Cancer Society","doi-asserted-by":"publisher","award":["R327-A18942"],"award-info":[{"award-number":["R327-A18942"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"award":["R327-A18942"],"award-info":[{"award-number":["R327-A18942"]}],"id":[{"id":"https:\/\/ror.org\/03ytt7k16","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: To better understand the complexity of sexual dysfunction, we aim to construct multi-factorial explanatory models of sexual dysfunction using data from participants enrolled in the Danish cross-sectional Study of latE effects for those liviNg through cErvical CAncer (SENECA). Methods: In a nationwide survey, patient-reported outcomes (PRO) were collected from 2002 cervical cancer survivors treated with surgery and\/or radio(chemo)therapy between 2005\u20132020 and a reference cohort consisting of 7853 women without a history of cancer. PROs in the EORTC C30\/CX24 questionnaires were analysed. Bayesian Network models were developed for sexual activity and dyspareunia in reference and cancer survivor cohorts, resulting in four explanatory models. The reference cohort served as a structural prior for the cancer models. Sexual activity models included participants with complete data (6706 reference, 1694 cancer), while dyspareunia models included those reporting sexual activity in the past four weeks (4521 reference, 996 cancer). Results: Respondents were stratified by treatment received: (1) reference group (n = 7853), (2) surgery alone (n = 1285), (3) radio(chemo)therapy (RCT) with\/without prior surgery (n = 951). Sexual inactivity was reported by 28%, 29% and 49% of reference, surgery and RCT groups respectively, and dyspareunia by 23%, 39% and 54%. Sexual activity was associated with age, treatment modality and social functioning. Social functioning was associated with cognitive and role functioning, global QoL, and financial difficulties, all of which were associated strongly with fatigue. Dyspareunia was associated with vaginal functioning and soreness. The strong associations observed in the cancer survivor cohort between fatigue and functional outcomes\/QoL\/sexual activity were absent in the reference cohort. Conclusions: Sexual inactivity and dyspareunia were more common in cervical cancer patients, particularly in those treated with RCT compared with the reference cohort. Differences in explanatory factors between cancer and reference cohorts highlight the need for cancer-specific approaches to sexual rehabilitation.<\/jats:p>","DOI":"10.3390\/cancers18162683","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:30:53Z","timestamp":1787131853000},"page":"2683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sexual Dysfunction in Cervix Cancer Survivors After Surgery and\/or Radio(chemo)therapy: A Bayesian Network Analysis Based on the SENECA Study Cohort"],"prefix":"10.3390","volume":"18","author":[{"given":"Adriel","family":"Ngo","sequence":"first","affiliation":[{"name":"Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 2M9, Canada"},{"name":"Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5T 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Tanderup","sequence":"additional","affiliation":[{"name":"Danish Center for Particle Therapy, Aarhus University Hospital, 8200 N Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, 8000 C Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese","family":"Juul","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University, 8000 C Aarhus, Denmark"},{"name":"Department of Surgery, Aarhus University Hospital, 8200 N Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3227-9475","authenticated-orcid":false,"given":"Gunn","family":"Ammitzb\u00f8ll","sequence":"additional","affiliation":[{"name":"Cancer Survivorship, Danish Cancer Institute, 2100 Copenhagen, Denmark"},{"name":"Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0701-410X","authenticated-orcid":false,"given":"Jakob","family":"Tanderup","sequence":"additional","affiliation":[{"name":"Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University, 8000 C Aarhus, Denmark"},{"name":"Department of Surgery, Aarhus University Hospital, 8200 N Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-2730","authenticated-orcid":false,"given":"Susanne O.","family":"Dalton","sequence":"additional","affiliation":[{"name":"Cancer Survivorship, Danish Cancer Institute, 2100 Copenhagen, Denmark"},{"name":"Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark"},{"name":"Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2400 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars U.","family":"Fokdal","sequence":"additional","affiliation":[{"name":"Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8347-1398","authenticated-orcid":false,"given":"Susanne K.","family":"Kj\u00e6r","sequence":"additional","affiliation":[{"name":"Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark"},{"name":"Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Serban","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5T 1P5, Canada"},{"name":"Department of Radiation Oncology, University of Toronto, Toronto, ON M5G 2M9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cianci, S., Tarascio, M., Arcieri, M., La Verde, M., Martinelli, C., Capozzi, V.A., Palmara, V., Gulino, F., Gueli Alletti, S., and Caruso, G. (2023). Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review. Medicina, 59.","DOI":"10.3390\/medicina59040704"},{"key":"ref_2","first-page":"1","article-title":"Prevalence of Sexual Dysfunction in Women with Cancer: A Systematic Review and Meta-Analysis","volume":"20","author":"Ilkhani","year":"2022","journal-title":"Int. J. Reprod. Biomed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1080\/13697137.2019.1606796","article-title":"Sexual Function after Cancer: Paying the Price of Survivorship","volume":"22","author":"Bober","year":"2019","journal-title":"Climacteric"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e70074","DOI":"10.1002\/cncr.70074","article-title":"Sexual Health among Danish Cancer Survivors and Individuals with No History of Cancer: Baseline Findings from the Nationwide Project SEXUS Cohort Study","volume":"131","author":"Madsen","year":"2025","journal-title":"Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1743-6109.2009.01620.x","article-title":"Cancer and Sexual Problems","volume":"7","author":"Sadovsky","year":"2010","journal-title":"J. Sex. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.pec.2021.11.020","article-title":"The Needs of Gynecological Cancer Survivors at the End of Primary Treatment: A Scoping Review and Proposed Model to Guide Clinical Discussions","volume":"105","author":"Galica","year":"2022","journal-title":"Patient Educ. Couns."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1097\/AOG.0000000000001621","article-title":"Sexual Health in Women Affected by Cancer: Focus on Sexual Pain","volume":"128","author":"Coady","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1080\/00224499.2012.658586","article-title":"Body Image and Female Sexual Functioning and Behavior: A Review","volume":"49","author":"Woertman","year":"2012","journal-title":"J. Sex. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/ijgo.13865","article-title":"Cancer of the Cervix Uteri: 2021 Update","volume":"155","author":"Bhatla","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_10","first-page":"e12738","article-title":"A Comprehensive Review of Sexual Health Concerns after Cancer Treatment and the Biopsychosocial Treatment Options Available to Female Patients","volume":"27","author":"Sears","year":"2018","journal-title":"Eur. J. Cancer Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/GCO.0000000000000743","article-title":"Vaginal Symptoms in Women Who Are Affected by Gynecologic Cancer","volume":"33","author":"Madsen","year":"2021","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1200\/JCO.2017.75.8995","article-title":"Interventions to Address Sexual Problems in People with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline","volume":"36","author":"Carter","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ijrobp.2014.01.032","article-title":"Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study","volume":"89","author":"Kirchheiner","year":"2014","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.radonc.2021.01.019","article-title":"Risk Factors and Dose-Effects for Bladder Fistula, Bleeding and Cystitis after Radiotherapy with Imaged-Guided Adaptive Brachytherapy for Cervical Cancer: An EMBRACE Analysis","volume":"158","author":"Spampinato","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Varyt\u0117, G., and Bartkevi\u010dien\u0117, D. (2021). Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances. Medicina, 57.","DOI":"10.3390\/medicina57040336"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"109501","DOI":"10.1016\/j.radonc.2023.109501","article-title":"Association of Persistent Morbidity after Radiotherapy with Quality of Life in Locally Advanced Cervical Cancer Survivors","volume":"181","author":"Spampinato","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_17","unstructured":"Koller, D., and Friedman, N. (2010). Probabilistic Graphical Models: Principles and Techniques. Adaptive Computation and Machine Learning, MIT Press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1214\/10-STS330","article-title":"To Explain or to Predict?","volume":"25","author":"Shmueli","year":"2010","journal-title":"Stat. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology","volume":"85","author":"Aaronson","year":"1993","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1002\/cncr.22217","article-title":"The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Cervical Cancer Module: EORTC QLQ-CX24","volume":"107","author":"Greimel","year":"2006","journal-title":"Cancer"},{"key":"ref_21","unstructured":"Fayers, P., Aaronson, N.K., Bjordal, K., Groenvold, M., Curran, D., and Bottomley, A. (2001). EORTC QLQ-C30 Scoring Manual, European Organisation for Research and Treatment of Cancer."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10994-006-6889-7","article-title":"The Max-Min Hill-Climbing Bayesian Network Structure Learning Algorithm","volume":"65","author":"Tsamardinos","year":"2006","journal-title":"Mach. Learn."},{"key":"ref_23","unstructured":"Geiger, D., and Heckerman, D. (2021). Learning Gaussian Networks. arXiv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S0888-613X(99)00041-9","article-title":"Priors on Network Structures. Biasing the Search for Bayesian Networks","volume":"24","author":"Castelo","year":"2000","journal-title":"Int. J. Approx. Reason."},{"key":"ref_25","unstructured":"Steck, H. (2012). Learning the Bayesian Network Structure: Dirichlet Prior versus Data. arXiv."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nadel, L. (2006). Hill-climbing Search. Encyclopedia of Cognitive Science, Wiley. [1st ed.].","DOI":"10.1002\/0470018860"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.tra.2018.08.012","article-title":"Bayesian Networks and Structural Equation Modelling to Develop Service Quality Models: Metro of Seville Case Study","volume":"118","year":"2018","journal-title":"Transp. Res. Part A Policy Pract."},{"key":"ref_28","unstructured":"Kline, R.B. (2023). Principles and Practice of Structural Equation Modeling. Methodology in the Social Sciences, The Guilford Press. [5th ed.]."},{"key":"ref_29","first-page":"23","article-title":"Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures","volume":"8","author":"Moosbrugger","year":"2003","journal-title":"Methods Psychol. Res. Online"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v035.i03","article-title":"Learning Bayesian Networks with the bnlearn R Package","volume":"35","author":"Scutari","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v048.i02","article-title":"Lavaan: An R Package for Structural Equation Modeling","volume":"48","author":"Rosseel","year":"2012","journal-title":"J. Stat. Softw."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e03636","DOI":"10.1590\/s1980-220x2019029903636","article-title":"Sexual Dysfunction after Cervical Cancer Treatment","volume":"54","author":"Correia","year":"2020","journal-title":"Rev. Esc. Enferm. USP"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7428","DOI":"10.1200\/JCO.2004.00.3996","article-title":"Quality of Life and Sexual Functioning in Cervical Cancer Survivors","volume":"23","author":"Frumovitz","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"938","DOI":"10.4103\/0973-1482.175427","article-title":"Survey of Cervical Cancer Survivors Regarding Quality of Life and Sexual Function","volume":"12","author":"Zhou","year":"2016","journal-title":"J. Cancer Res. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.ijrobp.2021.08.036","article-title":"Impact of Vaginal Symptoms and Hormonal Replacement Therapy on Sexual Outcomes After Definitive Chemoradiotherapy in Patients with Locally Advanced Cervical Cancer: Results from the EMBRACE-I Study","volume":"112","author":"Kirchheiner","year":"2022","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1188\/14.ONF.297-306","article-title":"Supportive Care Needs After Gynecologic Cancer: Where Does Sexual Health Fit in?","volume":"41","author":"McCallum","year":"2014","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/cncr.11877","article-title":"Early-stage Cervical Carcinoma, Radical Hysterectomy, and Sexual Function: A Longitudinal Study","volume":"100","author":"Jensen","year":"2004","journal-title":"Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/jocn.12647","article-title":"Fatigue and Quality of Life in Women Treated for Various Types of Gynaecological Cancers: A Cross-sectional Study","volume":"24","author":"Sekse","year":"2015","journal-title":"J. Clin. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1111\/j.1471-0528.2007.01445.x","article-title":"Chronic Fatigue and Its Correlates in Long-term Survivors of Cervical Cancer Treated with Radiotherapy","volume":"114","author":"Vistad","year":"2007","journal-title":"BJOG An. Int. J. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"100234","DOI":"10.1016\/j.tipsro.2024.100234","article-title":"The Value of PROMs for Predicting Erectile Dysfunction in Prostate Cancer Patients with Bayesian Network","volume":"31","author":"Osong","year":"2024","journal-title":"Tech. Innov. Patient Support Radiat. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1111\/cas.15624","article-title":"A Bayesian Network Predicting Survival of Cervical Cancer Patients\u2014Based on Surveillance, Epidemiology, and End Results","volume":"114","author":"Liu","year":"2023","journal-title":"Cancer Sci."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Qiao, Y., Li, H., and Peng, B. (2022). Neoadjuvant and Adjuvant Treatments Compared to Concurrent Chemoradiotherapy for Patients with Locally Advanced Cervical Cancer: A Bayesian Network Meta-Analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.745522"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.1007\/s10508-022-02348-x","article-title":"Sexual Inactivity and Dysfunction in Denmark: A Project SEXUS Study","volume":"51","author":"Andresen","year":"2022","journal-title":"Arch. Sex. Behav."},{"key":"ref_44","unstructured":"Bose, J. (2001). Nonresponse Bias Analysis at the National Center for Education Statistics. Proceedings of Statistics Canada Symposium, Statistics. Catalogue No. 11-522-X20010016269."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Stone, B.M. (2021). The Ethical Use of Fit Indices in Structural Equation Modeling: Recommendations for Psychologists. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.783226"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/PPO.0b013e31819585df","article-title":"A Review of Couple-Based Interventions for Enhancing Women\u2019s Sexual Adjustment and Body Image After Cancer","volume":"15","author":"Scott","year":"2009","journal-title":"Cancer J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jso.20811","article-title":"Combined Brief Psychosexual Intervention after Mastectomy: Effects on Sexuality, Body Image, and Psychological Well-Being","volume":"96","author":"Kalaitzi","year":"2007","journal-title":"J. Surg. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.apmr.2023.01.008","article-title":"Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients with Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis","volume":"104","author":"Calatayud","year":"2023","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"479","DOI":"10.2147\/NDT.S150464","article-title":"The Effect of Exercise on Cancer-Related Fatigue in Cancer Survivors: A Systematic Review and Meta-Analysis","volume":"14","author":"Kessels","year":"2018","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"kae041","DOI":"10.1093\/jncics\/pkae041","article-title":"Interventions for Insomnia in Cancer Patients and Survivors\u2014A Comprehensive Systematic Review and Meta-Analysis","volume":"8","author":"Nissen","year":"2024","journal-title":"JNCI Cancer Spectr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1093\/jnci\/djx293","article-title":"Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial","volume":"110","author":"Zachariae","year":"2018","journal-title":"JNCI J. Natl. Cancer Inst."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/16\/2683\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:38:40Z","timestamp":1787132320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/16\/2683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":51,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["cancers18162683"],"URL":"https:\/\/doi.org\/10.3390\/cancers18162683","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]}}}