Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Anticancer Research
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Anticancer Research

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Visit us on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies
Open Access

Sleep Problems Prior to Radio-chemotherapy in Patients With Locally Advanced Cancer of the Esophagus or the Esophagogastric Junction

DIRK RADES, SVENJA KOPELKE, STEVEN E. SCHILD, SOEREN TVILSTED, TROELS W. KJAER and TOBIAS BARTSCHT
Anticancer Research September 2022, 42 (9) 4529-4533; DOI: https://doi.org/10.21873/anticanres.15955
DIRK RADES
1Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: dirk.rades@uksh.de
SVENJA KOPELKE
1Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
2Department of Hematology and Oncology, University of Lübeck, Lübeck, Germany;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
STEVEN E. SCHILD
3Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SOEREN TVILSTED
4Research Department, Zealand University Hospital, Køge, Denmark;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
TROELS W. KJAER
5Neurological Department, Zealand University Hospital, Roskilde, Denmark;
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
TOBIAS BARTSCHT
2Department of Hematology and Oncology, University of Lübeck, Lübeck, Germany;
6Department of Hematology, Oncology and Stem Cell Transplantation, Helios Hospital, Schwerin, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background/Aim: Many patients with locally advanced cancer of the esophagus or esophagogastric junction receive definitive or neoadjuvant radiochemotherapy. Patient anticipation of this treatment can cause or aggravate distress and sleep disorders. This study aimed to identify the prevalence of sleep disorders and risk factors. Patients and Methods: Thirty-eight patients assigned to radio-chemotherapy were retrospectively evaluated for pre-treatment sleep disorders. Investigated characteristics included age; sex; performance score; comorbidity index; previous malignancies; family history; distress score; emotional, physical or practical problems; tumor site; histology and grading; tumor stage; planned treatment; and relation to 2019 Coronavirus pandemic. Results: Sleep problems were reported by 15 patients (39.5%). Significant associations were found for higher distress scores (p=0.016) and greater numbers of emotional problems (p<0.0001). A trend was observed for greater numbers of physical problems (p=0.176). Conclusion: The prevalence of sleep problems was high. Risk factors were found that can help identify patients requiring psychological support already prior to radio-chemotherapy.

Key Words:
  • Esophageal cancer
  • adenocarcinoma of the esophagogastric junction
  • radio-chemotherapy
  • sleep problems
  • prevalence
  • risk factors

The group of malignant upper gastrointestinal tumors include esophageal cancers, cancers of the esophagogastric junction and gastric cancers. When compared to other solid malignancies, upper gastrointestinal cancers are less common. For example, the annual incidence of esophageal cancer is 8 of 100,000 inhabitants for men and 2 of 100,000 inhabitants for women (1). Many patients with cancer of the esophagus and the esophagogastric junction receive radio-chemotherapy, either alone as definitive treatment or prior to surgery as neoadjuvant treatment. This applies particularly to squamous cell cancers (SCC) that are mainly located in the proximal (upper) two thirds of the esophagus. The majority of the tumors found in more distal locations are adenocarcinomas that are often treated with neoadjuvant chemotherapy followed by surgical resection. The histology of the tumor is associated with sex; the majority (57.4%) of the male patients have adenocarcinomas, whereas the majority (58.6%) of female patients have SCC (2).

Since many patients with esophageal cancer and cancer of the esophagogastric junction present with locally advanced tumors and have unfavorable prognoses, the diagnosis of their malignant disease generally causes significant emotional distress resulting in an impairment of their quality of life. These patients often show symptoms related to this fatal situation including sleep disorders. Moreover, to be scheduled for multimodal anticancer treatment likely leads to an aggravation of the symptoms. It would be helpful to identify patients who likely will suffer from distress and sleep disorders prior to the start of treatment in order to be able to provide early psychological support.

Currently, very little data are available regarding the prevalence and risk factors of pre-treatment sleep disorders in patients with cancer of the esophagus and the esophagogastric junction. In a study including different types of cancer, 41.5% of the 65 patients with esophageal cancer reported sleep disorders prior to radiotherapy (3). This high rate of sleep problems illustrates the significance of this problem. However, no risk factors were identified for these patients. More studies are required investigating pre-treatment sleep disorders in patients with cancer of the esophagus or esophagogastric junction. The present study aimed to identify the prevalence of sleep disorders prior to radio-chemotherapy and corresponding risk factors in this group of patients.

Patients and Methods

Thirty-eight patients who were assigned to radio-chemotherapy of locally advanced cancer of the esophagus or esophagogastric junction and completed an evaluation of quality of life prior to their treatment with the National Comprehensive Cancer Network (NCCN) Distress Thermometer (4, 5) were included in this retrospective study, which was approved by the Ethics Committee of University of Lübeck (reference number 21-284). Twenty-nine patients had esophageal cancer, and nine patients had adenocarcinoma of the esophagogastric junction. Radiotherapy was performed as volumetric modulated arc therapy. The treatment volume included the primary tumor and locoregional lymph nodes. Planned total doses were 41.4-45.0 Gy (5×1.8 Gy per week) for neoadjuvant treatment and 54.0-59.4 Gy (5×1.8 Gy per week) for definitive treatment, respectively. In case of definitive treatment, the initial target volume (up to 45-50.4 Gy) included the primary tumor and loco-regional lymph nodes, which was followed by a boost of 9.0-14.4 Gy to primary tumor and involved lymph nodes. Median administered doses were 41.4 Gy for neoadjuvant and 59.4 Gy for definitive treatment, respectively. The planned concurrent chemotherapy included two courses of cisplatin (20 mg/m2/d1-5) and 5-fluorouracil (1,000 mg/m2/d1-5) or weekly carboplatin (area under the curve 2.0) plus paclitaxel (50 mg/m2). Finally, 18 patients received weekly carboplatin/paclitaxel, nine cisplatin/5-FU, four cisplatin alone, two paclitaxel alone, and five patients could not receive chemotherapy.

Seventeen characteristics (Table I) were evaluated for associations with sleep disorders prior to radio-chemotherapy sleep disorders. These characteristics included age (≤70 vs. ≥71 years, median=70 years); sex (female vs. male); Karnofsky performance score (≤80 vs. ≥90); Charlson comorbidity index (≤3 vs. ≥4); history of previous malignancy (no vs. yes); family history of malignancy (no vs. yes); distress score (0-3 vs. ≥4); numbers of emotional (0-1 vs. ≥2), physical (0-1 vs. ≥2) or practical (no vs. yes) problems according to the NCCN Distress Thermometer (4, 5); tumor site (esophagus vs. AEG); histology (squamous cell carcinoma vs. adenocarcinoma); histologic grading (G1-2 vs. G3); primary tumor stage (T1-2 vs. T3-4); nodal stage (N0 vs. N+); planned treatment (adjuvant vs. definitive radio-chemotherapy); and relation to the 2019 Coronavirus (COVID-19) pandemic (before vs. during). Evaluations of associations between sleep disorders prior to radiochemotherapy and the 17 characteristics were performed using the Fisher’s exact test. p-Values <0.05 were considered statistically significant and p-values <0.20 indicating a trend.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Characteristics evaluated for associations with pre-treatment sleep problems.

Results

Sleep disorders occurred in 15 of the 38 patients (39.5%) in the entire cohort, in 10 of 29 patients (34.5%) with esophageal cancer, and in five of nine patients (55.6%) with cancer of the esophagogastric junction, respectively. Significant associations with the occurrence of pre-treatment sleep problems were found for higher distress scores (p=0.016) and greater numbers of emotional problems (p<0.0001). Moreover, a trend was observed for greater numbers of physical problems (p=0.176). The COVID-19 pandemic was not associated with sleep disorders prior to the radio-chemotherapy course (p>0.999) (Table II).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Associations between characteristics and pre-treatment sleep problems.

Discussion

Many patients with locally advanced cancer of the esophagus and esophagogastric junction are assigned to radiochemotherapy. Anticipation of this treatment can lead to or aggravate emotional distress associated with significant sleep disorders. This is mainly due to concerns regarding the upcoming aggressive treatment, which is associated with severe side effects in the majority of the patients (6-12). Moreover, pre-treatment sleep disorders were reported to be associated with sleep disturbance after esophagectomy (13). Although sleep disorders represent a significant and potentially burdensome problem for the patients, very little data are available regarding the prevalence of sleep disorders prior to a course of radio-chemotherapy for patients with upper gastrointestinal cancers. Only one study reported the prevalence of sleep disorders prior to a course of radiotherapy in patients with esophageal cancer (3). In this study that included 330 eligible patients with different primary tumor types, 27 of 65 patients (41.5%) with esophageal cancer reported sleep disturbances prior to their course of radiotherapy. This prevalence was similar to the prevalence of 39.5% in the entire cohort of the present study.

Identification of risk factors for the occurrence of sleep disturbances prior to radio-chemotherapy was the second major goal of the present study in addition to determination of its prevalence. Significant associations between sleep disorders were found for higher distress scores and greater numbers of emotional problems, and a trend was found for greater numbers of physical problems. To our knowledge, no study so far has investigated potential risk factors prior to a course of radio-chemotherapy in patients with locally advanced cancer of the esophagus or esophagogastric junction. Therefore, it is difficult to compare the results of the present study to data from the literature. However, these results agree with the results of studies available for pre-treatment sleep problems in patients with lower gastrointestinal cancers, namely with colorectal cancers. In a study of 84 patients with early colorectal cancers, pre-treatment sleep disorders were associated with emotional problems (14). In another previous study, sleep problems at the time of diagnosis of colorectal cancer was significantly associated with the presence of physical problems and also with the presence of emotional problems (15). Moreover, in a cross-sectional study including 434 patients with colorectal cancer, insomnia prior to surgery was significantly associated with pain (physical problem) and anxiety (emotional problem) (16). In a recent study of patients irradiated for rectal or anal cancer, the occurrence of pre-radiotherapy sleep disorders was significantly associated with higher distress scores and greater numbers of emotional and physical problems (17). Moreover, in two previous studies of patients irradiated for malignancies in the thoracic region, namely for breast cancer or lung cancer, higher distress scores and greater numbers of emotional or physical problems were significantly associated with the occurrence of pre-treatment sleep problems (18, 19). However, the comparison of the results of the present study to previous studies performed in patients with other primary tumor types is difficult. In addition, the retrospective nature of the present study bearing the risk of hidden selection biases and its small sample size should be taken into consideration when interpreting the results.

In conclusion, the prevalence of sleep disorders was high, which demonstrates the meaning of this potentially burdensome symptom. The risk factors determined in this study can help identify patients who require psychological support already prior to their planned course of radiochemotherapy.

Acknowledgements

As part of the project NorDigHealth, this study was funded by the European Regional Development Fund through the Interreg Deutschland-Danmark program.

Footnotes

  • Authors’ Contributions

    D.R., S.K., S.E.S., S.T., T.W.K. and T.B. participated in the design of the study. D.R. and S.K. provided the data that were analyzed by D.R. The article, which was drafted by D.R. and S.E.S., was reviewed and approved by all Authors.

  • Conflicts of Interest

    On behalf of all Authors, the corresponding Author states that there are no conflicts of interest related to this study.

  • Received July 4, 2022.
  • Revision received July 23, 2022.
  • Accepted July 25, 2022.
  • Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (https://creativecommons.org/licenses/by-nc-nd/4.0).

References

  1. ↵
    1. He H,
    2. Chen N,
    3. Hou Y,
    4. Wang Z,
    5. Zhang Y,
    6. Zhang G and
    7. Fu J
    : Trends in the incidence and survival of patients with esophageal cancer: A SEER database analysis. Thorac Cancer 11(5): 1121-1128, 2020. PMID: 32154652. DOI: 10.1111/1759-7714.13311
    OpenUrlCrossRefPubMed
  2. ↵
    1. Hayes T,
    2. Smyth E,
    3. Riddell A and
    4. Allum W
    : Staging in esophageal and gastric cancers. Hematol Oncol Clin North Am 31(3): 427-440, 2017. PMID: 28501085. DOI: 10.1016/j.hoc.2017.02.002
    OpenUrlCrossRefPubMed
  3. ↵
    1. Wang J,
    2. Zhou BY,
    3. Lian CL,
    4. Zhou P,
    5. Lin HJ and
    6. Wu SG
    : Evaluation of subjective sleep disturbances in cancer patients: a cross-sectional study in a radiotherapy department. Front Psychiatry 12: 648896, 2021. PMID: 33868056. DOI: 10.3389/fpsyt.2021.648896
    OpenUrlCrossRefPubMed
  4. ↵
    1. Holland JC,
    2. Andersen B,
    3. Breitbart WS,
    4. Buchmann LO,
    5. Compas B,
    6. Deshields TL,
    7. Dudley MM,
    8. Fleishman S,
    9. Fulcher CD,
    10. Greenberg DB,
    11. Greiner CB,
    12. Handzo GF,
    13. Hoofring L,
    14. Hoover C,
    15. Jacobsen PB,
    16. Kvale E,
    17. Levy MH,
    18. Loscalzo MJ,
    19. McAllister-Black R,
    20. Mechanic KY,
    21. Palesh O,
    22. Pazar JP,
    23. Riba MB,
    24. Roper K,
    25. Valentine AD,
    26. Wagner LI,
    27. Zevon MA,
    28. McMillian NR and
    29. Freedman-Cass DA
    : Distress management. J Natl Compr Canc Netw 11(2): 190-209, 2013. PMID: 23411386. DOI: 10.6004/jnccn.2013.0027
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Mehnert A,
    2. Müller D,
    3. Lehmann C and
    4. Koch U
    : Die deutsche version des NCCN distress-thermometers. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 54(3): 213-223, 2022. DOI: 10.1024/1661-4747.54.3.213
    OpenUrlCrossRef
  6. ↵
    1. Tanishima Y,
    2. Nishikawa K,
    3. Arakawa Y,
    4. Matsumoto A,
    5. Yuda M,
    6. Tanaka Y,
    7. Mitsumori N and
    8. Yanaga K
    : Five-year outcomes of chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by oesophagectomy in oesophageal cancer. Anticancer Res 40(10): 5829-5835, 2020. PMID: 32988912. DOI: 10.21873/anticanres.14601
    OpenUrlAbstract/FREE Full Text
    1. Kurokawa T,
    2. Hamai Y,
    3. Emi M,
    4. Ibuki Y,
    5. Yoshikawa T,
    6. Ohsawa M,
    7. Hirohata R and
    8. Okada M
    : Risk factors for recurrence in esophageal squamous cell carcinoma without pathological complete response after trimodal therapy. Anticancer Res 40(8): 4387-4394, 2020. PMID: 32727767. DOI: 10.21873/anticanres.14442
    OpenUrlAbstract/FREE Full Text
    1. Takahashi K,
    2. Osaka Y,
    3. Ota Y,
    4. Watanabe T,
    5. Iwasaki K,
    6. Tachibana S,
    7. Nagakawa Y,
    8. Katsumata K and
    9. Tsuchida A
    : Phase II study of docetaxel, cisplatin, and 5-fluorouracil chemoradiotherapy for unresectable esophageal cancer. Anticancer Res 40(5): 2827-2832, 2020. PMID: 32366430. DOI: 10.21873/anticanres.14256
    OpenUrlAbstract/FREE Full Text
    1. Aoyama T,
    2. Atsumi Y,
    3. Hara K,
    4. Kazama K,
    5. Tamagawa H,
    6. Tamagawa A,
    7. Komori K,
    8. Maezawa Y,
    9. Kano K,
    10. Hashimoto I,
    11. Oshima T,
    12. Murakawa M,
    13. Numata M,
    14. Yukawa N,
    15. Masuda M and
    16. Rino Y
    : Postoperative bleeding after esophagectomy for esophageal cancer in patients receiving antiplatelet and anticoagulation treatment. Anticancer Res 40(4): 2359-2364, 2020. PMID: 32234938. DOI: 10.21873/anticanres.14204
    OpenUrlAbstract/FREE Full Text
    1. Aoyama T,
    2. Atsumi Y,
    3. Kawahara S,
    4. Tamagawa H,
    5. Tamagawa A,
    6. Ozawa Y,
    7. Maezawa Y,
    8. Kano K,
    9. Murakawa M,
    10. Kazama K,
    11. Segami K,
    12. Hara K,
    13. Numata M,
    14. Oshima T,
    15. Yukawa N,
    16. Masuda M and
    17. Rino Y
    : The clinical impact of the age-adjusted Charlson comorbidity index on esophageal cancer patients who receive curative treatment. In Vivo 34(5): 2783-2790, 2020. PMID: 32871815. DOI: 10.21873/invivo.12103
    OpenUrlAbstract/FREE Full Text
    1. Takao K,
    2. Konishi H,
    3. Fujiwara H,
    4. Shiozaki A,
    5. Shoda K,
    6. Kosuga T,
    7. Kubota T,
    8. Arita T,
    9. Morimura R,
    10. Murayama Y,
    11. Kuriu Y,
    12. Ikoma H,
    13. Nakanishi M,
    14. Okamoto K and
    15. Otsuji E
    : Clinical significance of Prognostic Nutritional Index in the treatment of esophageal squamous cell carcinoma. In Vivo 34(6): 3451-3457, 2020. PMID: 33144453. DOI: 10.21873/invivo.12184
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Suzuki T,
    2. Ishibashi Y,
    3. Tsujimoto H,
    4. Nomura S,
    5. Kouzu K,
    6. Itazaki Y,
    7. Sugihara T,
    8. Harada M,
    9. Ito N,
    10. Sugasawa H,
    11. Kishi Y and
    12. Ueno H
    : A novel systemic inflammatory score combined with immunoinflammatory markers accurately reflects prognosis in patients with esophageal cancer. In Vivo 34(6): 3705-3711, 2020. PMID: 33144487. DOI: 10.21873/invivo.12218
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Scarpa M,
    2. Pinto E,
    3. Saadeh LM,
    4. Parotto M,
    5. Da Roit A,
    6. Pizzolato E,
    7. Alfieri R,
    8. Cagol M,
    9. Saraceni E,
    10. Baratto F and
    11. Castoro C
    : Sleep disturbances and quality of life in postoperative management after esophagectomy for esophageal cancer. World J Surg Oncol 12: 156, 2014. PMID: 24886219. DOI: 10.1186/1477-7819-12-156
    OpenUrlCrossRefPubMed
  9. ↵
    1. Hyphantis T,
    2. Goulia P,
    3. Zerdes I,
    4. Solomou S,
    5. Andreoulakis E,
    6. Carvalho AF and
    7. Pavlidis N
    : Sense of coherence and defense style predict sleep difficulties in early non-metastatic colorectal cancer. Dig Dis Sci 61(1): 273-282, 2016. PMID: 26289259. DOI: 10.1007/s10620-015-3843-1
    OpenUrlCrossRefPubMed
  10. ↵
    1. Coles T,
    2. Bennett AV,
    3. Tan X,
    4. Battaglini CL,
    5. Sanoff HK,
    6. Basch E,
    7. Jensen RE and
    8. Reeve BB
    : Relationship between sleep and exercise as colorectal cancer survivors transition off treatment. Support Care Cancer 26(8): 2663-2673, 2018. PMID: 29470704. DOI: 10.1007/s00520-018-4110-8
    OpenUrlCrossRefPubMed
  11. ↵
    1. Sun GW,
    2. Yang YL,
    3. Yang XB,
    4. Wang YY,
    5. Cui XJ,
    6. Liu Y and
    7. Xing CZ
    : Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients. Support Care Cancer 28(6): 2911-2919, 2020. PMID: 31758321. DOI: 10.1007/s00520-019-05151-y
    OpenUrlCrossRefPubMed
  12. ↵
    1. Rades D,
    2. Kopelke S,
    3. Bartscht T,
    4. Schild SE,
    5. Tvilsted S and
    6. Kjaer TW
    : Evaluation of pre-radiotherapy sleep disorders in patients with rectal or anal cancer. Anticancer Res 41(9): 4439-4442, 2021. PMID: 34475066. DOI: 10.21873/anticanres.15251
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Rades D,
    2. Kopelke S,
    3. Tvilsted S,
    4. Kjaer TW,
    5. Schild SE and
    6. Bartscht T
    : Sleep disturbances in lung cancer patients assigned to definitive or adjuvant irradiation. In Vivo 35(6): 3333-3337, 2021. PMID: 34697166. DOI: 10.21873/invivo.12630
    OpenUrlAbstract/FREE Full Text
  14. ↵
    1. Rades D,
    2. Narvaez CA,
    3. Schild SE,
    4. Tvilsted S and
    5. Kjaer TW
    : Sleep disorders before and during the COVID-19 pandemic in patients assigned to adjuvant radiotherapy for breast cancer. In Vivo 35(4): 2253-2260, 2021. PMID: 34182504. DOI: 10.21873/invivo.12498
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Anticancer Research: 42 (9)
Anticancer Research
Vol. 42, Issue 9
September 2022
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Anticancer Research.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Sleep Problems Prior to Radio-chemotherapy in Patients With Locally Advanced Cancer of the Esophagus or the Esophagogastric Junction
(Your Name) has sent you a message from Anticancer Research
(Your Name) thought you would like to see the Anticancer Research web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
8 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Sleep Problems Prior to Radio-chemotherapy in Patients With Locally Advanced Cancer of the Esophagus or the Esophagogastric Junction
DIRK RADES, SVENJA KOPELKE, STEVEN E. SCHILD, SOEREN TVILSTED, TROELS W. KJAER, TOBIAS BARTSCHT
Anticancer Research Sep 2022, 42 (9) 4529-4533; DOI: 10.21873/anticanres.15955

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Sleep Problems Prior to Radio-chemotherapy in Patients With Locally Advanced Cancer of the Esophagus or the Esophagogastric Junction
DIRK RADES, SVENJA KOPELKE, STEVEN E. SCHILD, SOEREN TVILSTED, TROELS W. KJAER, TOBIAS BARTSCHT
Anticancer Research Sep 2022, 42 (9) 4529-4533; DOI: 10.21873/anticanres.15955
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A Novel Filtration Membrane for Clustered Circulating Tumor Cell Extraction: A Prospective Feasibility Study
  • Atezolizumab for EGFR-mutated Non-small Cell Lung Cancer Patients: An Observation Study in Ibaraki Group (ATTENTION-IBARAKI)
  • Early Phase Persistent Changes in the White Blood Cell Fraction in Patients With Advanced Urothelial Carcinoma Treated With Pembrolizumab: A Multicenter Retrospective Study
Show more Clinical Studies

Similar Articles

Keywords

  • Esophageal cancer
  • adenocarcinoma of the esophagogastric junction
  • radio-chemotherapy
  • sleep problems
  • prevalence
  • risk factors
Anticancer Research

© 2023 Anticancer Research

Powered by HighWire