Review for 10.1186/s12876-023-02639-0 (2023)

Title: Health-related quality of life and anxiety levels among patients under surveillance for
intraductal papillary mucinous neoplasm
Version: 1 Date: 07 Oct 2022
Reviewer's report:
Dear Editor,
Thanks for allowing me to revise this manuscript, that deal with a topic I am keen on.
The study evaluates the emotional burden associated with surveillance for IPMN, exploring the
patients’ perception of their quality of life and anxiety.
Many aspects warrant praise for the authors’ work. As they note, their conclusions carry
implications that should be considered in clinical practice, as the number of patients under
surveillance is poised to grow in the coming years.
One of the strongest elements of this work is the sample size and the methodology adopted.
However, I am concerned (I believe a MAJOR REVISION is required) about some aspects I
wish the authors would clarify before any acceptance:
- Age. This study includes subjects of varying ages from 29 to 83. It is unclear whether the
authors have considered or identified differences in anxiety levels and perceived quality of life
in younger patients. Some studies (PMID 32108397, 20623197) exposed how younger patients
(<45y) suffer higher levels of stress and cancer worry than older patients, however, they fare
better in time as young people maintain psychological gains over time (PMID 21774034). Can
the Authors comment on this?
- Time under surveillance. This study seems to have included patients who have been in follow-
up for over 10 years and new patients. Psychological distress and fear of pathological findings
may longitudinally impact adherence to screening protocols (PMID 30519369, 31625003).
In this study, does data support relevant differences between subjects recently referred to a
surveillance program and patients who have been known to the centre for years? Do years of
surveillance impact the patient’s perception of health status? Can the Authors comment on this?
- Familial and personal history. The literature shows that assisting relatives suffering from
pancreatic cancer negatively impacts a person’s cancer risk perception (PMID 29570238,
32108397). Direct knowledge of pancreatic malignancy, disease progression, the burden of
surgery for pancreatic resection and quality of life after surgery might affect a patient under
surveillance for IPMN, not only in stress levels but in adherence to follow-up. A personal history
of cancer has proved to raise stress levels for patients screening for other malignant diseases
(PMID 31625003). Have the authors considered these aspects in their analysis? Can the Authors
comment on this?
- Can the Authors comment on any possible difference between the potential effects of stress
undergoing surveillance for an IPMN vs due to family history? To investigate any impact
of pancreatic surveillance, it would be useful to compare IPMN patients under surveillance
to healthy subjects receiving surveillance for familiarity and/or genetic predisposition (PMID
32108397), possibly with those of them (actually a quarter) having IPMN and familiarity/genetic
predisposition. Any comment on this in the discussion may be beneficial for the context of the
manuscript place-on.