Title: Coping with breast cancer during medical and occupational rehabilitation: A qualitative
study of strategies and contextual factors
Version: 1 Date: 22 Nov 2023
Reviewer:  Dorothee Noeres
Reviewer's report:
This is an interesting and important topic, moreover a largely well-written paper, and certainly
qualifies for publication.
The authors aim to gain a deeper understanding of the coping processes of breast cancer survivors
(BCSs) during medical and occupational rehabilitation after acute treatment. Their objective
is well developed, and it should be recognised, that up to now, there seems to be no coping
taxonomy developed for women coping with breast cancer. Consequently, the authors have to
draw from a coding methodology described in 2005 for men with prostate cancer. This deserves
to be mentioned or even discussed. For that, the authors would have to elaborate more on the
existing empirical literature on coping, which is highly recommended here.
Some further revisions recommended:
Introduction and methods:
Some terms would need some more explanation:
• “period after acute treatment” and “medical rehabilitation phase”, when do they end?
• In the chapter “Coding trees” the authors relate to “contextual factors”. It would be nice to
have a reference as to which theoretical framework this belongs.
• Minimum and maximum age of interviewees would be nice to have in the table
It is legitimate and even useful to analyse – in more depth and with a different research question
– interview material subject to previous analysis and publication. However, it seems confusing
to me, that the authors report different research methods (Ref No. 29) for exactly the same
sample of respondents they interviewed between 8/2019 and 8/2020 (e.g. theoretical sampling
and grounded theory vs. purposeful sampling and content analysis) In the actual paper I would
therefore like an explanation of the adjustment.
Results and conclusion:
Even though the authors argue very carefully, one of their main conclusion is a bit confusing.
They imply that participation in an inpatient rehab program is one central part of approach
oriented coping and they underline that women who are capable of approach oriented strategies
and who suffer from adverse health are prone to participate in rehab programs (i.e. nearly 75%
of their interviewees). At the same time it is argued, that the absence of major health issues
often leads to avoidance-oriented coping strategies and may have a negative impact on women’s
health. This is understandable. Still I miss the thought, that in some cases, the decision not to
participate in rehab is based on a realistic assessment of one’s own health status and performance
and not always representing an avoidance-based strategy. It should not be left unmentioned,
that women, who would like to retire, need to participate in an inpatient-rehab in order to get
a pension approval.
It would help, if the authors reflected on the character/function of the coping strategies they
analyze. Are these personality related or just a reaction to a specific situation during the course
of illness?
The authors rightly consider, that “because of the qualitative approach, the generalizability
of results is limited”. It might me sensible to add, that this limitation especially applies to
associations being found between contextual factors and coping behavior of BCS.
Altogether, the paper would need some language revision for grammar and wording.