Reviewer’s report
Title: 
Perceptions of care after end-of-treatment among younger women with
different gynecologic cancer diagnoses– A qualitative analysis of written
responses submitted via a survey
Version: 
0 
Date: 
17 Jul 2020
Reviewer's report:
This authors present their findings about perceptions of care after end-of-
treatment among younger women with difference gynecologic cancer diagnoses.
The authors did a nice job of introducing the study, giving a good overview in
the background section. 
As part of a larger study, over 200 survivors aged 19-39
years participated in a study that involved a study-specific questionnaire and an
open-ended question about important aspects of care after end-of-treatment. 
The
authors analyzed the written responses via content analysis in relation to primary
disease site. The main categories of importance were: 1) unmet long-term
supportive care needs; 2) satisfying long-term supportive care; and 3) healthcare
organizational difficulties. 
Not surprisingly, sexual functioning and fertility-
related concerns emerged as well. 
These are key priority areas for focus when
looking at end-of-treatment concerns in younger women with gynecologic
malignancies.
1. 
While the methods are appropriate and clearly presented, a major issue with
this manuscript is that the data presented are part of a larger study. 
Line 109
mentions the cross-sectional survey but the Lines 111-112 say that the data
presented are from one open-ended question. 
The authors gone on to cite
publication of the study-specific questionnaire and the results from this
instrument. 
It is unclear whether or not the authors were able to incorporate the
findings from the original study survey with the open-ended questions, and
whether additional subgroup analyses were attempted. 
Either way, this should be
clearly stated (for example, if the results of the survey were used, then the
questions/responses and how the open-ended responses were analyzed/grouped
against the prior survey results should be explained clearly.
2. 
Were the authors able to look at sexual dysfunction concerns and fertility-
related concerns in women who received multi-modality treatment such as
chemoradiation for cervical cancer? 
Similarly, did women who underwent
fertility-sparing procedures have fewer concerns? 
Subgroup analyses
(exploratory) such as these, where prior research has been published identifying
treatment-specific and disease-specific associated with fertility and sexual
concerns should be evaluated. 
3. 
Without knowing what the original survey questions/results were, it is not
clear how many of the categories/comments were exacerbated by prior physical,
emotional, or mental-health issues. 
The authors should mention this as a
limitation, or address this by additional analyses/discussion.
4. 
What do the authors suggest can be done to improve upon the categories
identified by the patients in this study? 
Can the authors talk about how
survivorship care takes place in the region where these patients are from? 
Is there
a coordinated "hand-off" or transition back into the regular/community health-
care system? 
How much education is provided to patients on an ongoing basis -
eg. throughout the diagnosis, treatment, and follow-up period? 
Who
coordinates/manages routine surveillance, particularly in the first several years
after completion of primary treatment? 
Are women provided access to fertility
counseling, mental-health counseling services, and if so, at what point during the
treatment spectrum?
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Yes
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
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Acceptable
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Research funding in part from AstraZeneca but no other disclosures
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