Title: Coping with breast cancer during medical and occupational rehabilitation: A qualitative
study of strategies and contextual factors
Version: 1 Date: 30 Nov 2023
Reviewer:  Matthias Lukasczik
Reviewer's report:
This paper deals with an interesting topic. It gives a detailed and well illustrated presentation
of the qualitative findings. Associations of coping strategies with return to work/occupational
reintegration are described as one focus, which is certainly important. Below you will find my
comments and suggestions.
One general comment: I find it a little difficult that "rehabilitation" is understood/termed
throughout the text as the period following diagnosis and acute treatment with or without a
medical rehabilitation program (e.g., study design, recruitment and sampling, results). This
might be a bit confusing for readers. I'm not sure how to best "solve" this and wouldn't see it
as too serious; nonetheless, the authors might want to consider some clarifying comments or
rewording.
Abstract/Keywords
"Return to work" might be added as another keyword.
Introduction
p. 3, first paragraph: It is not entirely clear whether the authors refer to medical/occupational
rehabilitation as a general term for aftercare/further treatment/resuming work or as a (specific)
medical/occupational service in rehabilitation facilities that is financed by statutory health or
pension insurance. Clarification would be helpful here, even if the authors go into this further
below in the methods section.
p. 4, first paragraph: To what extent do the authors assume that the rehabilitation context
influences (or is associated with) coping?
Materials & Methods
p. 4, recruitment and sampling: What was the rationale behind choosing a period of 5-6 years
after diagnosis?
p. 5, data analysis: Please write "Ways of Coping Questionnaire" (with a capital W).
p. 5, data analysis: How well did the coding units "fit" into the pattern of coping styles that
was applied (approach vs. avoidance, emotion- vs. problem-focused)? Was there a significant
proportion of text passages/coding units that were rather difficult to categorize into the
deductively derived system? Some brief information on this would be interesting.
Results
pp. 8 et seq. and discussion, p. 16: Are there data on how participation in a medical rehabilitation
(MR) program and the use of specific coping strategies are related? For example, in figure 1,
non-use of MR is linked to avoidance coping, and the authors mention a possible association in
the discussion section - did all study participants not taking part in MR report avoidance coping,
a majority of them, ...?
pp. 8 et seq.: Are there data on how prevalent different coping strategies were in the sample, i.e.,
how often certain strategies were used or reported (as compared to others)?
Discussion
p. 16, lower half: Please write "approach-oriented coping may mitigate the impact OF health
care deficits...".
p. 18: Given the importance of work life/return to work for breast cancer survivors, it might be
worth mentioning in the "clinical implications" section that there is (at least to my knowledge) a
lack of interventions aimed at co-workers and employers of (breast) cancer survivors to promote
awareness or support reintegration from their side. In a review of return to work interventions
for breast cancer patients, the topic of "communication about the cancer" was only (explicitly)
mentioned as an intervention component in one study (Bilodeau et al., 2017). In a Cochrane
review of interventions to support work reintegration in cancer patients, no workplace/work-
related interventions were found that aimed to improve communication between CS, supervisors
and/or colleagues (DeBoer et al., 2015).
References:
Bilodeau, K., Tremblay, D. & Durand, M.#J. (2017). Exploration of return-to-work interventions
for breast cancer patients: a scoping review. Supportive Care in Cancer, 25(6), 1993–2007.
https://doi.org/10.1007/s00520-016-3526-2
DeBoer, A., Taskila, T. K., Tamminga, S. J., Feuerstein, M., Frings-Dresen, M.
H. W. & Verbeek, J. H. (2015). Interventions to enhance return-to-work for
cancer patients. Cochrane Database of Systematic Reviews, (9), CD007569. https://
doi.org/10.1002/14651858.CD007569.pub3