Title: ‘I was eager to do anything I could to improve the situation’: A qualitative study of
patients’ experiences and views of prehabilitation for ovarian cancer surgery
Version: 3 Date: 31 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Ovarian cancer management often involved multimodality treatment
strategy incorporating aggressive surgical tumor debulking and systemic chemotherapy
followed by maintenance therapy for optimal oncologic outcomes.  Prehabilitation programs
had been reported to improve postoperative outcomes in patients undergoing major surgeries.
However little research had been performed examining the patient acceptance and perceptions
with such a program.  This manuscript directly address this deficiency in current published
literature through qualitative research methodology.  Goals and objectives are clearly defined.
Methodology is well described. The paper is well written and the authors had adequately
addressed concerns raised by previous reviewers.  Some additional clarifications are suggested
below to further strengthen the manuscript.
REQUESTED REVISIONS:
1. “A diverse sample of women, due to undergo or following primary debulking surgery for
advanced ovarian cancer” was included. Please comment on the external validity of the findings
to the general ovarian cancer population.  Also would the authors expect difference in patients
perception of the prehab program whether the interview was taken before or after surgery ?
2. It would be beneficial for the readers to learn more in details about the Marsden Integrated
Lifestyle and Exercise (MILE) program.  Please provide additional information regarding the
frequency and intensity of physiotherapy, nutrition support, psychological support and medical
management provided to patients.  How was the compliance with the program established for
participants ?  Please provide information on how long patients were enrolled on the program
prior to their surgery ? Was there any significant recovery issues after surgery and does this
influence patients perception of the prehab program ?
3. “Twenty one patients from the specialist cancer centre and 23 patients from the teaching
hospital within the NHS in London, met the inclusion criteria and were invited to take part in the
study (Figure 1).  Of these, 9 from the specialist centre and 12 from the teaching hospital (total 21
participants) consented to be interviewed” – was there any significant different in demographics
in patients consented to be interviewed versus those who refused to participate in the study ?