Reviewer's report
Title:Sexual function and chemotherapy in postmenopausal women with breast
cancer
Version: 1Date:27 April 2012
Reviewer: Jennifer Jabson
Reviewer's report:
This paper, “Sexual function and chemotherapy in postmenopausal women with
breast cancer”, reports the findings generated by a study of sexual function
among breast cancer patient’s as compared to the sexual function reported by
no-cancer controls. The study’s findings indicate that sexual function declines
among breast cancer patients at two points, after diagnosis of breast cancer and
after administration of systemic chemotherapy. This finding could be valuable for
identifying the best possible points at which to provide cancer patients with
resources that address concerns regarding sexual function during breast cancer
treatment.
Major Concerns
The major and minor concerns identified in this paper are detailed below.
Addressing these issues could strengthen this paper and improve the
presentation of the study’s findings. One overarching concern is that the purpose
of the study seems unclear. Clarifying this wills strengthen the manuscript.
Introduction
• The overall research question(s) posed, and rationale, is unclear from the
introduction. This could be resolved and strengthened through thoughtful
reorganization and clarification.
• The meaning of the third sentence of the second paragraph is unclear. Clarify.
• The meaning of the fourth ‘paragraph’ (a single sentence) is unclear and its
meaning should be clarified. Specifically, ‘…between treatments and symptoms
remains controversial’ is unclear. What symptoms are being referenced?
Post-menopausal symptoms? Sexual function? Clarification would improve this
paragraph.
Methods
• A more clear description of the study design is needed. Typically when a nested
cohort study, a randomly selected subset of controls from a ‘cohort’ are
compared to incident cases. However, this manuscript does not report a
description of the cohort. Clarification will strengthen the description of the study
design.
• The inclusion of broad comments concerning the psychometric properties of the
FSFI included on page3-4 is unclear. These would be more useful to readers if
they were included in the methods section and should also include more detailed
information concerning reliability and validity.
• On page 5: Please provide detailed scoring information about how the FSFI is
scored for each sub-domain and for ‘total’ FSFI scores.
• It is not clear from the methods section when the second surveys were
administered. Please clarify when the survey was administered.
• It is not clear how many total women were approached to complete the survey,
how many of these women agreed to volunteer, and how many were either
excluded or refused participation. This information is essential for describing the
sample and having some knowledge of to whom the results apply.
Results
• The results section should include the presentation of test statistics (t test
values, chi-square values) alongside p-values.
• Page 7, paragraph 1: This paragraph could be strengthened if the control
group’s ‘pre-post’ scores were also provided.
• Page 7, paragraph 3: The meaning of the second half of the second sentence in
the paragraph is unclear.
• It could be valuable to combine tables. For example, a single table could
present all of the bivariate relationships between FSFI and tumor stage, and
demographic characteristics.
• Page 7, paragraph 11: Please clarify if ‘25% of participants’ refers to cases only
or cases and controls.
Discussion
• The second paragraph in the discussion might present too far a reach from the
findings of this research. It would be more useful to the reader if authors were
able to discuss the findings in more detail here.
• Page 10, paragraph 2: “We believe that merely receiving a diagnosis of breast
malignancy produces a significant sense of loss….”This discussion point, as it is
presented in this paragraph, is impossible to know from this data presented or
the findings generated by this study. To continue along this line of thinking
authors should tie their thoughts to extent literature concerning the topic of
sexual function after breast cancer diagnosis.
• Page 10, paragraph 5: In the methods section authors indicated that those with
prior diagnoses were excluded. However in this paragraph ‘there was no
significant association between reduction in FSFI scores and the prior diagnosis
variable…’ Please clarify if those with prior diagnosis were excluded or included
and/or which participants are being referred to in paragraph 5.
• The discussion could be strengthened if authors discussed the findings of the
study and their implications, as they relate to the existing literature that concerns
sexual function after cancer diagnosis.
• From the findings reported by this paper, that sexual function declines at two
points: a) after breast cancer diagnosis and b) after chemotherapy, it might be
that there are dual processes at work. For example, declines in sexual function
after diagnosis could be related to stress and psychosocial experiences
associated with experiencing a cancer diagnosis. Declines in sexual function that
occur after chemotherapy could be related to biological and physiological
experiences associated with exposure to chemotherapeutic agents. Discussion
concerning these issues and the relevant literature as they relate to the findings
presented in this manuscript could strengthen this work and potentially add to
what is known about sexual function after breast cancer. For example, in a recent
paper by Pumo and colleagues (2012) it was found that psychological effects
were related to sexual function. This could explain the finding that the current
manuscript reports where in sexual function declines after diagnosis before
exposure to chemotherapy.
Minor Concerns
• Citation needed for the FSFI page 3, last paragraph.
• To clarify the purpose of the ‘questionnaire’ (first mentioned in the fifth
paragraph on page 5), it could be helpful to refer to it as the ‘demographic
questionnaire’ throughout the manuscript. When describing this demographic
questionnaire, it would be helpful to readers if a) questions included on the
questionnaire were described with more detail, or citations were provided for the
original source of the questions.
• On page 5, 6th paragraph: It is unclear from the current single sentence
paragraph which ‘questionnaire’ was administered. Would be helpful to readers if
it was specified that the FSFI or the demographic questionnaire were being
referenced (or both?).
• Throughout this paper grammar, punctuation, sentence construction, and
paragraph development needs attention to improve the paper’s ability to
communicate the study’s findings. For example, one sentence does not
constitute a paragraph as illustrated by the first sentence in the introduction, and
the third ‘paragraph’ in the introduction (which is also a single sentence).
• In the discussion please address and describe the limitations of this study.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests.