Title: The relationship among psychosocial adaptation, medication adherence and quality of life
in breast cancer women with adjuvant endocrine therapy
Version: 1 Date: 27 Jan 2022
Reviewer's report:
In this study, the authors investigated the relationships among psychological adaptation, medical
adherence, and quality of life in patients undergoing adjuvant endocrine therapy after breast
cancer surgery in a cross-sectional study. Improving the adherence of endocrine therapy after
breast cancer surgery may contribute to improving outcomes such as recurrence of breast cancer
and is an important research area.  My comments are as follows:
Introduction
1. This section describes the significance and purpose of the study briefly and clearly.
Methods
2. It is stated that the selection of subjects was random, but is there a possibility of selection bias?
What percentage of all cases is the 354 cases judged to be eligible during the period from 2010
to 2020? This information is important in interpreting whether the results are representative of
the population.
3. It should be clearly stated that the research method is a cross-sectional study.
4. Eligibility criteria specify cases that have undergone endocrine therapy for at least 3 months. In
endocrine therapy, there should be a certain number of cases in which treatment is discontinued
early due to adverse events. Thus, the results exclude cases of early withdrawal and examine
adherence to endocrine therapy. The rationale for adding this eligibility criterion should be
clearly stated.
5. Is the psychosocial adaptation questionnaire used in the study an original scale of the authors?
If so, results verifying the reliability and validity of this questionnaire should be shown as a
cited paper.
6. The official name of the QOL questionnaire used for QOL evaluation in the study is The
Functional Assessment of Cancer Therapy-Breast (FACT-B). This name should be stated.
7. The Functional Assessment of Cancer Therapy-Endocrine Symptom (ES) is a more symptom-
specific QOL questionnaire for patients undergoing endocrine therapy after breast cancer
surgery. It is doubtful whether QOL associated with endocrine therapy can be evaluated in the
target patients.
Results
8. At the beginning of the results, the background factors related to the clinical pathology or
treatment history of the patients should be shown in a table.
9. The authors often use the term QOL in the results, but it is unclear what QOL means. FACT-B
includes multiple dimensions of physical well-being, psychological well-being, functional well-
being, social-role well-being, and breast cancer-specific scale. FACT-G total score, FACT-B
total score, FACT-B TOI, etc. are often used as summary scores for outcomes. There is a need
to clarify which summary score was used to evaluate quality of life in the study.
10. The number of valid responses for FACT-B, the mean subdomain score or the summary
score, and the standard deviation should be shown in a table.
11. Tables 2 and 3 merely show the classification of variables incorporated into the model and
are not informative. I think it would be better to describe these contents in the text.
Discussion
12. The discussion is well documented based on the results of this study and previous studies. I
agree with the conclusion "we should pay more attention to the improvement of patients' PSA in
the future clinical nursing work, which can improve the quality of life of patients more directly
and quickly." An important message can be sent to readers by revising the paper with reference
to the comments above.