Reviewer's report
Title:Symptom Interpretation and Health Care Seeking in Ovarian Cancer
Version: 1Date:28 January 2011
Reviewer: Jane Bryce
Reviewer's report:
Seibaek and authors describe the health care seeking process of Danish women
diagnosed with ovarian cancer in 2007 in an observational retrospective study.
The authors describe the health care contacts patients had with registered care
providers in the year of diagnosis, and data on these patients´subsequent referral
to hospital services. In addition, 10 women were interviewed after ovarian cancer
diagnosis in 2008 and 2009, both before and after primary surgery, in order to
explore patients perspectives on symptom development.
The Authors make good use of access to public health registries and are able to
describe well the inconsistencies in diagnosing ovarian cancer in the absence of
validated screening programmes. Further, in qualitative interviews with 10
recently diagnosed patients, the Authors are able to identify three subthemes
within the patient experience of the onset of symptoms.
This paper provides both a better understanding of patient persepective of
symptom development, and underlines the need for further study of this
phenomenon, as well as identifying the need for increased involvement of
General Practioners as key referral agents in ovarian cancer diagnosis.
Minor revisions
1. Background p 3. Please specify the referral populations for incidence of
ovarian cancer of 200,000 new cases per year (Europe, worldwide, etc), and
provide reference if different than ref 1 or 2 at end of paragraph.
2. Background. The Authors may wish to consider adding to the text and
references the work of Goff et.al (2007, Cancer) in the devlopment of the ovarian
cancer symptom index.
3. It would be informative to the reader to see some of the questions used in the
semistructured interview of patients.
4. Please place in text that all interviews were conducted by the same
interviewer, if that is the case (or describe who did interviews, training, etc)
5. Please provide a table or text description of interviewee characteristics. Were
these patients a convenience sample? why these patients in 2008 and 2009, and
just after diagnosis, when rest of study population was selected as patients with
ovarian cancer diagnosed in 2007?
6. A table , referring to all study subjects, describing demographics and ovarian
cancer stage at diagnosis would be interesting as well.
7. The Authors did not describe the time from onset of symptoms and women
seeking medical attention. Was this addressed in the interview. It would be
interesting also to know time from presenation to GP and time to referral to
hospital and ovarian cancer diagnosis. There is an ongoing sutdy MITO 12
(clinical trials identifier NCT01061619) with the European Network of
Gynecological Oncology Trials (ENGOT) that is evaluating time intervals
between sentinel events along the diagnostic pathway, that could further add to
the understanding of the potential medical, organizational, patient, and
sociocultural factors of diagnostic delay in ovarian cancer.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'