Title: Assessing the Survival Time of Women with Breast Cancer in Northwestern Ethiopia:
Using the Bayesian Approach
Version: 1 Date: 12 May 2023
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)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is an interesting study that investigated factors related to
prediction of outpatient breast cancer survival in a remote area in Ethiopia.  The concept of the
study is interesting but the design and write up have major fatal flaws that dampen the enthusiasm
for this manuscript.  The following are specific comments on each section of the manuscript:
1. Abstract:
Methods: method of collecting the survival information was missing (interview, medical
records, etc), who did it?  What is the proportion of missing data? What variables were included
in the analysis? How selection bias was not part of this study?
Results: no numbers or percentages about the listed variables, their significance of p-values.
2. Introduction:
The authors mentioned that the uniqueness of this study is the outpatient study population.  They
did not emphasize what this is a unique population.
3. Methods:
Two prescription refills was the main inclusion criteria.  The authors did not specify refill of
what? (chemotherapy, pain medication, cough medicine?  Does it make a difference what type of
refill?  If the patient is unable to come to the hospital and someone else picked up the refill, what
that count as survival?  What is the time period between the diagnosis, starting the treatment,
adherence to treatment, recurrence, different treatment time points, and refills?
Does it matter? What is the “event took place”? How were mortality records and death
certificates validated in this study population and the region in general? What are the treatment
protocols in this hospital and whether or not oncologists follow the protocols? What is the
hormone receptor status of the patients?  What is the completeness rate and validity of each of the
clinical data? What are the types of the different co-morbidities and how where they evaluated
and validated?  Weight assessment at what stage of the disease?  What about women who die
without reaching this hospital for breast cancer diagnosis or treatment?
4. Discussion:
The Discussion section includes results.  That should belong and be placed in the Results section.
The authors listed findings and variables without noting the direction of each variable.  On other
words, weight increases the risk of low survival.  What weigh change to lead in what percent
or unit of survival?  The authors talk about prognostic factors without having clinical authors
or treating oncologists as co-authors.
REQUESTED REVISIONS:
This is an interesting study that investigated factors related to prediction of outpatient breast
cancer survival in a remote area in Ethiopia.  The concept of the study is interesting but the
design and write up have major fatal flaws that dampen the enthusiasm for this manuscript.  The
following are specific comments on each section of the manuscript:
1. Abstract:
Methods: method of collecting the survival information was missing (interview, medical
records, etc), who did it?  What is the proportion of missing data? What variables were included
in the analysis? How selection bias was not part of this study?
Results: no numbers or percentages about the listed variables, their significance of p-values.
2. Introduction:
The authors mentioned that the uniqueness of this study is the outpatient study population.  They
did not emphasize what this is a unique population.
3. Methods:
Two prescription refills was the main inclusion criteria.  The authors did not specify refill of
what? (chemotherapy, pain medication, cough medicine?  Does it make a difference what type of
refill?  If the patient is unable to come to the hospital and someone else picked up the refill, what
that count as survival?  What is the time period between the diagnosis, starting the treatment,
adherence to treatment, recurrence, different treatment time points, and refills?
Does it matter? What is the “event took place”? How were mortality records and death
certificates validated in this study population and the region in general? What are the treatment
protocols in this hospital and whether or not oncologists follow the protocols? What is the
hormone receptor status of the patients?  What is the completeness rate and validity of each of the
clinical data? What are the types of the different co-morbidities and how where they evaluated
and validated?  Weight assessment at what stage of the disease?  What about women who die
without reaching this hospital for breast cancer diagnosis or treatment?
4. Discussion:
The Discussion section includes results.  That should belong and be placed in the Results section.
The authors listed findings and variables without noting the direction of each variable.  On other
words, weight increases the risk of low survival.  What weigh change to lead in what percent
or unit of survival?  The authors talk about prognostic factors without having clinical authors
or treating oncologists as co-authors.
ADDITIONAL REQUESTS/SUGGESTIONS:
No.  All comments are copied above.