Reviewer ’s report  
 
Title: Preliminary Study on the Effects of Treatment for Breast C ancer: Immunological Markers 
as they relate to Qu ality of Life and Neuropsychological Performance  
 
Version: 1 Date: 07 Feb 2020  
 
Reviewer: Paul Newhouse  
 
Reviewer's report:  
 
Although the nature of the paper is preliminary and the interpretation needs to be viewed through 
that lens, this paper examines a very important and often overlooked aspect of cancer  care and 
cancer recovery.  
 
 
Background  
 
* Page 3 Lines 53 -56: "The goal of this study was to provide more evidence that there is a 
connection that exists between the factors mentioned and immunology."  Mention the 
factors explicitly here to make it clear er what precisely will be examined.  
 
 
Methods  
 
* It would be helpful to include a true demographics table (at least in the supplement). I 
know you have age and education in table 1, but Table 1 is really a baseline 
characteristics table and not a demograph ics table.  
 
* Include a demographics table that, in addition to age and education, includes information 
for each group about the chemo regimens they received, whether or not they received 
hormone treatments, radiation, surgery, type of breast cancer (tripl e negative, HER2+, 
HR+, etc), cancer staging, rounds of chemo received, average treatment length, etc.  
 
* Include a study design figure (at least in the supplement) that shows the approximate 
timing of each visit for each group.  
 
* Page 6 Lines 41 -53: "The se were all women who had completed treatment for breast 
cancer at least a year previously (N=26), including chemotherapy (N=17). The cancer 
survivor comparison group members were also excluded if a medical history revealed any 
of the exclusion neuropsycho logical risk factors as noted above for the active treatment 
group. All the survivors received both radiation and chemotherapy during their 
treatment."  
 
o These two sentences are confusing. The first sentence implies that only 17 of 
the 26 that had complete d treatment received chemotherapy, whereas a 
following sentence states that all the survivors received both radiation and 
chemotherapy during their treatment. Clarify this as to whether everyone 
received chemo and radiation or only some received both.  
 
* For all the scales you list in the "questionnaires" section, add information for each scale 
clarifying whether or not higher or lower scores on each scale indicated better or worse 
functioning/symptoms/etc.  
 
* Page 12 Lines 46 -58: It initially seemed like everyone in the active treatment group 
received both chemo and radiation, but this section states that some only received 
radiation?  
 
 
Discussion  
 
Most of the findings that are discussed are related to the wome n undergoing active treatment, 
which is not new. We do know, however, that there are some women with breast cancer that 
continue to experience cognitive dysfunction even years after finishing chemo. Talking briefly 
about that in the context of their result s would greatly add to the discussion.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to asse ss the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisa tion t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimb ursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relati on to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
None  
 
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