Title: The role of daughters in relation to their mother’s cervical cancer diagnosis and treatment
in Guatemala: a descriptive study
Version: 2 Date: 16 Feb 2023
Reviewer's report:
Thanks for the opportunity to review this interesting paper describing the role of daughters in
relation to their mother’s cervical cancer diagnosis and treatment in Guatemala. The manuscript
is in general well written and uses a sound methodology. However, some clarifications are
needed.
Major concerns:
1. Abstract:
a. The authors use the term “most likely” but there are no statistics to support it. Authors are
limited to present frequency distributions given the small sample size (n=145 patients and n=71
caregivers).
b. Conclusion is unclear and needs revision, specially because in the title, abstract, results and
discussion the authors describe the burden daughters experience as caregivers for patients with
cervical cancer.
2. Methods:
a. Authors stated that a non-probabilistic sampling approach was used in the discussion.
However, there is no explanation as to which method was used to obtain the non-probabilistic
sample. If possible, it will be interesting to know how many patients and companions were
invited and and how many refused to be included in the study to have an idea of a response rate.-
see point 4-a in the discussion.
3. Results:
a. Table 2 shows the companion’s relationship to the patient. Fathers are not reported in the
table, yet they are listed in the results. Also, it is unclear if they are the fathers of the patient or
the father of the companion (i.e., the spouse/partner of the patient).
b. Provide some examples of the major roles the daughters fulfilled when the patient was seeking
treatment.  This is unclear from the methods and the results.
c. Clarify what do you mean by “double burden of cervical cancer in women”
4. Discussion:
a. There are 145 patients and only 71 companions, explain why are they so different. Did the 74
remining women had no companions? Did their companions refuse to participate in the study?
Address how it biases the study results and impact generalization of study findings.
b. This is unclear –What burden of cervical cancer? Do you mean as a caregiver? – how can the
authors extend their findings to reach global policy makers?
“Furthermore, this evidence on the burden of cervical cancer on daughters in Guatemala provides
global policymakers with additional support for expanding cervical cancer screening programs,
which will help lead to the eventual elimination of cervical cancer worldwide.”
5. Conclusion:
a. Same as in 1-a. The conclusion needs to be revised.
Minor concerns:
6. Authors mentioned a study from which the data comes from but no reference is provided:
“This study utilizes data from a cross-sectional study conducted at INCAN that aimed to
understand the pathways to care for cervical cancer. The study recruited women seeking cervical
cancer care and their companions.”
7. The study is too small and the design does not allow to demonstrate “that women diagnosed
with cervical cancer in Guatemala rely predominately …” – perhaps a better word to use is to
“indicate” or “suggest”
8. Add sample size to each figure.
9. Table 1: add if income is in Quetzales or USD
10. Table 2: not all %s add to 100%, please add categories as it is unclear if they are “no” or
“missing” or both
11. Tables 1 and 2: please add age in years
12. Citation format needs to be reviewed and add links for reports/websites alongside accessing
date.