Reviewer ’s report  
 
Title: Health Related Quality of Life of Gynaecologic Cancer Patients attending at Tikur Anbesa 
Specialized Hospital (TASH), Addis Ababa, Ethiopia  
 
Version: 0 Date: 23 Oct 2017  
 
Reviewer: Jeremy Jonathan Owen Herod  
 
Reviewer's report:  
 
Firstly I enjoyed reading the manuscript and am supportive of the study. There is very little 
published about QOL in GYnae Cancer patients , particularly in countries like Ethiopia.  
However, I do think that the manuscript would benefit  form some significant revision prior to 
publication. I have tried to summarise my thoughts below.  
1) Decide if you are writing in English or American English. English uses the term 
'Gynaecological' w hereas American uses 'Gynecologic'. These are frequently confused or 
misspelt throughout the manuscript . Importantly  you need to choose which you wish to use 
for your keywords. Examples at Line 26,46, 68,  etc etc etc  
2) Line 26. Should use 'sequelae' inst ead of 'sequel'. Also  need to amend in abstract  
3) Line 49. replace 'got' with 'has received greater'  
4) Please note that although I am trying to help with lots of suggestions to improve the written 
English of the paper I have not fully proof -read the pa per for you and that does need to be 
done  
5) Line 51> Replace 'about' and use 'with'  
6) Line 88: I would use: However patients who had previously received oncological treatment 
were excluded from the study  
7) 103-110: You need  to include a much more exte nsive description of the patient 
characteristics. There is no description of stage etc which as you acknowledge later is an 
important determinant of symptoms and QOL.  
8) Your results  section fails to include data that you then go onto discuss in the disc ussion 
section of the manuscript. If you are going to talk about the relative effects on QOL of 
different tumour sites then you need to include  the data in the results  section. You have not 
done this. Basically the results section feels very incomplete an d I would extensively revise it  
9) Line 113 -114: you need to adjust the placement of the results in these lines. There  are two 
numbers together but each should follow the description   that they refer to: It should read 
'social function 42.26 (SD±32.08), was  the most affected domain followed by role function 
50.12 (SD±35.11))'  
10) Line 122: "Patients coming out of Addis Ababa have" should read  "Patients coming from 
outside Addis Ababa have"  
11) Line 128: similar point to Line 122 above  
12) Line 145 -6: Age, ethnicity and religion were not found not to affect any of EORTC QLQ -
C30 scores in a significant manner.  This SENTENCE DOES NOT MAKE SENSE. NOT 
SURE WHAT YOU ARE TRYING TO SAY BUT NEEDS RE -PHRASING  
13) 13) Line 151 -2: Where are the refere nces linked the following statement?   Studies done in 
Tanzania and Indonesia have also shown financial difficulty to be the highest score among 
the symptom scale with a mean value of 84.2, 83.34 respectively  
14) Line 153: insert 'the' prior to 'second'  
15) Line 153: referring to 'a couple of studies' is not good pr actice. You need to be more precise 
in your writing  
16) Lines 154 -8  Replace - 'This can be due to the inaccessibility of the oncology service and 
lack of health insurance in Ethiopian setup.  The mean score for GHS in this study was 40.95 
bit lower than the Tanzanian report (50.5) done among all types of cancer[10]. This 
difference could be attributed by the difference in socio -demographic, cancer type and health 
services access between the tw o communities.'  
with 
'This may be due to the inaccessibility of the oncology service and a lack of health insurance in 
the Ethiopian setup. The mean score for GHS in this study was 40.95 which  is a little lower than 
the Tanzanian report (50.5) performed  amongst all types of cancer[10]. This difference could be 
attributed to the difference in socio -demographic group, cancer type and access  to health 
services between the two communities.'  
 
17) Line 162 -4 Replace - 'In one Iranian study[11] it was found n ot correlated in any of the 
scores where as a study done in Turkey[12, 13] showed married participants to have a low 
score in emotional function in contrary to ours; which shows a positive correlation with 
emotional function and a negative with appetite lo ss[3, 14].'  
with 
' 'In an Iranian study[11]there was no correlation  found  in any of the scores whereas a study done 
in Turkey[12, 13] showed married participants to have a low score in emotional function. This 
contrasts with our findings that show a pos itive correlation with emotional function and a 
negative correlation with appetite loss[3, 14].'  
18) Line 165: replace 'has' with 'have'  
19) Line 168: replace ' for free' with 'free of charge'  
20) Line 172: Omit 'has'  
20) Line 180 -181: Why is the information you are referring to not in the results  
 
I think a significant review ios needed before this paper could be accepted. In brief you need to  
1) Improve results  section  
2) Ensure discussion reflects information in results section  
3) Proof  read and improve English  
 
Another point is that I did wonder id you have considered  the use of a control group . It is 
difficult  to know what the QOL indicators mean if they are not compared to those of the 
background population. Th at may be a piece of work for the future though  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any sta tistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistic s 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the followin g questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any sto cks or shares in an organisation that 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 reimbursements, 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 competi ng interests in relation 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.  
 
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