Title: Logistic and time burdens reported by gynecologic and breast cancer survivors
Version: 2 Date: 28 Aug 2024
Reviewer's report:
Thank you for the opportunity to review this manuscript. This touches upon a necessary topic in
the breast and gynecologic cancer fields, although it has been widely published on in the past.
Please see my comments below concerning this manuscript:
Abstract
The purpose doesn't seem groundbreaking or showing any new information based on the
research in the field.
You don't consider financial stability or financial toxicity a logistic cost of cancer care???
Conclusions do not reveal anything we didn't already know about these topics.
Introduction
Last sentence of paragraph 1 - please clarify as to whether you are referring to adult cancers here.
It's interesting how in paragraph 2 you discuss financial toxicity, a growing area of research, but
do not name it in the Abstract as a logistic or time burden of cancer survivorship care.
In paragraph 3 you switch from calling it "logistic and time costs of cancer care" and refer to it
as "logistic toxicity" and "time toxicity". I would remain consistent throughout.
In this same paragraph, there are also additional citations that are newer that can be utilized,
including those among financial toxicity and survivorship concerns among young women with
breast cancer (authors Ganz, Partridge, Rosenberg, Dibble, etc.).
In paragraph 4, you give your purpose for analyzing logistic and time costs - but you already
discussed these factors sociodemographically in your introduction - I'm not sure how what you
are proposing with your analysis differs from research done in the past? It seems the same to
me, as described.
Methods
Are the GOLD and BOLD studies registered in clinicaltrials.gov?
Has the Oncology Opportunity Cost Assessment Tool been utilized in breast cancer and/or
gynecologic cancer research prior? More information is needed referencing this measure, it's
outcomes, item style, responses, reliability and validity, since it is not well-published.
Where did the primary exposures of interest originate? Sociodemographic survey portion? These
items need to be described in detail before dichotomizing or categorization.
When did the participants report these sociodemographics? As part of the 2022 cross-sectional
survey or were they collected at baseline in 2017/2018? This needs to be clarified. If not part of
the cross-sectional survey, it's not necessarily possible to categorize these sociodemographics
into groups for analysis on another measure data that was collected years later.
The analyses conducted in this study are very simple compared to the purpose of the study.
There should have been at least stratified analyses run by sociodemographic characteristics of
interest that differed.
What was done to account for missing data? What about missing item responses?
Results
Again, was the sociodemographic survey collected as a part of the OOCAT questionnaire? The
first paragraph of your results makes them seem as though they were collected at different time
points.
You had a wide range of ages who completed this survey - I suggest stratifying by age at survey
completion and age at diagnosis to see how "toxicities" differ, as this has been suggested widely
in past literature.
After reviewing Table 1, it appears as though the GOLD and BOLD participants differed
significantly by study demographics of interest - you should be running a more involved analysis,
including several sensitivity analyses, to see exactly if they differ on OOCAT outcomes.
Additionally, since they are significantly different on so many of the sociodemographic
characteristics, it is not advisable to combine them into one cohort together, but rather, analyze
as separate cohorts or as a part of a logistic model. It is highly recommended to rerun these
analyses appropriately.
Discussion
It is not advisable to edit/comment on the discussion until the analyses and results sections are
appropriately updated.