Title: Assessing the Relationship between Body Image and Quality of Life among Rural and
Urban Breast Cancer Survivors in China
Version: 1 Date: 28 Dec 2021
Reviewer's report:
Assessing the Relationship between Body Image and Quality of Life among Rural and Urban
Breast Cancer Survivors in China
BMC Women's Health
I would like to thank BMC Women's Health for the opportunity to review this article. This
study provides an ambitious objective with a large sample size, and I found very interesting its
contribution to include the habitat (rural or urban) of women as a possible variable in studies in
patients with breast cancer. Please see all my comments below.
Comment 1. In abstract showed statistical signification (p values) doesn’t matter. I suggest added
correlation coefficient (lines 9-10, page 2).
Comment 2. Breast cancer treatments could worse many spheres in patients. I suggest re-write
the sentence “Breast cancer treatments can result in loss of a breast, scarring, alopecia, and skin
alterations as well as weight changes, among other alterations”. (line 5, page 3).
Comment 3. Please provide a reference for this statement “body image concerns are one of the
most common psychosocial issues experienced by breast cancer survivors” (line 10, page 3).
Comment 4. The reference #14 didn’t refer to western women, this term is confusion. Could you
use other terminology associated with the correct reference? (line 21, page 3).
Comment 5. I cannot associate the shortage of radiation therapy as a reason to not reconstruction
breast. Could you explain this argument? (line 5, page 4).
Comment 6. “More progressive breast cancer” what does it mean? More aggressive, it is
diagnosed at a higher stage? Please, modified it (line 8, page 4).
Comment 7. Why in QoL only included physical and mental instead of global QoL? Justify in
the manuscript or compared with similar studies that only included these domains.
Comment 8. Please specified the name of hospitals instead of “a large city in northwestern
China”. (line 5, page 7).
Comment 9. “In this study, the Cronbach’s alpha values for the five subscales ranged from 0.72
to 0.82” Please, specified reference. (line 12, page 8).
Comment 10. Please specified how control for demographic and clinical covariates (statistical
method used) (line 10, page 9). Also, specified and justify what outcomes was considered as
covariable.
Comment 11. How you support that there is survivorship with surgery, but more than 70% per
group are undergoing chemotherapy? It is a kind of palliative chemotherapy? In addition, a time
of 2 months after surgery unfortunately, it is too soon to considerer survivorship. Please define
in the manuscript, what is the definition of survivor in your case.
Comment 12. Figure 2. Please change the signal of your image, it is too similar in both groups,
therefore difficult its lecture.
Comment 13. Any of the women included in the analysis has breast reconstruction?
Comment 14. Please, aware the number of hospitals in your recruitment, two or three?
Comment 15. In your model, only of 21% of your regression could explain how much contribute
rural environment to body imagine…  It seems a poor finding. In your regression model could
be impossible added more outcomes to explain your model?
Comment 16. It is possible, add more possible outcomes that explain body image in the
regression analyses? If not… It should be noted in limitations. In my opinion, your main analysis
is quite scarce (table 4).
Comment 17. As a general comment. I would like to reduce text in introduction section, there
are many information unvaluable.