Reviewer’s report
Title: 
Exploration of fertility and early menopause related information needs and
development of online information for young breast cancer survivors
Version: 
1 
Date: 
23 Feb 2022
Reviewer's report:
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Thank you for the opportunity to review this paper. I agree that a better
qualitative understanding of the challenges women experience following breast
cancer treatment is required. The strength of this paper is that the authors have
included the differing phases and have followed through on the development and
implementation phase. This is a wonderful outcome for women.
I am unclear why the hyphen is used between fertility- and throughout the paper.
See comment for Line 25: There is a typographical error in the cover page
abstract under the conclusion heading in line 3: It reads "designed, developed en
nationally implemented" 
Line 3 and 4: Inconsistent tense:…breast cancer desire to conceive after they
finished treatment. My suggestion is to remove the past tense from finished.
Line 18 My suggestion is to add a clarifier for who thought it was most
important. Such as women and professionals identified the following as most
important…
Line 25 There is a typographical error in the cover page abstract under the
conclusion heading in line 3: It reads "designed, developed en nationally
implemented"
Line 26 I would consider changing the word accommodated to provided
Line 29 Consider adding women as a keyword
Line 35 Consider changing the language from nor allowed to conceive to: not
recommended to conceive.
Line 39 and 40 My suggestion is to remove lines 39 and part of line 40 and
reword to: Significant advances in oncology practice over the years have
improved breast cancer survival rates. This contributes to the fact that
approximately half of premenopausal women diagnosed with breast cancer desire
to conceive after they finished treatment.
Line 43 Suggest rewording to: The majority of women experience concerns
about the risk of infertility after cancer treatment
Line 45 I'm wondering if associated is the most suitable word here - could you
consider: These concerns often present as depressive symptoms and a
diminished quality of life among young cancer survivors.
Line 47 and 48 My suggestion is to bring the women and their partners into this
statement. Consider rewording to: For women and their partners, the grief
associated with the loss of fertility can be as painful an experience as the cancer
diagnosis.
Line 60 My suggestion is to remove the word therefore at the beginning of the
sentence.
Line 61 My suggestion is to remove by all means
Line 63 and 64 My suggestion is to make the decision plural as women will need
to make more than one decision throughout their treatment. Consider rewording
to: …in order to make well-informed treatment decisions
Line 67 Suggest changing wording to:…if the wish to conceive changes.
Line 94 Suggest rewording to clarify. Is it inconsistent?
Line 106 and 107 You could clarify how many were conducted face to face and
how many were by telephone. For example: 
The interviews were conducted face to face (n= ) and by telephone (n= ).
Lines 118 and 149 I suggest that you move the method of recording and
transcribing into data collection - currently this is sitting under data analysis for
phases 1 and 2. I also recommend that you specify if this was video, or audio
recorded.
Line 132 I recommend adding a statement to identify how the authors concluded
that they had reached saturation. I note this is further developed in the results
section for phase 1 (line 208). My suggestion is that this is moved to analysis
rather than results.
Line 138 and 139 
You could clarify how many were conducted face to face and
how many were by telephone. For example: The interviews were conducted face
to face (n= ) and by telephone (n= ).
149 Suggest rewording to: Field notes were made by the first author. (or
whomever is suitable) 
151 A statement regarding how thematic analysis was applied is suggested IE:
six step analysis and how was this carried out?
Line 154 and 155 I suggest adding which authors the interviewer and the RA are
referring to.
Line 157 …researcher (WN) would be consulted. This turned out not to be
necessary. Suggest rewording to: researcher (WN) would be consulted although
this was not required.
Line 180 Wondering if this is one of the authors? The you could state which
number author. 
Line 185 Suggest using the term weighted rather than weighed
Line 204 - 206 I suggest that the numbers of face to face and telephone
interviews and the length of interviews are included in the data collection
sections. 
Line 203 - Phase 1 The authors highlight that thematic analysis was used
however the results are not presented in themes. 
Line 223 The flow of this paper becomes confusing at this point. Earlier on Line
202 there is a subheading stating results which I would expect is the results of all
the phases however on line 223 information regarding participants is presented
again however this has been included earlier in the manuscript on line 123.
Line 231 
I recommend that the subheading Interview results includes a clarifier
that this is with the women participants.
Line 235 Suggest rewording to: Women in this study identified that the risk of
infertility as discussed by their medical oncologist…..
Line 236 Suggest rewording to: Women in this study identified that the most
important topics were…..
Line 238 Suggest adding the percentage of women after stating almost hal of the
women (IE: 48.6%).
Line 239 Add a percentage after using four (22.2%)
Line 241 Specify the women in this study
Line 244 Women in this study identified the most important topics….
Line 246 Suggest rewording to: Only 1 woman who participated in an interview
as referred to a gynecologist.
General statement I recommend specifying throughout the paper "women in this
study" or "women who participated in an interview" - This will help to clarify
you are referring to the study results and not making a broader statement. 
Line 259 Recommend rewording to: This gave them
This will ensure you are using past tense as these are results
Line 261 Recommend rewording to: The preferred medium was a website
This will ensure you are using past tense as these are results
General statement Read through the manuscript to check consistency of tense as
I am sure I may have missed some of these inconsistencies.
Line 264 Rather than stating women felt. I would suggest that women in this
study identified, or women stated.
Line 266 Rather than stating women thought. I would suggest that women in this
study identified, or women stated.
Line 268 Many participants in this study identified that they wanted to be able to
ask questions online (check the tense)
Line 269 See tense comment
PHASE 2 FINDINGS QUOTES My recommendation is that rather than having
the quotes within a table, seeing these immediately within the text would help
keep the women central to the findings.
Line 380 Women in this study identified the most important topics as:….
Line 389 - 390 I would suggest rewording to: It is therefore important to provide
high quality and easily accessible information to women about the risk of
infertility at various points. This includes at the time of diagnosis, throughout
treatment and also after treatment has ceased.
Line 393 
check tense - suggest expressed
Line 395 I suggest literature highlights that …. Just to clarify this is not a direct
finding of your study
Line 398 Findings from this study aligned with what is stated in the literature
and further highlighted that additional information related to self-care, long term
consequences of early menopause, sexuality and information for relatives was
needed.
Line 412 My suggestion is to remove the statement "although we provided an
extensive set of qualitative data, quantifying these
results was not within the scope of the current study".
I do not see this as a limitation as women's reports are rich data in themselves.
Maybe you could simply add that future research could include a survey
regarding women's information needs.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes