Title: Effectiveness of a self-management mobile app on the quality of life of women with breast
cancer: a study in a developing country
Version: 2 Date: 11 Jul 2022
Reviewer:  Thais De Oliveira Gozzo
Reviewer's report:
The study's objective is very interesting and necessary for women with breast cancer to do self-
management.
But the paper present needs some work.
Attention to punctuation (period and commas), which compromises the understanding of the
text.
Background: The 2 first sentences look like the authors are addressing the participants. Suggest
review.  Need to improve the method description.  Review the conclusion according to the
study’s aim, to answer it.
Introduction:  More interesting information about self-management, and apps used to educate
patients than the incidence of breast cancer, which is well known.
Review the sentence: "In addition, breast cancer therapies have been linked with physical side
effects such as pain, fever, diarrhea, dry skin (...)" These are not common adverse effects of
breast cancer treatment. The number 3 reference (Association of physical activity, body mass
index and reproductive history with breast cancer by menopausal status in Iranian women), is
not about physical side effects of breast cancer therapies. The study focuses on the association
between breast cancer and physical activity. Need review the text presented. This reference
(number 11) "A smartphone app–based mindfulness intervention for cancer survivors: protocol
for a randomized controlled trial", talks about cancer survivors in general, not specifically in
breast cancer.
Methods: First phase description- Despite this first phase having been published (a very
interesting article, congratulations to the authors), I believe that more information about the
identified content suggestions should be addressed in this article as well. And some information
about the participants (such as where were they approach? The treatment they did, age, etc).
Second phase- These 24 participants included in this phase, were in the first phase?  Third phase-
How many participants are in this phase? Were they the same as the other phases? Who were
they? In each phase of breast cancer treatment were they? How mobile app was evaluated?
Results: I agree with the positive effects of the app, but I question if the authors consider
other variables, that could interfere with the women’s answers. For example: finished the
acute treatment (chemotherapy, radiotherapy, surgery). Cognitive problems could be related
to chemotherapy (such as chemo brain, see the paper  DOI: 10.1007/s40264-022-01182-3),
which can be an adverse event experienced by the participants. I urge caution in related
statements about cognitive problems (see the sentence "Cognitive problems (...) which shows the
effectiveness of the self-management mobile app on women with breast cancer". The pain was
related to surgery? Why chemotherapy? how long after these treatments was the app used? Was
this considered? (see the sentence "Pain averaged (...) which can also be considered positive.").
I suggest that the sentences about the benefits of the app be reviewed (see "The reduction
in negative feelings is caused by the use of the self-management mobile app"; "In fact, this
reduction reflects the greater impact of the self-management mobile app in this area."). The
sample was small and statistical analyzes were not performed for these statements. I believe that
the results suggest the app benefits, but not such strong statements. According to the aim of this
study (to design, develop, and evaluate a mobile self-management app for Iranian women with
breast cancer), the authors do not show aspects of the evaluation of the using the app. Such as
functionality, the design, etc, as shown in figures 2 and 3. Need review.
DIscussion: I agree that these points (information acquisition, lifestyle management,
psychological management, symptom management, and change compatibility ) need attention
in women with breast cancer care. But clinical and research experience points out that the
kind of information changes over time. For example, a woman needs some information during
chemotherapy (especially about appearance because of alopecia), but this will change, after
surgery and survival. Because of that, I suggest caution in the statements about the benefits of
the app, as the different moments of the treatments that the women were in were not evaluated,
which may interfere with some answers, and they were not presented in this paper. The quality of
life was not evaluated and was not the aim of this study. I suggest reviewing this parts. Distress-
family is not just related to the fear about some members have cancer. Is related to the family
do not understand the woman’s cancer-related needs and feelings. I suggest being careful to
generalize. Need to discuss the other aspects of the app (such as the functionality), not just the
content.