Reviewer ’s report  
 
Title: Social networks and quality of life among female breast c ancer patients at Tikur Anbessa 
Specialzed Hospital, Addis Ababa, Ethiopia 2019  
 
Version: 1 Date: 28 Jan 2020  
 
Reviewer: Maria-Victoria Zunzunegui  
 
Reviewer's report:  
 
This revised version of the paper did not take into consideration any of my comments to the 
previous version.   
However, the new version has slightly improved and has allowed me to understand that this is a 
descriptive paper. It aims to describe two outcomes, quality of life (QoL) and social networks, in 
women with a diagnosis of breast cancer attending a hospital in Ethiopia.  The authors have  
assumed that social networks are positively related to quality of life in these Ethiopian women 
diagnosed with breast cancer. This strong assumption is not tested in this paper; authors should 
justify theoretically or empirically this assumption. Many cir cumstances may be relevant to the 
quality of life of a woman with breast cancer including the quality of medical care, nursing care, 
and the woman's material and social circumstances, particularly having enough money to cover 
basic needs and to cover expen ses associated with cancer.   
Breast cancer incidence is increasing in most African countries.  The study could be worthy of 
publication given that there is very little information on quality of life of women with breast cancer 
in Africa.  
However, the des cription of the measurement of the two outcome variables, the decisions to 
categorize both variables and the analytical strategy (logistic regressions) used to estimate the 
strength of the associations with covariates are questionable.  
 
1. Both quality of life and social networks are continuous measures and categorization of both 
measures seems quite arbitrary.  
 
2. In my previous review I asked to use quality of life as a continuous score or to justify why to 
use a dichotomy and the choice of a cut -off poin t. In fact I wrote:  " The dichotomization of quality 
of life should be avoided since there is a large loss of information: it classifies 92% of women with 
poor quality of life, as if their QoL were similar.  
 
2. Diversity of Social networks is measured wit h the index proposed by Cohen et al. Diversity os 
one of the many attributes of social networks and it should be briefly explained as the number of 
different types of ties in one individual social networks (see Cohen et al paper, reference 21). The 
element s contributing to that index should be shown in a table. How many women had spouse, 
children, extended families, friends, ….etc.). In addition, the categorization should be better 
explained as High diversity (6 or more different types of ties), medium dive rsity (four or five 
different types of ties) and low diversity (0,1,2,3 ties).   The measurement tool (SNI)  should be 
explained more clearly and reasons for its categorization should be given.  
 
3. Please, remove the paragraph on sample size. The aim of th is study is not to estimate any 
proportion but: 1)  to describe the distribution of quality of life scores and their associated variables 
and 2) to describe the social networks and their associated variables. Notice that the  formula used 
is adequate to es timate a proportion with a given precision but it does not address the problem of 
estimating the difference in scores of quality of life in groups defined by  a categorical variable.  
 
Lastly, in my previous review I had asked to provide more contextual inf ormation about the 
population of women attending this hospital and to try to explain the very young distribution of 
these patients diagnosed with breast cancer, a very unique feature suggesting that most breast 
cancer is pre -menopausal and it occurs in wom en in childbearing ages.   
 
This paper would benefit from an English review to ensure error -free and flawless language.  I am 
not a Native English speaker but I notice many expression errors  that hinder reading and 
understanding.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in y our comments to the authors.  
 
Yes 
 
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 statistics 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 statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an 
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
1. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicati on of this manuscript, either now or in the future?  
 
2. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
3. 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?  
 
4. Do you have any other financial competing interests?  
 
5. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I decla re that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
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