Title: “I wanted information”: Navigating Breast Cancer and Its Treatment in Lima, Peru
Version: 2 Date: 19 Jan 2023
Reviewer's report:
This paper addresses an important area of patient experience in the treatment and care of breast
cancer: the need for consistent, comprehensive, and reliable information during all stages of
their cancer, from diagnosis to treatment, and after.
The strength of the paper lies in its ability to glean valuable insights from patients regarding the
challenges they face in the absence of such information and the measures they are forced to take
not only  to look after themselves but also to cope with the emotional effects of the cancer. It is
clear that that there is a huge unmet need here that must be addressed.
There are some potentially confusing areas that, if clarified, would greatly strengthen this paper’s
readability and core proposition. I will number them here by way of priority:
1. Why Peru?
Recommend: A clearly articulated rationale for choice of target group through a brief lit review
of the current level of breast cancer education in Peru might help to situate the study on firmer
ground
2. Fuller demographic details: “This study took place in a range of middle-class districts in
Lima, Peru” (Line 70), but later we are told that “the remaining nine interviews were conducted
in lower income neighborhoods” (Line 81). What does "lower income" mean? Were there any
indigenous participants?
3. More clarity about what is being compared here: “Furthermore, breast cancer patients report
the importance of support throughout their experience, yet research in resource-limited areas,
including Latin America, found a lack of educational resources, awareness, and advocacy [6,12]
(Lines 53-55)
Recommend rephrasing to signal the shift from social support to educational support.
4. Misdiagnosis (line 153): a different issue and significant enough to warrant further questioning
and elaboration, than to be tucked within a discussion on informational/social support.
Recommend: either highlight or acknowledge as area for further investigation
5. Structure and organization:
Informational Support as sub-heading of Social Support (Line 139)
Lines 140-206 document lack of information from health professionals--oncologist, surgeon,
and nurses-- not social support
Also,  information gathered from scholarly articles on breast cancer, self-help books, and internet
research would appear to be self-management methods unless these have been informed and
accessed through social networks (Line 208)
Appearance (Lines 224-235)-- not clear how this discussion falls under support
6. Analysis:
(A)  “Have confidence in God and in the doctor. Do everything they say” (Line 265) —
Recommend providing an analysis of what this means in relation to the earlier discussion of
the severe dearth of medical information and the indifference of physicians regarding patients’
queries regarding their treatment and post-treatment care (173-219).
(B) “20 years ago, there was little information, no? All I knew about cancer was that it was
something serious that could kill you” (Lines 150-152)
Recommend comparing with those who have completed treatment more recently. Has there been
any change in information delivery?
This paper has strong potential, and I would recommend its publication with a more fulsome
background and a stronger comparative analysis of patient narratives.