Changes in Health State Utility Values in Japanese Patients with End-Stage Breast Cancer
Round 1
Reviewer 1 Report
The methodology of the study was well conducted, with correct data and adequate statistical processing. The subject is delicate and particularly appropriate in this patient setting. The conclusions are effective and the resulting message is useful to elaborate on the topic.
The limits are represented by a small number of cases and by a difficult transfer of the method in racial contexts of other geographical areas.
Author Response
Thank you for your valuable comments.
We have added the limitation of the lack of racial diversity in our study. We noted that it might be difficult to apply our findings to the racial contexts of other geographical areas.
Reviewer 2 Report
I've read manuscript with interest. My main concerns are related to the study design. I would like to know: Why authors divided patients to too many groups? How they recruited patients to the study?
How did the patients completed questionnaires at each atage of the study? Also disscusion part must be improved. In the second paragraph of discusion section authors repeated the results. The results from the study should be compared to previous studies.The study could be valuable for publication after implementing these suggestion.
Author Response
Thank you for your valuable comments. We have made five amendments based on your comments.
1) We have added a new Figure 1 to make the research design easier to understand.
2) We have added the following statement to clarify the reason for dividing the patients into several groups: As the aim of this study was to identify dynamic trends in HSUV in patients with end-stage breast cancer, we decided to compare patients according to their survival status and disease state; thus, we classified them into end-stage and non-end-stage.
3) We have included the following details on how we registered the patients: Patients were consecutively sampled during the principal investigator's outpatient clinic days, and patients who gave written consent to participate in the study were enrolled.
4) We have included the following additional details on how the questionnaires were completed: The survey was carried out in the privacy of the patients. Research assistants distributed the questionnaires to the participants before the physician’s examination and collected them approximately 30 min later. After collecting the questionnaires from the patients, the research assistants checked the responses and asked the patients to complete any missing items.
5) We have removed the duplication of results in the Discussion section. We have also cited the paper by Haslam et al. to show that there are few reports on the dynamic trends of HSUVs in end-stage breast cancer patients and to reinforce the significance of our study.
Reviewer 3 Report
This study aimed to determine the dynamic trends in health state utility values (HSUVs) in BCa patients and compared three group of pts (PBC vs MBC vs MBC end stage). They reported that patients with end-stage BCa had well-controlled HSUVs up to 3 months before death but observed sharp declined in HSUVs in the 3 months before their death while there were no significant difference in change of HSUV in both PBS and MBS survivor groups.
Overall, it is interesting study findings with good study design.
One minor question,
Data (Figure 4) demonstrated clearly that patients at the end-stage BCa had well-controlled HSUVs 3 months before their death and a sharp decline in HSUVs in the 3 months leading up to death.
We know that some pts live longer or shorter than predictive survival time suggested by oncologists. In this case, how did you make judgement for QOL data collection time? eg, some pts predicted survival time are 3 months but they live more than 3 months or vice versa.
Author Response
Thank you for your comments. We have added a new Figure 1 to make the research design easier to understand. We built a prospective cohort database of HSUVs for Japanese patients with breast cancer, which was linked to their social background and treatment history (Line 98–120). We extracted the data from the database as shown in Figure 1 and examined the HSUVs.
Round 2
Reviewer 2 Report
I would like to thank the authors for improving the manuscript.
In my opinion current version could be accept for publication in Current Oncology.
